Racial and Ethnic Disparities in Patient-Provider Communication, Quality-of-Care Ratings, and Patient Activation Among Long-Term Cancer Survivors

Palmer, Nynikka R.; Kent, Erin E.; Forsythe, Laura P.; Arora, Neeraj; Rowland, Julia H.; Aziz, Noreen M.; Blanch‐Hartigan, Danielle; Oakley-Girvan, Ingrid; Hamilton, Ann S.; Weaver, Kathryn E.

doi:10.1200/jco.2014.55.5060

Cited by 104 publications

(82 citation statements)

References 48 publications

(21 reference statements)

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“…First, unmeasured differences in clinical presentation and severity are most likely to drive within-physician variations in treatment. Second, the contribution of race/ethnicity and SES to differences in treatment could be the result of differences in patient-provider communication, 42,43 or differences in preferences for care. In that vein, research has shown that white and minority colorectal cancer patients have similar rates of specialty referral, yet lower rates of adjuvant treatments even after appropriate referral.…”

Section: Discussionmentioning

confidence: 99%

Racial/Ethnic and Socioeconomic Differences in Colorectal and Breast Cancer Treatment Quality

et al. 2016

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Background: Despite a large body of research showing racial/ ethnic and socioeconomic disparities in cancer treatment quality, the relative role of physician-level variations in care is unclear. Objective: To examine the effect of physicians on disparities in breast and colorectal cancer care. Subjects: Linked SEER Medicare data were used to identify Medicare beneficiaries diagnosed with colorectal and breast cancer during 1995–2007 and their treating physicians. Research Design: We identified treating physicians from Medicare claims data. We measured the use of NIH guideline-recommended therapies from SEER and Medicare claims data, and used logistic models to examine the relationship between race/ethnicity, socioeconomic status, and cancer quality of care. We used physician fixed effects to account for between-physician variations in treatment. Results: Minority and low socioeconomic status beneficiaries with breast and colorectal cancer were less likely to receive any recommended treatments as compared with whites. Overall, between- physician variation explained <20% of the total variation in quality of care. After accounting for between-physician differences, median household income explained 14.3%, 18.4%, and 13.2% of the variation in use of breast-conserving surgery, chemotherapy, and radiation for breast cancer, and 13.7%, 12.9%, and 12.6% of the within-physician variation in use of colorectal surgery, chemotherapy, and radiation for colorectal cancer, whereas race and ethnicity explained <2% of the within-physician variation in cancer care. Conclusions: Between-physician variations partially explain racial disparities in cancer care. Residual within-physician disparities may be due to differences in patient-provider communication, patient preferences and treatment adherence, or unmeasured clinical severity.

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Section: Discussionmentioning

confidence: 99%

Racial/Ethnic and Socioeconomic Differences in Colorectal and Breast Cancer Treatment Quality

et al. 2016

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“…In addition, ample evidence suggests that racial and ethnic minorities, especially blacks and Mexican-Americans, have poorer access to quality healthcare than whites in the USA. [26][27][28][29][30][31][32][33][34][35][36][37] These findings highlight the significant need to improve access to healthcare services for Mexican-Americans and blacks so that aggressively combining early detection strategies with delivery of evidencebased therapeutic interventions at early stages can help prevent CKD progression. However, caution must be used in the overall interpretation of the results stratified by race due to some small sample sizes, especially in CKD stages 3b-5.…”

Section: Antihypertensive Medicationsmentioning

confidence: 99%

“…Under this system, KDOQI recommended avoiding glyburide treatment in stages 3-5 of CKD, and initiating treatment with other agents, using appropriate dose adjustments, and urges special care with metformin. The Kidney Disease: Improving Global Outcomes (KDIGO) updated CKD staging in 2012, accounting for the presence of albuminuria, and subdividing stage 3 into 3a (eGFR 45-59) and 3b (eGFR [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]. 1 Traditionally, eGFR has been calculated with the well-established Modification of Diet in Renal Disease (MDRD) equation, which consists of four variables: age, sex, race/ ethnicity, and serum creatinine concentration.…”

Section: Introductionmentioning

confidence: 99%

Understanding CKD among patients with T2DM: prevalence, temporal trends, and treatment patterns—NHANES 2007–2012

Bell

Stanford

et al. 2016

BMJ Open Diab Res Care

165

113

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ObjectiveTo describe the estimated prevalence and temporal trends of chronic kidney disease (CKD) treatment patterns, and the association between CKD and potential factors for type 2 diabetes mellitus (T2DM) in different demographic subgroups.Research design and methodsThis was a cross-sectional analysis of adults with T2DM based on multiple US National Health and Nutrition Examination Survey (NHANES) datasets developed during 2007–2012. CKD severity was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 guidelines using the CKD Epidemiology Collaboration (CKD-EPI) equation: mild to moderate=stages 1–3a; moderate to kidney failure=stages 3b–5. Multivariable logistic regression analyses were performed to assess the associations between CKD and potential factors.ResultsOf the adult individuals with T2DM (n=2006), age-adjusted CKD prevalence was 38.3% during 2007–2012; 77.5% were mild-to-moderate CKD. The overall age-adjusted prevalence of CKD was 40.2% in 2007–2008, 36.9% in 2009–2010, and 37.6% in 2011–2012. The prevalence of CKD in T2DM was 58.7% in patients aged ≥65 years, 25.7% in patients aged <65 years, 43.5% in African-Americans and Mexican-Americans, and 38.7% in non-Hispanic whites. The use of antidiabetes and antihypertensive medications generally followed treatment guideline recommendations. Older age, higher hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and having hypertension were significantly associated with CKD presence but not increasing severity of CKD.ConclusionsCKD continued to be prevalent in the T2DM population; prevalence remained fairly consistent over time, suggesting that current efforts to prevent CKD could be improved overall, especially by monitoring certain populations more closely.

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“…Despite the importance of patient-provider communication, cancer patients’ communication needs often go unmet (Bruinessen et al, 2013). In addition to the demonstrated gaps in the communication quality experienced by cancer patients in general, some studies report more pronounced patient-provider communication barriers among racial and ethnic minority patients (Maly, Liu, Liang, & Ganz, 2015; Palmer et al, 2014). In a qualitative study of the experiences of African American cancer patients, study participants reported dissatisfaction with the level of communication from health care providers during cancer diagnosis and treatment phases in several areas including: (1) communication of cancer information; (2) communication of shared decision making; (3) communication of empathy and understanding; and (4) communication of respect (Song, Hamilton, & Moore, 2012).…”

Section: Introductionmentioning

confidence: 99%

The Relationship of Patient–Provider Communication on Quality of Life among African-American and White Cancer Survivors

Matthews

Dossaji

et al. 2017

Journal of Health Communication

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Prior research has demonstrated poorer patient-provider communication ratings among African American compared to White patients. The quality of patient-provider communication has been shown to impact treatment outcomes among cancer patients. A secondary data analysis design was used to determine the relationship of six patient-provider communication variables on the physical health quality of life (PHQOL) and mental health quality of life (MHQOL) of African American and White cancer patients (N = 479). We also examined whether the relationship between communication patterns and QOL differed based on race/ethnicity. Mean physical and mental health QOL scores for the sample were 69.8 and 77.6, respectively. After controlling for significant socio-demographic, clinical, and hospital variables, results showed that patients who experienced fewer interpersonal communication barriers who were more satisfied with the information given by providers had higher PHQOL and MHQOL scores. Additionally, patients who felt more comfort in asking questions or had fewer unmet information needs had higher MHQOL. A stratified analysis showed that the relationship of overall satisfaction with information on MHQOL was stronger among African American patients than White patients. Future research should focus on the development of interventions to improve patient-provider communication as a means for enhancing QOL outcomes among cancer survivors.

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Racial and Ethnic Disparities in Patient-Provider Communication, Quality-of-Care Ratings, and Patient Activation Among Long-Term Cancer Survivors

Abstract: Asian survivors report poorer follow-up care communication and care quality. More research is needed to identify contributing factors beyond PPC, such as cultural influences and medical system factors.

Cited by 104 publications

References 48 publications

Racial/Ethnic and Socioeconomic Differences in Colorectal and Breast Cancer Treatment Quality

Racial/Ethnic and Socioeconomic Differences in Colorectal and Breast Cancer Treatment Quality

Understanding CKD among patients with T2DM: prevalence, temporal trends, and treatment patterns—NHANES 2007–2012

The Relationship of Patient–Provider Communication on Quality of Life among African-American and White Cancer Survivors

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