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Patient centered care requires good patient-provider communication so that patients' needs and wants are understood and addressed, and patients understand and participate in their own care.85,86,87,88 This style of care has been shown to improve patients' health. 86,87,88,89 Unfortunately, there are barriers to good communication: about a third of Americans are suboptimally "health literate," 90,91 which means they lack the "capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions."92 They receive less preventive care,93 have poorer understanding of their conditions and care,90,94,95 higher use of emergency and inpatient services, higher rates of rehospitalization,96,97 lower adherence to medications,96 and lower participation in medical decisionmaking.98 Low health literacy costs an estimated $29 billion to $69 billion per year.99 Providers also differ in communication proficiency, including varied listening skills and views of symptoms and treatment effectiveness, compared with their patients' views.100 Additional factors influencing patient centeredness and patient-provider communication include language barriers and effects of disabilities on patients' health care experiences.
Racial and ethnic differences in patient centered care have been observed, though findings are somewhat complex. Some research reveals that minorities report worse health care experiences and poorer communication than Whites.101,102,103 Other studies find minorities are equally or more satisfied with their care.104,105,106,107 Additional research shows race and ethnicity as weak, inconsistent predictors of health care experiences.104,108,109