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Patient-clinician interactions and disparities in breast cancer care: the equality in breast cancer care study

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Abstract

Purpose

To examine whether interpersonal aspects of patient-clinician interactions, such as patient-perceived medical discrimination, clinician mistrust, and treatment decision-making contribute to racial/ethnic/educational disparities in breast cancer care.

Methods

A telephone interview was administered to 542 Asian/Pacific Islander (API), Black, Hispanic, and White women identified through the Greater Bay Area Cancer Registry, ages 20 and older diagnosed with a first primary invasive breast cancer. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated from logistic regression models that assessed associations between race/ethnicity/education, medical discrimination, clinician mistrust, and treatment decision-making with concordance to breast cancer treatment guidelines (guideline-concordant treatment) and perceived quality of care (pQoC).

Results

Approximately three-quarters of women received treatment that was guideline-concordant (76.6%) and reported that their breast cancer care was excellent (72.1%). Non-college-educated Black women had lower odds of guideline-concordant care (aOR (CI) = 0.29 (0.12–0.67)) vs. college-educated White women. Odds of excellent pQoC were lower among the following: college-educated Hispanic women (aOR (CI) = 0.09 (0.02–0.47)) and API women regardless of education (aORs ≤ 0.50) vs. college-educated White women, women reporting low and moderate levels of discrimination (aORs ≤ 0.44) vs. none, and women reporting any clinician mistrust (aOR (CI) = 0.50 (0.29–0.88)) vs. none. Disparities in guideline-concordant care and pQoC persisted after controlling for medical discrimination, clinician mistrust, and decision-making.

Conclusions

Interpersonal aspects of the patient-clinician interaction had an impact on pQoC but not receipt of guideline-concordant treatment and did not explain disparities in either outcome.

Implications for Cancer Survivors

Although breast cancer survivors’ interpersonal interactions with clinicians did not influence receipt of appropriate treatment, intervention strategies to improve patient-clinician relations may help attenuate disparities in survivors’ pQoC.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgments

We would like to thank Dr. Gem Le, Dr. Thu Quach, the staff of the Equality in Breast Cancer Care (EBCC) Study, and the EBCC participants for their contributions to this study.

Funding

The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 5NU58DP006344; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute, Cancer Registry of Greater California. The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors.

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Authors and Affiliations

  1. Division of Cancer Control and Population Sciences, The Colorado Trust, National Cancer Institute, Rockville, MD, USA

    Felisa A. Gonzales

  2. Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, 550 16th Street, San Francisco, CA, USA

    Meera Sangaramoorthy, Salma Shariff-Marco, Juan Yang, Laura Allen & Scarlett Lin Gomez

  3. Cape Fox Facilities Services, Manassas, VA, USA

    Laura A. Dwyer

  4. Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, 550 16th Street, San Francisco, CA, USA

    Salma Shariff-Marco & Scarlett Lin Gomez

  5. School of Public Health, University of California Berkeley, Berkeley, CA, USA

    Amani M. Allen

  6. Health Research & Policy (Epidemiology), School of Medicine, Stanford University, Stanford, CA, USA

    Allison W. Kurian

  7. Stanford Cancer Institute, Stanford University, Stanford, CA, USA

    Allison W. Kurian

  8. Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA

    Michelle M. Langer

  9. Center for Health Measurement, Duke University School of Medicine, Durham, NC, USA

    Bryce B. Reeve

  10. Center for Global Health, National Cancer Institute, Rockville, MD, USA

    Stephen H. Taplin

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  1. Felisa A. Gonzales
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  2. Meera Sangaramoorthy
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Correspondence to Scarlett Lin Gomez.

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Gonzales, F.A., Sangaramoorthy, M., Dwyer, L.A. et al. Patient-clinician interactions and disparities in breast cancer care: the equality in breast cancer care study. J Cancer Surviv 13, 968–980 (2019). https://doi.org/10.1007/s11764-019-00820-7

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