Patient-Clinician Interactions and Disparities in Breast Cancer Care: The Equality in Breast Cancer Care Study

Details

• Alternative Title:
  J Cancer Surviv
• Personal Author:
  Gonzales, Felisa A. ; Sangaramoorthy, Meera ; Dwyer, Laura A. ; Shariff-Marco, Salma ; Allen, Amani M. ; Kurian, Allison W. ; Yang, Juan ; Langer, Michelle M. ; Allen, Laura ; Reeve, Bryce B. ; Taplin, Stephen H. ; Gomez, Scarlett Lin
• Description:
  Purpose:
  
  To examine whether interpersonal aspects of patient-clinician interactions, such as patient-perceived medical discrimination, clinician mistrust, and treatment decision-making contribute to racial/ethnic/educational disparities in breast cancer care.
  
  Methods:
  
  A telephone interview was administered to 542 Asian/Pacific Islander (API), Black, Hispanic and White women identified through the Greater Bay Area Cancer Registry, ages 20 and older diagnosed with a first primary invasive breast cancer. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated from logistic regression models that assessed associations between race/ethnicity/education, medical discrimination, clinician mistrust, and treatment decision-making with concordance to breast cancer treatment guidelines (guideline-concordant treatment) and perceived quality of care (pQoC).
  
  Results:
  
  Approximately three-quarters of women received treatment that was guideline-concordant (76.6%) and reported that their breast cancer care was excellent (72.1%). Non-college-educated Black women had lower odds of guideline-concordant care (aOR (CI) =0.29 (0.12–0.67)) vs. college-educated White women. Odds of excellent pQoC were lower among: college-educated Hispanic women (aOR (CI)=0.09 (0.02–0.47)) and API women regardless of education (aORs≤0.50) vs. college-educated White women; women reporting low and moderate levels of discrimination (aORs ≤ 0.44) vs. none; and women reporting any clinician mistrust (aOR (CI)=0.50 (0.29–0.88)) vs. none. Disparities in guideline-concordant care and pQoC persisted after controlling for medical discrimination, clinician mistrust, and decision-making.
  
  Conclusions:
  
  Interpersonal aspects of the patient-clinician interaction had an impact on pQoC but not receipt of guideline-concordant treatment and did not explain disparities in either outcome.
  
  Implications for Cancer Survivors:
  
  Although breast cancer survivors’ interpersonal interactions with clinicians did not influence receipt of appropriate treatment, intervention strategies to improve patient-clinician relations may help attenuate disparities in survivors’ pQoC.
  
  
• Subjects:
  Adult Aged Aged, 80 And Over Article Breast Cancer Breast Neoplasms Cancer Survivors Decision-making Discrimination Disparities Female Healthcare Disparities Humans Middle Aged Mistrust Physician-Patient Relations Quality Of Health Care

  More +
• Source:
  J Cancer Surviv. 13(6):968-980
• Pubmed ID:
  31646462
• Pubmed Central ID:
  PMC10187984
• Document Type:
  Journal Article
• Funding:
  HHSN261201800032I/CA/NCI NIH HHSUnited States/ ; 5NU58DP006344/CC/CDC HHSUnited States/
• Volume:
  13
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:e121f4fd036dcd5994bb3d530e1a8bb2f6d0a368174cfb8c0731c4466547751d
• Download URL:
  https://stacks.cdc.gov/view/cdc/128495/cdc_128495_DS1.pdf
• File Type:
  [PDF - 444.75 KB ]