1. Disparities Associated with Decision to Undergo Oncologic Surgery: A Prospective Mixed-Methods Analysis.
- Author
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Van Haren RM, Kovacic MB, Delman AM, Pratt CG, Griffith A, Arbili L, Harvey K, Kohli E, Pai A, Topalian A, Rai SN, Shah SA, and Kues J
- Subjects
- Humans, Prospective Studies, Middle Aged, Male, Female, Aged, Black or African American statistics & numerical data, Black or African American psychology, Prognosis, Gastrointestinal Neoplasms surgery, Lung Neoplasms surgery, Follow-Up Studies, Cultural Competency, Communication, White People statistics & numerical data, Minority Groups statistics & numerical data, Adult, Physician-Patient Relations, Healthcare Disparities, Decision Making, Trust
- Abstract
Background: Underrepresented minority patients with surgical malignancies experience disparities in outcomes. The impact of provider-based factors, including communication, trust, and cultural competency, on outcomes is not well understood. This study examines modifiable provider-based barriers to care experienced by patients with surgical malignancies., Methods: A parallel, prospective, mixed-methods study enrolled patients with lung or gastrointestinal malignancies undergoing surgical consultation. Surveys assessed patients' social needs and patient-physician relationship. Semi-structured interviews ascertained patient experiences and were iteratively analyzed, identifying key themes., Results: The cohort included 24 patients (age 62 years; 63% White and 38% Black/African American). The most common cancers were lung (n = 18, 75%) and gastroesophageal (n = 3, 13%). Survey results indicated that food insecurity (n = 5, 21%), lack of reliable transportation (n = 4, 17%), and housing instability (n = 2, 8%) were common. Lack of trust in their physician (n = 3, 13%) and their physician's treatment recommendation (n = 3, 13%) were identified. Patients reported a lack of empathy (n = 3, 13%), lack of cultural competence (n = 3, 13%), and inadequate communication (n = 2, 8%) from physicians. Qualitative analysis identified five major themes regarding the decision to undergo surgery: communication, trust, health literacy, patient fears, and decision-making strategies. Five patients (21%) declined the recommended surgery and were more likely Black (100% vs. 21%), lower income (100% vs. 16%), and reported poor patient-physician relationship (40% vs. 5%; all p < 0.05)., Conclusions: Factors associated with declining recommended cancer surgery were underrepresented minority race and poor patient-physician relationships. Interventions are needed to improve these barriers to care and racial disparities., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)
- Published
- 2024
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