Racial and Ethnic Disparities in Patient-Provider Communication With Breast Cancer Patients: Evidence From 2011 MEPS and Experiences With Cancer Supplement

Abstract

The current study explores racial/ethnic disparities in the quality of patient-provider communication during treatment, among breast cancer patients. A unique data set, Medical Expenditure Panel Survey and Experiences With Cancer Supplement 2011, is used to examine this topic. Using measures of the quality of patient-provider communication that patients are best qualified to evaluate, we explore the relationship between race/ethnicity and patients’ perspectives on whether (1) patient-provider interactions are respectful, (2) providers are listening to patients, (3) providers provide adequate explanations of outcomes and treatment, and (4) providers spend adequate time in interacting with the patients. We also examine the relationship between race/ethnicity and patients’ perspectives on whether their (1) doctor ever discussed need for regular follow-up care and monitoring after completing treatment, (2) doctor ever discussed long-term side effects of cancer treatment, (3) doctor ever discussed emotional or social needs related to cancer, and (4) doctor ever discussed lifestyle or health recommendations. Multivariate ordinary least squares and ordered logistic regression models indicate that after controlling for factors such as income and health insurance coverage, the quality of patient-provider communication with breast cancer patients varies by race/ethnicity. Non-Hispanic blacks experience the greatest communication deficit. Our findings can inform the content of future strategies to reduce disparities.

Engaging young African American women breast cancer survivors: A novel storytelling approach to identify patient‐centred research priorities

“…Consistent with the literature, the patient‐centred research agenda and recommendations in regard to breast cancer outcome disparities are related to patient‐, provider‐ and health system‐level factors . Our patients’ personal stories indicated that lack of insurance, fear of mammogram and treatment delay due to fear of death or lack of insurance all contribute to disparities at the patient level.…”

“…At the provider level, our patients' stories showed that some doctors may ignore or inadequately address minority women's serious side-effects of treatment. Our finding also highlighted the importance of addressing patient-provider communication factors 29,30 such as training providers as good listeners and addressing patients' spirituality needs when necessary. 31 Health system factors such as higher copayment requirements, lack of a routine source of care, distance to care, fragmentation of care and uneven distribution of screening and treatment resources also exacerbate disparities.…”

“…At the provider level, our patients’ stories showed that some doctors may ignore or inadequately address minority women's serious side‐effects of treatment. Our finding also highlighted the importance of addressing patient‐provider communication factors such as training providers as good listeners and addressing patients’ spirituality needs when necessary …”

“…22 Consistent with the literature, the patient-centred research agenda and recommendations in regard to breast cancer outcome disparities are related to patient-, provider-and health system-level factors. 28,29 Our patients' personal stories indicated that lack of F I G U R E 1 Number of final voting for recommendation or solution statements (by three different types of stakeholders) insurance, fear of mammogram and treatment delay due to fear of death or lack of insurance all contribute to disparities at the patient level. At the provider level, our patients' stories showed that some doctors may ignore or inadequately address minority women's serious side-effects of treatment.…”

Understanding racial/ethnic differences in breast cancer-related physical well-being: the role of patient–provider interactions

“…Specifically, racial/ethnic minority patients, particularly Asian and black patients, tend to report suboptimal communication with providers, and more discrimination by providers. 7–12 Therefore, interactions between oncology providers and their patients represent a potential target for interventions aimed at reducing disparities in symptom management.…”