Association between patient–surgeon race and gender concordance and patient-reported outcomes following breast cancer surgery

Abstract

Purpose: Surgeon and patient-related factors have been shown to in uence patient experiences, quality of life (QoL), and surgical outcomes. We examined the association between surgeon-patient race-and gender-concordance with QoL after breast reconstruction.Methods: We conducted a retrospective cross-sectional analysis of patients who underwent lumpectomy or mastectomy followed by breast reconstruction over a 3-year period. We created the following categories with respect to the race and gender of a patient-surgeon triad: no-, intermediate-, and perfectconcordance. Multivariable regression was used to correlate post-operative global (SF-12) and conditionspeci c (BREAST-Q) QoL performance with patient-level covariates, gender-and race-concordance.Results: We identi ed 375 patients with a mean (±SD) age of 57.6±11.9 years, median (IQR) body mass index of 27.5 (24.0, 32.0), and median morbidity burden of 3 (2, 4). The majority of encounters were of intermediate concordance for gender (70%) and race (52%). Compared with gender discordant triads, intermediate gender concordance was associated with higher SF-Mental scores (b, 2.60; 95% CI, 0.21 to 4.99, p=0.003). Perfect race concordance (35% of encounters) was associated with signi cantly higher adjusted SF-Physical scores (b, 2.14; 95% CI, 0.50 to 4.22, p=0.045) than the race-discordant group. There were no signi cant associations observed between race-or gender-concordance and BREAST-Q performance.Conclusions: Race concordant relationships following breast cancer surgery were more likely to have improved global QoL. Perfect gender concordance was not associated with variation in QoL outcomes. Policy-level interventions are needed to facilitate personalized care and optimize breast cancer surgery outcomes.

Social concordance and patient reported experiences in countries with different gender equality: a multinational survey

“…Some studies find associations between female concordance and specific PREMs [3][4][5][6][7], such as physician communication or experienced agreement on advice. Other studies find no significant association between gender concordance and PREMs [8][9][10][11][12][13]. Some of these findings can be explained by lack of statistical power [9] or the use of too broad outcome variables [10].…”

“…Other studies find no significant association between gender concordance and PREMs [8][9][10][11][12][13]. Some of these findings can be explained by lack of statistical power [9] or the use of too broad outcome variables [10]. Nonetheless, the study of Takeshita et al [8] was large and comprehensive and showed no association between gender concordance and one specific PREM: the likelihood of recommending the physician to a friend (on a 1 to 5 scale).…”

“…This study, containing over 100.000 patient experience survey's, showed no association between gender concordance and Press Ganey scores (reflecting the likelihood of recommending the physician to others). Also, other studies find that gender concordance is not related to experienced participatory decision-making, encounter quality, trust, quality of life or quality of care [9][10][11][12][13]. Research on age concordance is scarce, but existing evidence suggests associations with enhanced health care quality perceptions [7].…”

Patient-Surgeon Communication: A Literature Review and Thematic Analysis

“…Demographic characteristics that are shared by surgeon and patient, such as sex and ethnicity, promote a better understanding between the protagonists and improve satisfaction and surgical outcomes [29,30]. In a population-based cohort study in Canada, difference in sex between surgeons and patients was found to negatively impact outcomes following common surgical procedures [31].…”

Examining Racial and Gender Diversity in the Plastic Surgery Pipeline: Where is the Leak?

“…Hassan et al found that breast cancer patients who had a shared racial identity with their operating plastic surgeon reported greater improvements in their physical quality of life than patients who did not. 5 Although the benefits of increased racial and gender diversity have been established in medicine, [6][7][8][9][10][11] the rapidly changing demographics in medical schools have not consistently been mirrored in physician populations. 1 This is especially true for surgical subspecialties such as plastic surgery, for which racial and ethnic diversity lags behind that of nonsurgical residency training programs.…”