Racial/Ethnic Differences in Patients’ Selection of Surgeons and Hospitals for Breast Cancer Surgery
Published Date:May 2015
Source:JAMA Oncol. 1(2):222-230.
European Continental Ancestry Group
Health Care Surveys
Health Knowledge, Attitudes, Practice
Quality Indicators, Health Care
Referral And Consultation
Surveys And Questionnaires
Pubmed Central ID:PMC4944092
Funding:HHSN261201000034C/PHS HHS/United States
HHSN261201000035C/PHS HHS/United States
HHSN261201000140C/PHS HHS/United States
K24 CA181510/CA/NCI NIH HHS/United States
K24CA181510/CA/NCI NIH HHS/United States
U58DP003862-01/DP/NCCDPHP CDC HHS/United States
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.
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.
Reasons for surgeon and hospital selection, ratings of surgeon and hospital.
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.
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