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Disparities Associated with Decision to Undergo Oncologic Surgery: A Prospective Mixed-Methods Analysis
Robert M Van Haren1, Melinda Butsch Kovacic2,3,4, Aaron M Delman2
1University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA. vanharrm@ucmail.uc.edu.
Annals of Surgical Oncology
|June 13, 2024
Summary
Underrepresented minority patients with surgical cancer face care disparities. Poor patient-physician relationships and minority status were linked to declining recommended surgery, highlighting the need for improved interventions.
Area of Science:
- Surgical Oncology
- Health Disparities Research
- Patient-Physician Relationship Studies
Background:
- Underrepresented minority patients with surgical malignancies experience significant outcome disparities.
- Provider-based factors like communication, trust, and cultural competency are not fully understood in relation to patient outcomes.
- This study investigates modifiable provider-based barriers impacting care for patients with surgical malignancies.
Purpose of the Study:
- To examine provider-based barriers to care for patients with surgical malignancies.
- To identify factors influencing the decision-making process for cancer surgery among diverse patient populations.
- To understand the impact of patient-physician relationships on treatment adherence.
Main Methods:
- A prospective, mixed-methods study enrolled patients with lung or gastrointestinal malignancies undergoing surgical consultation.
- Surveys assessed social needs and patient-physician relationships; semi-structured interviews explored patient experiences.
- Iterative qualitative analysis identified key themes related to surgical decision-making.
Main Results:
- The cohort (n=24) included 38% Black/African American patients; common cancers were lung (75%) and gastroesophageal (13%).
- Social needs like food insecurity (21%) and transportation issues (17%) were prevalent. Poor patient-physician relationships (13%), lack of trust (13%), empathy (13%), and cultural competence (13%) were reported.
- Five patients (21%) declined surgery; they were more likely to be Black, lower income, and report poor patient-physician relationships (all p < 0.05).
Conclusions:
- Underrepresented minority race and poor patient-physician relationships are associated with declining recommended cancer surgery.
- Addressing modifiable provider-based factors is crucial to improve care access and reduce racial disparities in surgical oncology.
- Interventions targeting communication, trust, and cultural competency are needed to overcome these barriers.
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