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Patient-Clinician Interactions and Disparities in Breast Cancer Care: The Equality in Breast Cancer Care Study
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12 2019
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Source: J Cancer Surviv. 13(6):968-980
[PDF-444.75 KB]
Details:
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Alternative Title:J Cancer Surviv
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Personal Author:
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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.
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Source:
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Pubmed ID:31646462
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Pubmed Central ID:PMC10187984
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Funding:
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Volume:13
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Issue:6
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