Racial/Ethnic Differences in Patients’ Selection of Surgeons and Hospitals for Breast Cancer Surgery

Details

• Alternative Title:
  JAMA Oncol
• Personal Author:
  Freedman, Rachel A. ; Kouri, Elena M. ; West, Dee W. ; Keating, Nancy L.
• Description:
  Importance
  
  Racial differences in breast cancer treatment may result in part from differences in the providers from whom patients receive their care. However, little is known about differences in patients’ selection of providers.
  
  Objective
  
  To examine racial/ethnic differences in how women selected their surgeons and hospitals for breast cancer surgery.
  
  Design, Setting, Participants
  
  We surveyed 500 women (222 non-Hispanic white, 142 non-Hispanic black, 89 English-speaking Hispanic, and 47 Spanish-speaking Hispanic) from northern California cancer registries with stage 0–III breast cancer diagnosed during 2010–2011 (participation rate=68.5%). We used multivariate logistic regression to assess the reasons for surgeon and hospital selection by race/ethnicity, adjusting for other patient characteristics. We also assessed the association between reasons for physician selection and patients’ ratings of their surgeon and hospital.
  
  Main Outcome
  
  Reasons for surgeon and hospital selection, ratings of surgeon and hospital.
  
  Results
  
  The most frequently-reported reason for surgeon selection was referral by another doctor (77.6%); the most frequently-reported reason for hospital selection was because it was a part of a patient’s health plan (58.4%). After adjustment, 78.6%–86.5% of black and Spanish-speaking Hispanic women reported selecting their surgeon based on a doctor’s referral versus 75.7% of white women (P=.007). Black and Hispanic patients were less likely than white patients to report selecting their surgeon based on reputation (adjusted rates=17.5–22.1% of blacks and Hispanics vs. 31.9% of whites; P=.02). Black and Hispanic women were also less likely than white women to select their hospital based on reputation (adjusted rates=7.2%–15.0% vs. 23.2%, P=.003). Women who selected their surgeon based on reputation more often rated the care from their surgeon excellent (adjusted odds ratio [OR]=2.21, 95%CI=1.24–3.93); those reporting their surgeon was one of the only surgeons available through the health plan less often reported excellent quality of surgical care (OR=0.56, 95%CI=0.34–0.91).
  
  Conclusions and Relevance
  
  Compared with white breast cancer patients, minority patients were less actively involved in physician and hospital selection, relying more on physician referral and health plans rather than reputation. Interventions to promote involvement in provider selection may have potential for addressing disparities related to care from lower-quality providers.
  
  
• Subjects:
  Black Or African American Breast Neoplasms California Chi-Square Distribution Choice Behavior Clinical Competence Female Healthcare Disparities Health Care Surveys Health Knowledge, Attitudes, Practice Hispanic Or Latino Hospitals Humans Insurance, Health Insurance Coverage Logistic Models Middle Aged Multivariate Analysis Odds Ratio Patient Preference Quality Indicators, Health Care Referral And Consultation Surgeons Surveys And Questionnaires White People

  More +
• Source:
  JAMA Oncol. 1(2):222-230
• Pubmed ID:
  26181027
• Pubmed Central ID:
  PMC4944092
• Document Type:
  Journal Article
• Funding:
  U58DP003862-01/DP/NCCDPHP CDC HHSUnited States/ ; HHSN261201000140C/CA/NCI NIH HHSUnited States/ ; HHSN261201000035C/CA/NCI NIH HHSUnited States/ ; K24CA181510/CA/NCI NIH HHSUnited States/ ; HHSN261201000035I/CA/NCI NIH HHSUnited States/ ; HHSN261201000034C/CA/NCI NIH HHSUnited States/ ; U58 DP003862/DP/NCCDPHP CDC HHSUnited States/ ; K24 CA181510/CA/NCI NIH HHSUnited States/
• Volume:
  1
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:61a8d59e5e0f1ee5d911404d307fcacbc5f7cbbd1822769a13028a74b73efe83
• Download URL:
  https://stacks.cdc.gov/view/cdc/40350/cdc_40350_DS1.pdf
• File Type:
  [PDF - 321.33 KB ]