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Kakish H, Zhao J, Ahmed FA, Elshami M, Hardacre JM, Ammori JB, Winter JM, Ocuin LM, Hoehn RS. Understanding surgical attrition for "resectable" pancreatic cancer. HPB (Oxford) 2024; 26:370-378. [PMID: 38042732 DOI: 10.1016/j.hpb.2023.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/21/2023] [Accepted: 11/17/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVES We used a novel combined analysis to evaluate various factors associated with failure to undergo surgery in non-metastatic pancreatic cancer. METHODS We identified rates of surgery and reasons for surgical attrition from clinical trials, which studied neoadjuvant therapy in resectable pancreatic cancer. Next, we queried the National Cancer Database (NCDB) for Stage I-III, T1-3 pancreatic adenocarcinoma patients. We investigated the rates and factors associated with the receipt of surgery. Finally, we evaluated variable importance predicting the receipt of surgery. RESULTS In clinical trials, 25-30 % of patients did not undergo surgery, mostly due to disease progression. In the NCDB, the overall surgical rate was only 49 %, but increased to 67 % in a curated cohort meant to mirror clinical trial patients. Patients treated at low-volume institutions (OR = 0.64, 95 % CI: 0.61-0.67) and who were uninsured (OR = 0.56, 95 % CI: 0.52-0.62) and Medicaid-insured (OR = 0.67, 95 % CI: 0.64-0.71) were less likely to receive potentially curative surgery. CONCLUSION We have identified a realistic target surgery rate of 70%-75 % in potentially-resectable pancreatic cancer. While attrition to pancreatic cancer surgery is mostly due to tumor biology, our study identified the most important non-medical barriers, such as facility volume and insurance, affecting pancreatic cancer surgery.
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Affiliation(s)
- Hanna Kakish
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Jack Zhao
- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Fasih A Ahmed
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Mohamedraed Elshami
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Jeffrey M Hardacre
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - John B Ammori
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Jordan M Winter
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Lee M Ocuin
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Richard S Hoehn
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA.
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Lozano P, Randal FT, Peters A, Aschebrook-Kilfoy B, Kibriya MG, Luo J, Shah S, Zakin P, Craver A, Stepniak L, Saulsberry L, Kupfer S, Lam H, Ahsan H, Kim KE. The impact of neighborhood disadvantage on colorectal cancer screening among African Americans in Chicago. Prev Med Rep 2023; 34:102235. [PMID: 37252073 PMCID: PMC10213351 DOI: 10.1016/j.pmedr.2023.102235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/13/2023] [Accepted: 05/08/2023] [Indexed: 05/31/2023] Open
Abstract
Historically, colorectal cancer (CRC) screening rates have been lower among African Americans. Previous studies that have examined the relationship between community characteristics and adherence to CRC screening have generally focused on a single community parameter, making it challenging to evaluate the overall impact of the social and built environment. In this study, we will estimate the overall effect of social and built environment and identify the most important community factors relevant to CRC screening. Data are from the Multiethnic Prevention and Surveillance Study (COMPASS), a longitudinal study among adults in Chicago, collected between May 2013 to March 2020. A total 2,836 African Americans completed the survey. Participants' addresses were geocoded and linked to seven community characteristics (i.e., community safety, community crime, household poverty, community unemployment, housing cost burden, housing vacancies, low food access). A structured questionnaire measured adherence to CRC screening. Weighted quantile sum (WQS) regression was used to evaluate the impact of community disadvantages on CRC screening. When analyzing all community characteristics as a mixture, overall community disadvantage was associated with less adherence to CRC screening even after controlling for individual-level factors. In the adjusted WQS model, unemployment was the most important community characteristic (37.6%), followed by community insecurity (26.1%) and severe housing cost burden (16.3%). Results from this study indicate that successful efforts to improve adherence to CRC screening rates should prioritize individuals living in communities with high rates of insecurity and low socioeconomic status.
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Affiliation(s)
- Paula Lozano
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | | | - Briseis Aschebrook-Kilfoy
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Muhammad G. Kibriya
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Jiajun Luo
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Sameep Shah
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Paul Zakin
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Andrew Craver
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Liz Stepniak
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Loren Saulsberry
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Sonia Kupfer
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Helen Lam
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Habibul Ahsan
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Karen E. Kim
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
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Hines RB, Zhu X, Lee E, Eames B, Chmielewska K, Johnson AM. Health insurance and neighborhood poverty as mediators of racial disparities in advanced disease stage at diagnosis and nonreceipt of surgery for women with breast cancer. Cancer Med 2023; 12:15414-15423. [PMID: 37278365 PMCID: PMC10417299 DOI: 10.1002/cam4.6127] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/26/2023] [Accepted: 05/14/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND In our recent study, advanced disease stage and nonreceipt of surgery were the most important mediators of the racial disparity in breast cancer survival. The purpose of this study was to quantify the racial disparity in these two intermediate outcomes and investigate mediation by the more proximal mediators of insurance status and neighborhood poverty. METHODS This was a cross-sectional study of non-Hispanic Black and non-Hispanic White women diagnosed with first primary invasive breast cancer in Florida between 2004 and 2015. Log-binomial regression was used to obtain prevalence ratios (PR) with 95% confidence intervals (CIs). Multiple mediation analysis was used to assess the role of having Medicaid/being uninsured and living in high-poverty neighborhoods on the race effect. RESULTS There were 101,872 women in the study (87.0% White, 13.0% Black). Black women were 55% more likely to be diagnosed with advanced disease stage at diagnosis (PR, 1.55; 95% CI, 1.50-1.60) and nearly twofold more likely to not receive surgery (PR, 1.97; 95% CI, 1.90-2.04). Insurance status and neighborhood poverty explained 17.6% and 5.3% of the racial disparity in advanced disease stage at diagnosis, respectively; 64.3% remained unexplained. For nonreceipt of surgery, insurance status explained 6.8% while neighborhood poverty explained 3.2%; 52.1% was unexplained. CONCLUSIONS Insurance status and neighborhood poverty were significant mediators of the racial disparity in advanced disease stage at diagnosis with a smaller impact on nonreceipt of surgery. However, interventions designed to improve breast cancer screening and receipt of high-quality cancer treatment must address additional barriers for Black women with breast cancer.
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Affiliation(s)
- Robert B. Hines
- Department of Population Health SciencesUniversity of Central Florida College of MedicineOrlandoFloridaUSA
| | - Xiang Zhu
- Research Administration ‐ OperationsUniversity of Central Florida College of MedicineOrlandoFloridaUSA
| | - Eunkyung Lee
- Department of Health SciencesCollege of Health Professions and SciencesUniversity of Central FloridaOrlandoFloridaUSA
| | - Bradley Eames
- Department of Medical EducationUniversity of Central Florida College of MedicineOrlandoFloridaUSA
| | - Karolina Chmielewska
- Department of Medical EducationUniversity of Central Florida College of MedicineOrlandoFloridaUSA
| | - Asal M. Johnson
- Department of Environmental Sciences and StudiesPublic Health Program, Stetson UniversityDeLandFloridaUSA
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Workman SC, Thompson MC, Lau L. Decolonising medical knowledge - The case of breast cancer and ethnicity in the UK. J Cancer Policy 2022; 36:100365. [PMID: 36244645 DOI: 10.1016/j.jcpo.2022.100365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/06/2022] [Accepted: 10/05/2022] [Indexed: 02/27/2023]
Abstract
National and global efforts have led to significant improvements in breast health and diagnosis, globally (Lukong, 2017). These achievements, however, are not even. Focusing on the case of breast cancer in the UK, we argue that enduring forms of medical racism leave Black women more vulnerable to advanced forms of the disease, explaining higher mortality rates and later-stage diagnosis. In particular, we show how a lack of dedicated policy, inadequate data collection, and a lack of representation conspire to place Black women at additional and unnecessary risk of worse breast cancer outcomes. We thus propose key recommendations to address the ethnic disparities in and make steps to decolonise breast cancer care. These are early screening for at-risk groups, community-led interventions, and more and better representation of Black women and their risks in breast cancer resources.
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Mitchell KAR, Brassil KJ, Osborne ML, Lu Q, Brown RF. Understanding racial-ethnic differences in patient-centered care (PCC) in oncology through a critical race theory lens: A qualitative comparison of PCC among Black, Hispanic, and White cancer patients. PATIENT EDUCATION AND COUNSELING 2022; 105:2346-2354. [PMID: 34857428 PMCID: PMC9117574 DOI: 10.1016/j.pec.2021.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 11/02/2021] [Accepted: 11/12/2021] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Patient-centered care (PCC) experiences can vary by race and ethnicity and likely contribute to cancer care disparities. We compared PCC concepts between Non-Hispanic White (White), Hispanic, and Non-Hispanic Black (Black) cancer patients utilizing Critical Race Theory (CRT) to understand the relationships between racial-ethnic identity and PCC. METHODS A thematic analysis and in-depth CRT-informed analysis of individual interviews exploring patient values, unmet needs, preferences, and priorities were performed. RESULTS Participants were aged> 25 yrs old, 53% male, and included 5 Hispanic, 4 Black and 6 White cancer patients. Unmet needs for time to make decisions, and provider interaction between visits and the value for finding meaning in the illness emerged among Blacks and Whites. The unmet need for a long-term treatment plan emerged among Blacks, and the preference of research participation among Whites. A value for optimism was observed among Hispanics and Whites. Racial-ethnic variations in patient descriptions and experiences of their values, unmet needs, preferences, and priorities were identified. CONCLUSIONS Underrepresented groups face subtle but significant challenges in feeling cared for and understood, voicing concerns, and obtaining quality care. PRACTICE IMPLICATIONS Increased mutual understanding and provider knowledge of unique PCC experiences among underrepresented cancer patients are needed.
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Affiliation(s)
| | | | | | - Qian Lu
- Department of Health Disparities Research, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard F Brown
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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6
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Thomas G, Lewis RK, Brown K, Maryman J, LoCurto J, Ojeda-Leitner D, Siwierka J, Dean A, Bey A, Redmond M. Breast Cancer Treatment Experiences of Witness Project of Kansas Participants. J Natl Med Assoc 2020; 112:507-515. [PMID: 32713602 DOI: 10.1016/j.jnma.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 04/13/2020] [Accepted: 04/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND African American women continue to die at a higher rate than White women from breast cancer. Kansas has a high death rate among African American women. Their voices needed to be heard. OBJECTIVES This exploratory study will ask the following questions: 1) Were African American and White women having different breast cancer treatment experiences with their health care providers? And 2) How satisfied were they with their treatment? METHOD A total of 15 breast cancer survivors were recruited to participate in this qualitative research study. We conducted focus groups in two communities in the Midwest. Forty percent of the sample was White women, 53% of the sample was African American women and 7% of the sample was Hispanic/Latina. RESULTS Overall six themes emerged. Generally both African American women and White women were satisfied with their health care; both felt they were treated equally by health care professionals. However, they felt that health care professionals should pay more attention to their significant others and to continue to educate young women about early detection. CONCLUSIONS As a result of the focus groups a gap in services emerged in educating the patient's partners about what is needed for their significant others and what role partners play in the recovery process.
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Affiliation(s)
| | - Rhonda K Lewis
- Wichita State University, 1845 N. Fairmount, Box 34, Wichita, KS, 67260, USA.
| | - Kyrah Brown
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, 500 W. Nedderman, 227 Maverick Activities Center | Box 19259, Arlington, TX, 76019, USA
| | | | - Jamie LoCurto
- Child Health and Development Institute of CT. Inc. 270 Farmington Avenue, Suite 362, Farmington, CT, 06032, USA
| | - Debbie Ojeda-Leitner
- National Center for Transgender Equality, 1133 19th St NW Suite 302, Washington, DC, USA
| | - Julia Siwierka
- The Rucks Group, LLC, 714 E. Monument Ave, Suite 222, Dayton, OH, 45402, USA
| | - Amber Dean
- Community Engagement Institute, 1845 N. Fairmount, Box 34, Wichita State University, Wichita, KS, 67260, USA
| | - Alissa Bey
- Wichita State University, 1845 N. Fairmount, Box 34, Wichita, KS, 67260, USA
| | - Michelle Redmond
- Population Health, University of Kansas-Wichita, 1010 N. Kansas, Wichita, KS, 67208, USA
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Conley CC, Small BJ, Christie J, Hoogland AI, Augusto BM, Garcia JD, Pal T, Vadaparampil ST. Patterns and covariates of benefit finding in young Black breast cancer survivors: A longitudinal, observational study. Psychooncology 2020; 29:1115-1122. [PMID: 32323400 DOI: 10.1002/pon.5398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/03/2020] [Accepted: 04/14/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the patterns and covariates of benefit finding over time among young Black breast cancer (BC) survivors. METHODS Black women (N = 305) with invasive BC diagnosed ≤50 years were recruited an average of 1.9 years post-BC diagnosis. Participants completed self-report questionnaires of benefit finding, social support, and illness intrusions at three time points (M time since BC diagnosis: T2 = 3.1 years, T3 = 4.0 years). Relationships between posttraumatic growth constructs (social support, illness intrusions) and benefit finding over time were examined using mixed models. Models controlled for cultural variables (religiosity, time orientation, and collectivism), receipt of chemotherapy, general health status, and partner status. RESULTS Participants reported high levels of benefit finding (M = 2.99, SE = 0.04 on a 0-4 scale). When accounting for covariates, benefit finding did not change over time since BC diagnosis (P = .21). Benefit finding scores at BC diagnosis were associated with more illness intrusions, greater religiosity, and having received chemotherapy (all Ps < .04). Social support was associated with change in benefit finding scores over time, such that a 1-point increase in social support was associated with a 0.05 increase in benefit finding per year (P = .02). CONCLUSIONS This study addresses key gaps in knowledge regarding benefit finding among Black cancer survivors. Consistent with findings from majority White samples, social support and illness intrusions appear to play a key role in benefit finding in Black BC survivors. Cultural constructs-including religiosity-must also be considered in future studies of benefit finding among minority populations.
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Affiliation(s)
- Claire C Conley
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Brent J Small
- School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Juliette Christie
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Bianca M Augusto
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Jennifer D Garcia
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Tuya Pal
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
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Nocon CC, Ajmani GS, Bhayani MK. A contemporary analysis of racial disparities in recommended and received treatment for head and neck cancer. Cancer 2019; 126:381-389. [PMID: 31580491 DOI: 10.1002/cncr.32342] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/21/2019] [Accepted: 05/27/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Racial disparities in squamous cell carcinoma of the head and neck (HNSCC) negatively affect non-Hispanic black (NHB) patients. This study was aimed at understanding how treatment is prescribed and received across all HNSCC subsites. METHODS With the National Cancer Database, patients from 2004 to 2014 with surgically resectable HNSCCs, including tumors of the oral cavity (OC), oropharynx (OP), hypopharynx (HP), and larynx (LX), were studied. The treatment received was either upfront surgery or nonsurgical treatment. Treatment patterns were compared according to race and subsite, and how these differences changed over time was evaluated. RESULTS NHB patients were less likely than non-Hispanic white (NHW) patients to receive surgery across all subsites (relative risk [RR] for OC, 0.87; RR for OP, 0.75; RR for HP, 0.73; RR for LX, 0.87; all P values <.05). They were also more likely to refuse a recommended surgery (RR for OC, 1.50; RR for OP, 1.23; RR for HP, 1.23; RR for LX, 1.34), and this difference was significant except for HP. NHB patients were more likely to not be offered surgery across all subsites (RR for OC, 1.38; RR for OP, 1.07; RR for HP, 1.05; RR for LX, 1.03; all P values <.05). Rates of surgery increased and rates of not being offered surgery declined for both NHB and NHW patients from 2004 to 2014, but the absolute disparities persisted in 2014. CONCLUSIONS Across all HNSCC subsites, NHB patients were less likely than NHW patients to be recommended for and receive surgery and were more likely to refuse surgery. These differences have closed over time but persist. Enhanced shared decision making may improve these disparities.
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Affiliation(s)
- Cheryl C Nocon
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois.,Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Gaurav S Ajmani
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Mihir K Bhayani
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois.,Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, Illinois
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Sutton AL, He J, Edmonds MC, Sheppard VB. Medical Mistrust in Black Breast Cancer Patients: Acknowledging the Roles of the Trustor and the Trustee. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:600-607. [PMID: 29552705 PMCID: PMC7061268 DOI: 10.1007/s13187-018-1347-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Studies indicate that Black patients report higher medical mistrust compared to their White counterparts. However, little is known about factors associated with higher medical mistrust among Black breast cancer patients. We examined predictors of medical mistrust and relationships between medical mistrust, subscales of mistrust, and process of care factors to identify opportunities to promote positive healthcare interactions between the trustees (e.g., providers) and Black breast cancer patients, or the trustors. A secondary analysis was conducted of survey data from 210 Black women with confirmed diagnosis of invasive breast cancer. Participants completed telephone surveys consisting of questions pertaining to sociodemographics, attitudes, and beliefs about medical care and breast cancer treatments. Multiple linear regression determined factors associated with medical mistrust and mistrust subscales. Most participants (61%) were over the age of 50 and currently single (64.8%). Women with greater medical mistrust reported less satisfaction with the trustee's technical ability (p < 0.0001) and greater satisfaction with their own propensity to access care (p < 0.05). Additionally, women with public insurance demonstrated greater mistrust (p < 0.01) and suspicion (p < 0.05) than women with private insurance, and women with less education reported greater perceived discrimination than women who have at least a bachelor's degree. Findings from this study may inform future endeavors to educate providers on ways to effectively interact with and treat Black breast cancer patients. Opportunities to develop interventions that address and tackle issues of mistrust as reported by Black patients may contribute to ongoing efforts to reduce health disparities.
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Affiliation(s)
- Arnethea L Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, 9th Floor, Suite 919, Richmond, VA, 23219, USA.
| | - Jun He
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, 9th Floor, Suite 919, Richmond, VA, 23219, USA
| | - Megan C Edmonds
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, 9th Floor, Suite 919, Richmond, VA, 23219, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, 9th Floor, Suite 919, Richmond, VA, 23219, USA
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Sheppard VB, Huei-Yu Wang J, Hurtado-de-Mendoza A, Sutton AL, LaVeist TA. Psychometric Properties of the Medical Mistrust Index (MMI) in Latina Immigrants. Behav Med 2019; 45:128-133. [PMID: 31343969 DOI: 10.1080/08964289.2019.1585326] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Medical mistrust measures have not been validated in Latino immigrants. This study examined the psychometric properties of the Medical Mistrust Index and its association with health care satisfaction in a sample of Latina immigrants. Participants were 168 self-identified Latinas ≥40 years old. Women were recruited from three Latino-serving health clinics and through a Latino radio program. A bilingual interviewer administered the Medical Mistrust Index in Spanish along with items pertaining to sociodemographic and health care factors. Principal component extraction method was used to evaluate internal consistency reliability to examine Medical Mistrust Index underlying factors. Construct validity was assessed by analyzing the relationship between the Medical Mistrust Index with three related measures (racism, discrimination, trust in doctors). To assess the criterion validity of the Medical Mistrust Index, a logistic regression model examined whether medical mistrust was associated with Latina women's satisfaction with health care controlling for sociodemographic and health care factors. Participants were 51 years old on average, around half had completed High school or less and were uninsured. Most were monolingual Spanish speakers. Two factors: competence and suspicion explained 40% of the total Medical Mistrust Index variance. Internal consistency was favorable and construct validity was supported. Results support the reliability and validity of the Medical Mistrust Index and its association with Latina's satisfaction with health care.
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Affiliation(s)
- Vanessa B Sheppard
- a Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine
| | - Judy Huei-Yu Wang
- b Department of Oncology, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center
| | - Alejandra Hurtado-de-Mendoza
- b Department of Oncology, Georgetown University Medical Center and Georgetown-Lombardi Comprehensive Cancer Center
| | - Arnethea L Sutton
- a Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine
| | - Thomas A LaVeist
- c School of Public Health and Tropical Medicine, Tulane University
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Sheppard JP, Lagman C, Romiyo P, Nguyen T, Azzam D, Alkhalid Y, Duong C, Yang I. Racial Differences in Hospital Stays among Patients Undergoing Craniotomy for Tumour Resection at a Single Academic Hospital. Brain Tumor Res Treat 2019; 7:122-131. [PMID: 31686443 PMCID: PMC6829091 DOI: 10.14791/btrt.2019.7.e29] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/22/2019] [Accepted: 06/04/2019] [Indexed: 01/17/2023] Open
Abstract
Background Racial differences in American patients undergoing brain tumour surgery remain poorly characterized within urban medical centres. Our objective was to assess racial differences in operative brain tumour patients at a single academic hospital in Los Angeles, California. Methods We reviewed medical records of adult patients undergoing craniotomy for tumour resection from March 2013 to January 2017 at UCLA Medical Centre. Patients were categorized as Asian, Hispanic, Black, or White. Racial cohorts were matched on demographic variables for comparisons. Our primary outcome was post-operative length of stay (LOS). Secondary outcomes included hospital mortality and discharge disposition. Results In this study, 462 patients identified as Asian (15.1%), Hispanic (8.7%), Black (3.9%), or White (72.3%). After cohort matching, non-White patients had elevated risk of prolonged LOS [odds ratio (OR)=2.62 (1.44, 4.76)]. No differences were observed in hospital mortality or non-routine discharge. Longer LOS was positively correlated with non-routine discharge [rpb (458)=0.41, p<0.001]. Black patients with government insurance had average LOS 2.84 days shorter than Black patients with private insurance (p=0.04). Among Hispanics, government insurance was associated with non-routine discharge [OR=4.93 (1.03, 24.00)]. Conclusion Racial differences manifested as extended LOS for non-White patients, with comparable rates of hospital mortality and non-routine discharge across races. Prolonged LOS loosely reflected complicated clinical course with greater risk of adverse discharge disposition. Private insurance coverage predicted markedly lower risk of non-routine discharge for Hispanic patients, and LOS of three additional days among Black patients. Further research is needed to elucidate the basis of these differences.
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Affiliation(s)
- John P Sheppard
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Carlito Lagman
- Department of Radiation Oncology, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Prasanth Romiyo
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Thien Nguyen
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Daniel Azzam
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Yasmine Alkhalid
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Courtney Duong
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA
| | - Isaac Yang
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA.,Department of Radiation Oncology, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA.,Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA.,Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center of the David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, USA.,Department of Neurosurgery, Harbor-UCLA Medical Center, Torrance, CA, USA.,Los Angeles Biomedical Research Institute (LA BioMed), Harbor-UCLA Medical Center, Torrance, CA, USA.
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Lewis K, Kulkarni S, Adams SA, Brandt HM, Lead JR, Ureda JR, Fedrick D, Mathews C, Friedman DB. "For lack of knowledge, our people will perish": Using focus group methodology to explore African-American communities' perceptions of breast cancer and the environment. ENVIRONMENT INTERNATIONAL 2018; 121:111-118. [PMID: 30195624 PMCID: PMC6221986 DOI: 10.1016/j.envint.2018.08.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/15/2018] [Accepted: 08/28/2018] [Indexed: 05/27/2023]
Abstract
Among women living in the United States, breast cancer is the second leading cause of cancer death. Disproportionate racial disparities in breast cancer exist, with African American (AA) women consistently having the highest rates of breast cancer related mortality despite lower incidence. This study attends to the Institute of Medicine's (IOM) call to action recommending the identification of effective strategies for communicating accurate and reliable breast cancer risk information to diverse audiences. Using focus group methodology, this study explores how AAs perceive and decipher information related to breast cancer and its relationship to their environment. Six focus groups were conducted. The sample (n = 50) was African American, 98% female, with an average age of 50.1 years. The focus group protocol consisted of open-ended questions designed to elicit information about participants' perceptions of their environment and its link to breast cancer. Focus groups were audio recorded and professionally transcribed. Analysis of the focus group transcripts revealed themes pertaining to these categories: (1) general knowledge and beliefs about breast cancer, (2) perceived environmental risks factors for breast cancer, (3) importance of seeking knowledge about breast cancer and the environment, and (4) recommended communication strategies. The emergent themes reflect the knowledge participants possessed about breast cancer and environmental risk factors, in addition to concerns about the importance of possessing accurate information, and how culturally appropriate health communication strategies can be used to disseminate breast cancer knowledge in the community. Findings from this study can be used for culturally appropriate communication about breast cancer and the environment with AA communities.
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Affiliation(s)
- Kaleea Lewis
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 921 Assembly St, Columbia, SC 29208; Lewis: ; Kulkarni: ; Brandt: ; Friedman
| | - Shibani Kulkarni
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 921 Assembly St, Columbia, SC 29208; Lewis: ; Kulkarni: ; Brandt: ; Friedman
| | - Swann Arp Adams
- Department of Epidemiology & Biostatistics, University of South Carolina, Arnold School of Public Health, 921 Assembly St, Columbia, SC 29208; Adams:
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC 29208
- Statewide Cancer Prevention and Control Program, University of South Carolina, Discovery 1 Building, Suite 200, 915 Greene Street Columbia, SC 29208
| | - Heather M. Brandt
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 921 Assembly St, Columbia, SC 29208; Lewis: ; Kulkarni: ; Brandt: ; Friedman
- Statewide Cancer Prevention and Control Program, University of South Carolina, Discovery 1 Building, Suite 200, 915 Greene Street Columbia, SC 29208
| | - Jamie R. Lead
- Department of Environmental Health Sciences, University of South Carolina, Arnold School of Public Health, 921 Assembly St, Columbia, SC 29208; Lead:
- Center for Environmental Nanoscience and Risk, University of South Carolina, Arnold School of Public Health, 921 Assembly St, Columbia, SC 29208
| | - John R. Ureda
- Insights Consulting, Inc., 1441 St Andrews Rd, Columbia, SC 29210; Ureda:
| | - Delores Fedrick
- Chester County Literacy Council, 109 Ella Street Chester, SC 29706; Fedrick:
| | - Chris Mathews
- Turning Pages Greater Columbia Literacy Council, 4840 Forest Drive, Suite 6B-PMB 267 Columbia, SC 29206; Mathews:
| | - Daniela B. Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 921 Assembly St, Columbia, SC 29208; Lewis: ; Kulkarni: ; Brandt: ; Friedman
- Statewide Cancer Prevention and Control Program, University of South Carolina, Discovery 1 Building, Suite 200, 915 Greene Street Columbia, SC 29208
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Dutta SW, Peterson JL, Vallow LA, Mahajan A, Rosenfeld SS, Quiñones-Hinojosa A, Trifiletti DM. National care among patients with WHO grade I intracranial meningioma. J Clin Neurosci 2018; 55:17-24. [PMID: 29910033 DOI: 10.1016/j.jocn.2018.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/06/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To analyze the national treatment trends of patients diagnosed with benign intracranial meningioma. METHODS AND MATERIALS Data was obtained from the National Cancer Database (NCDB) for patients with WHO grade I meningioma tumors between 2004 and 2014 (190,527 patients), diagnosed by either surgical specimen or diagnostic imaging. Univariable and multivariable analyses (binary logistic models) were performed to generate odds ratios (OR) and investigate factors associated with definitive initial treatment compared to initial observation. Initial treatments considered included surgical resection and/or radiation, including either fractionated external beam radiotherapy (EBRT) or stereotactic radiosurgery (SRS). RESULTS The rate of observation increased over time, from 37% in 2004 to 55% in 2014 (p < 0.001). Conjointly, the rate of resection decreased from 50% to 37% from 2004 to 2014 (p < 0.001). The utilization of radiotherapy, including SRS, remained generally stable over time at 6% or less. SRS was more frequently utilized, compared to EBRT, as definitive treatment (4.6% versus 1.7%, respectively, p < 0.001). Compared to Community Cancer programs, patients at Academic/Research programs were more likely to receive definitive initial treatment over observation (OR = 2.909, each p < 0.001). CONCLUSIONS There is a national trend favoring initial observation for radiographically diagnosed WHO grade I meningioma. However, patients presenting to academic facilities are more likely to receive definitive initial treatment. Further research into differing approaches among treatment facilities for this common tumor may help clarify this trend.
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Affiliation(s)
- Sunil W Dutta
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA.
| | - Jennifer L Peterson
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA; Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Laura A Vallow
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Daniel M Trifiletti
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA; Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
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Drake BF, Tannan S, Anwuri VV, Jackson S, Sanford M, Tappenden J, Goodman MS, Colditz GA. A Community-Based Partnership to Successfully Implement and Maintain a Breast Health Navigation Program. J Community Health 2016; 40:1216-23. [PMID: 26077018 PMCID: PMC4626535 DOI: 10.1007/s10900-015-0051-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Breast cancer screening combined with follow-up and treatment reduces breast cancer mortality. However, in the study clinic, only 12 % of eligible women ≥40 years received a mammogram in the previous year. The objective of this project was to implement patient navigation, in our partner health clinic to (1) identify women overdue for a mammogram; and (2) increase mammography utilization in this population over a 2-year period. Women overdue for a mammogram were identified. One patient navigator made navigation attempts over a 2-year period (2009-2011). Navigation included working around systems- and individual-level barriers to receive a mammogram as well as the appropriate follow-up post screening. Women were contacted up to three times to initiate navigation. The proportion of women navigated and who received a mammogram during the study period were compared to women who did not receive a mammogram using Chi square tests for categorical variables and t tests for continuous variables with an α = 0.05. Barriers to previous mammography were also assessed. With 94.8 % of eligible women navigated and 94 % of these women completing mammography, the implementation project reached 89 % of the target population. This project was a successful implementation of an evidence-based patient navigation program that continues to provide significant impact in a high-need area. Cost was the most commonly cite barrier to mammography. Increasing awareness of resources in the community for mammography and follow-up care remains a necessary adjunct to removing structural and financial barriers to accessing preventive services.
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Affiliation(s)
- Bettina F Drake
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave., Campus Box 8100, St. Louis, MO, 63110, USA. .,Alvin J. Siteman Cancer Center, St. Louis, MO, USA. .,Institute of Public Health, Washington University, St. Louis, MO, USA.
| | - Shivon Tannan
- Betty Jean Kerr People's Health Centers, St. Louis, MO, USA
| | - Victoria V Anwuri
- Institute of Public Health, Washington University, St. Louis, MO, USA
| | | | - Mark Sanford
- Betty Jean Kerr People's Health Centers, St. Louis, MO, USA
| | - Jennifer Tappenden
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave., Campus Box 8100, St. Louis, MO, 63110, USA
| | - Melody S Goodman
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave., Campus Box 8100, St. Louis, MO, 63110, USA.,Alvin J. Siteman Cancer Center, St. Louis, MO, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave., Campus Box 8100, St. Louis, MO, 63110, USA.,Alvin J. Siteman Cancer Center, St. Louis, MO, USA.,Institute of Public Health, Washington University, St. Louis, MO, USA
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15
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Rayne S, Schnippel K, Firnhaber C, Wright K, Kruger D, Benn CA. Fear of Treatments Surpasses Demographic and Socioeconomic Factors in Affecting Patients With Breast Cancer in Urban South Africa. J Glob Oncol 2016; 3:125-134. [PMID: 28717750 PMCID: PMC5493272 DOI: 10.1200/jgo.2015.002691] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Breast cancer is the most common cause of cancer in women in South Africa, and often patients present late. There is little understanding of the psychosocial stresses affecting women with breast cancer in Africa. Methods A questionnaire was distributed to 263 patients with breast cancer at two sites (one government and one private facility) in Johannesburg. Self-reported levels of fear were recorded on summative scales and their relationship to demographic variables assessed through univariable and multivariable modified Poisson regression. Results Fears related to treatments and prognosis, particularly radiation, loss of hair, and loss of breast, were far stronger than those related to socioeconomic barriers. Relative risk (RR) of most fears was higher in women younger than age 40 years, including treatment affordability (RR, 1.80; 95% CI, 1.26 to 2.56), hair loss (RR, 1.48; 95% CI, 1.12 to 2.95), and surgery (RR, 1.31; 95% CI, 1.02 to 1.68). Difficulty taking time off work predicted fear of job loss (RR, 2.59; 95% CI, 1.59 to 4.21) and missing appointments because of transport (RR, 2.46; 95% CI, 1.52 to 3.96) or family commitments (RR, 2.46; 95% CI, 1.52 to 3.96). Women with dependents and black women were more afraid of dying (RR, 1.73; 95% CI, 1.03 to 2.90; and RR, 1.79; 95% CI, 1.33 to 2.24, respectively); however, socioeconomic status in this sample was a strong confounder of race and explained most of the racial differences in levels of fear. Conclusion The most significant fears around breast cancer were related to treatment modalities and adverse effects rather than transport, financial, or work concerns. Young age and job insecurity were predictive of increased fears. Education about treatments has a key role to play in improving access to breast cancer care in South Africa.
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Affiliation(s)
- Sarah Rayne
- All authors, University of the Witwatersrand; and Kathryn Schnippel and Cynthia Firnhaber, Right to Care, Johannesburg, South Africa
| | - Kathryn Schnippel
- All authors, University of the Witwatersrand; and Kathryn Schnippel and Cynthia Firnhaber, Right to Care, Johannesburg, South Africa
| | - Cynthia Firnhaber
- All authors, University of the Witwatersrand; and Kathryn Schnippel and Cynthia Firnhaber, Right to Care, Johannesburg, South Africa
| | - Kathryne Wright
- All authors, University of the Witwatersrand; and Kathryn Schnippel and Cynthia Firnhaber, Right to Care, Johannesburg, South Africa
| | - Deirdre Kruger
- All authors, University of the Witwatersrand; and Kathryn Schnippel and Cynthia Firnhaber, Right to Care, Johannesburg, South Africa
| | - Carol-Ann Benn
- All authors, University of the Witwatersrand; and Kathryn Schnippel and Cynthia Firnhaber, Right to Care, Johannesburg, South Africa
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Molina Y, Kim S, Berrios N, Calhoun EA. Medical mistrust and patient satisfaction with mammography: the mediating effects of perceived self-efficacy among navigated African American women. Health Expect 2015; 18:2941-50. [PMID: 25308749 PMCID: PMC4393336 DOI: 10.1111/hex.12278] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Medical mistrust is salient among African American women, given historic and contemporary racism within medical settings. Mistrust may influence satisfaction among navigated women by affecting women's perceptions of their health-care self-efficacy and their providers' roles in follow-up of abnormal test results. OBJECTIVES To (i) examine whether general medical mistrust and health-care self-efficacy predict satisfaction with mammography services and (ii) test the mediating effects of health-related self-efficacy. DESIGN The current study is a part of a randomized controlled patient navigation trial for medically underserved women who had received a physician referral to obtain a mammogram in three community hospitals in Chicago, IL. After consent, 671 African American women with no history of cancer completed questionnaires concerning medical mistrust and received navigation services. After their mammography appointment, women completed health-care self-efficacy and patient satisfaction questionnaires. RESULTS Women with lower medical mistrust and greater perceived self-efficacy reported greater satisfaction with care. Medical mistrust was directly and indirectly related to patient satisfaction through self-efficacy. CONCLUSIONS Preliminary findings suggest future programmes designed to increase health-care self-efficacy may improve patient satisfaction among African American women with high levels of medical mistrust. Our findings add to a growing body of literature indicating the importance of self-efficacy and active participation in health care, especially among the underserved.
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Affiliation(s)
- Yamile Molina
- School of Public HealthUniversity of WashingtonSeattleWAUSA
- Fred Hutchinson Cancer Research CenterSeattleWAUSA
- School of Public HealthUniversity of Illinois‐ChicagoChicagoILUSA
| | - Sage Kim
- School of Public HealthUniversity of Illinois‐ChicagoChicagoILUSA
| | - Nerida Berrios
- School of Public HealthUniversity of Illinois‐ChicagoChicagoILUSA
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17
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Hassett MJ, Schymura MJ, Chen K, Boscoe FP, Gesten FC, Schrag D. Variation in breast cancer care quality in New York and California based on race/ethnicity and Medicaid enrollment. Cancer 2015; 122:420-31. [PMID: 26536043 DOI: 10.1002/cncr.29777] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 09/19/2015] [Accepted: 10/12/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Racial/ethnic and socioeconomic disparities persist in part because our current understanding of the care provided to minority and disadvantaged populations is limited. The authors evaluated the quality of breast cancer care in 2 large states to understand the disparities experienced by African Americans, Hispanics, Asian/Pacific Islanders (APIs), and Medicaid enrollees and to prioritize remediation strategies. METHODS Statewide cancer registry data for 80,436 women in New York and 121,233 women in California who were diagnosed during 2004 to 2009 with stage 0 through III breast cancer were used to assess underuse and overuse of surgery, radiation, chemotherapy, and hormone therapy based on 34 quality measures. Concordance values were compared across racial/ethnic and Medicaid-enrollment groups. Multivariable models were used to quantify disparities across groups for each treatment in each state. RESULTS Overall concordance was 76% for underuse measures and 87% for overuse measures. The proportions of patients who received care concordant with all relevant measures were 35% in New York and 33% in California. Compared with whites, African Americans were less likely to receive recommended surgery, radiation, and hormone therapy; Hispanics and APIs were usually more likely to receive recommended chemotherapy. Across states, the same racial/ethnic groups did not always experience the same disparities. Medicaid enrollment was associated with decreased likelihood of receiving all recommended treatments, except chemotherapy, in both states. Overuse was evident for hormone therapy and axillary surgery but was not associated with race/ethnicity or Medicaid enrollment. CONCLUSIONS Patient-level measures of quality identify substantial problems with care quality and meaningful disparities. Remediating these problems will require prioritizing low-performing measures and targeting high-risk populations, possibly in different ways for different regions.
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Affiliation(s)
- Michael J Hassett
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Maria J Schymura
- Cancer Registry, New York State Department of Health, Albany, New York
| | - Kun Chen
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Francis P Boscoe
- Cancer Registry, New York State Department of Health, Albany, New York
| | - Foster C Gesten
- Office of Quality and Patient Safety, New York State Department of Health, Albany, New York
| | - Deborah Schrag
- Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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18
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Keegan THM, Kurian AW, Gali K, Tao L, Lichtensztajn DY, Hershman DL, Habel LA, Caan BJ, Gomez SL. Racial/ethnic and socioeconomic differences in short-term breast cancer survival among women in an integrated health system. Am J Public Health 2015; 105:938-46. [PMID: 25790426 PMCID: PMC4386534 DOI: 10.2105/ajph.2014.302406] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVES We examined the combined influence of race/ethnicity and neighborhood socioeconomic status (SES) on short-term survival among women with uniform access to health care and treatment. METHODS Using electronic medical records data from Kaiser Permanente Northern California linked to data from the California Cancer Registry, we included 6262 women newly diagnosed with invasive breast cancer. We analyzed survival using multivariable Cox proportional hazards regression with follow-up through 2010. RESULTS After consideration of tumor stage, subtype, comorbidity, and type of treatment received, non-Hispanic White women living in low-SES neighborhoods (hazard ratio [HR] = 1.28; 95% confidence interval [CI] = 1.07, 1.52) and African Americans regardless of neighborhood SES (high SES: HR = 1.44; 95% CI = 1.01, 2.07; low SES: HR = 1.88; 95% CI = 1.42, 2.50) had worse overall survival than did non-Hispanic White women living in high-SES neighborhoods. Results were similar for breast cancer-specific survival, except that African Americans and non-Hispanic Whites living in high-SES neighborhoods had similar survival. CONCLUSIONS Strategies to address the underlying factors that may influence treatment intensity and adherence, such as comorbidities and logistical barriers, should be targeted at low-SES non-Hispanic White and all African American patients.
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Affiliation(s)
- Theresa H M Keegan
- Theresa H. M. Keegan, Li Tao, Daphne Y. Lichtensztajn, and Scarlett L. Gomez are with the Cancer Prevention Institute of California, Fremont. Allison W. Kurian is with the Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA. Kathleen Gali is with the School of Social Sciences, Humanities and Arts, University of California, Merced. Dawn L. Hershman is with the Columbia University Medical Center, New York, NY. Laurel A. Habel and Bette J. Caan are with the Division of Research, Kaiser Permanente, Oakland, CA
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Daly B, Olopade OI. A perfect storm: How tumor biology, genomics, and health care delivery patterns collide to create a racial survival disparity in breast cancer and proposed interventions for change. CA Cancer J Clin 2015; 65:221-38. [PMID: 25960198 DOI: 10.3322/caac.21271] [Citation(s) in RCA: 233] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 02/09/2015] [Accepted: 02/11/2015] [Indexed: 12/11/2022] Open
Abstract
It is well known that there is a significant racial divide in breast cancer incidence and mortality rates. African American women are less likely to be diagnosed with breast cancer than white women but are more likely to die from it. This review explores the factors that may contribute to the racial survival disparity. Consideration is paid to what is known about the role of differences in tumor biology, genomics, cancer screening, and quality of cancer care. It is argued that it is the collision of 2 forces, tumor biology and genomics, with patterns of care that leads to the breast cancer mortality gap. The delays, misuse, and underuse of treatment for African American patients are of increased significance when these patients are presenting with more aggressive forms of breast cancer. In the current climate of health care reform ushered in by the Affordable Care Act, this article also evaluates interventions to close the disparity gap. Prior interventions have been too narrowly focused on the patient rather than addressing the system and improving care across the continuum of breast cancer evaluation and treatment. Lastly, areas of future investigation and policy initiatives aimed at reducing the racial survival disparity in breast cancer are discussed.
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Affiliation(s)
- Bobby Daly
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Olufunmilayo I Olopade
- Walter L. Palmer Distinguished Service Professor and Director Center for Clinical Cancer Genetics, Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
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20
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Al-Hussami M, Zeilani R, AlKhawaldeh OA, Abushaika L. Jordanian women's personal practices regarding prevention and early detection of breast cancer. Int J Nurs Knowl 2014; 25:189-94. [PMID: 25088985 DOI: 10.1111/2047-3095.12045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breast cancer, as a leading cause of mortality, is responsible for 12.5% of all deaths in Jordan. OBJECTIVES The aim of this study was to describe Jordanian women's personal practices and perceptions of breast cancer screening tests. METHODS A quantitative cross-sectional survey using a proportionate stratified sample of 331 women was conducted. The target population includes all Jordanian women living in high- and low-density neighborhoods. The population involved women from the 12 governorates areas. RESULTS Perception of susceptibility, confidence in performing breast self-examination (BSE) barriers of the group that had previously performed BSE were significantly higher than those who did not practice (t = 8.38, p = .02; t = 9.90, p = .00; t = -0.98, p = .01, respectively). CONCLUSION The results of this study provide information to policy makers and healthcare leaders who seek to improve breast cancer prevention and response to cancer control efforts.
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21
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Choi EK, Kim IR, Chang O, Kang D, Nam SJ, Lee JE, Lee SK, Im YH, Park YH, Yang JH, Cho J. Impact of chemotherapy-induced alopecia distress on body image, psychosocial well-being, and depression in breast cancer patients. Psychooncology 2014; 23:1103-10. [DOI: 10.1002/pon.3531] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 01/28/2014] [Accepted: 02/28/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Eun Kyung Choi
- Cancer Education Center; Samsung Comprehensive Cancer Center; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Im-Ryung Kim
- Cancer Education Center; Samsung Comprehensive Cancer Center; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Oliver Chang
- Krieger School of Arts and Sciences; Johns Hopkins University; Baltimore MD USA
| | - Danbee Kang
- Department of Health Sciences and Technology, SAIHST; Sungkyunkwan University; Seoul Korea
| | - Seok-Jin Nam
- Department of Surgery; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Jeong Eon Lee
- Department of Surgery; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Se Kyung Lee
- Department of Surgery; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Young-Hyuck Im
- Department of Hematology and Oncology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Yeon Hee Park
- Department of Hematology and Oncology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Jung-Hyun Yang
- Department of Surgery; Konkuk University Medical Center; Konkuk University School of Medicine; Seoul Korea
| | - Juhee Cho
- Cancer Education Center; Samsung Comprehensive Cancer Center; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
- Department of Health Sciences and Technology, SAIHST; Sungkyunkwan University; Seoul Korea
- Department of Health, Behavior and Society; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
- Department of Epidemiology; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
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22
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Kent EE, Alfano CM, Smith AW, Bernstein L, McTiernan A, Baumgartner KB, Ballard-Barbash R. The roles of support seeking and race/ethnicity in posttraumatic growth among breast cancer survivors. J Psychosoc Oncol 2013; 31:393-412. [PMID: 23844921 DOI: 10.1080/07347332.2013.798759] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Posttraumatic growth (PTG) after cancer can minimize the emotional impact of disease and treatment; however, the facilitators of PTG, including support seeking, are unclear. The authors examined the role of support seeking on PTG among 604 breast cancer survivors ages 40 to 64 from the Health Eating, Activity, and Lifestyle (HEAL) Study. Multivariable linear regression was used to examine predictors of support seeking (participation in support groups and confiding in health care providers) as well as the relationship between support seeking and PTG. Support program participation was moderate (61.1%) compared to the high rates of confiding in health professionals (88.6%), and African Americans were less likely to report participating than non-Hispanic Whites (odds ratio = .14, confidence intervals [0.08, 0.23]). The mean (SD) PTG score was 48.8 (27.4) (range 0-105). Support program participation (β = 10.4) and confiding in health care providers (β = 12.9) were associated (p < .001) with higher PTG. In analyses stratified by race/ethnicity, PTG was significantly higher in non-Hispanic Whites and African American support program participants (p < .01), but not significantly higher in Hispanics/Latinas. Confiding in a health care provider was only associated with PTG for non-Hispanic Whites (p = .02). Support program experiences and patient-provider encounters should be examined to determine which attributes facilitate PTG in diverse populations.
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Affiliation(s)
- Erin E Kent
- Division of Cancer Control and Population Sciences and Center for Cancer Training, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA.
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Racial disparities in Medicaid patients after brain tumor surgery. J Clin Neurosci 2012; 20:57-61. [PMID: 23084348 DOI: 10.1016/j.jocn.2012.05.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 05/06/2012] [Indexed: 11/24/2022]
Abstract
The presence of healthcare-related disparities is an ongoing, widespread, and well-documented societal and health policy issue. We investigated the presence of racial disparities among post-operative patients either with meningioma or malignant, benign, or metastatic brain tumors. We used the Medicaid component of the Thomson Reuter's MarketScan database from 2000 to 2009. Univariate and multivariate analysis assessed death, 30-day post-operative risk of complications, length of stay, and total charges. We identified 2321 patients, 73.7% were Caucasian, 57.8% were women; with Charlson comorbidity scores of <3 (56.2%) and treated at low-volume centers (73.4%). Among all, 26.3% of patients were of African-American ethnicity and 22.1% had meningiomas. Mortality was 2.0%, mean length of stay (LOS) was 9 days, mean total charges were US$42,422, an adverse discharge occurred in 22.5% of patients, and overall 30-day complication rate was 23.4%. In a multivariate analysis, African-American patients with meningiomas had higher odds of developing a 30-day complication (p=0.05) and were significantly more likely to have longer LOS (p<0.001) and greater total charges (p<0.001) relative to Caucasian counterparts. The presence of one post-operative complication doubled LOS and nearly doubled total charges, while the presence of two post-operative complications tripled these outcomes. Patients of African-American ethnicity had significantly higher post-operative complications than those of Caucasian ethnicity. This higher rate of complications seems to have driven greater healthcare utilization, including greater LOS and total charges, among African-American patients. Interventions aimed at reducing complications among African-American patients with brain tumor may help reduce post-operative disparities.
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Lewis PE, Sheng M, Rhodes MM, Jackson KE, Schover LR. Psychosocial concerns of young African American breast cancer survivors. J Psychosoc Oncol 2012; 30:168-84. [PMID: 22416954 DOI: 10.1080/07347332.2011.651259] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Thirty-three African American breast cancer survivors age 45 or younger participated in semistructured phone interviews about psychosocial concerns. Twenty-six percent believed treatment interfered with employment. One third wanted additional emotional support at and after diagnosis. One half felt cancer negatively influenced romantic relationships. Forty-five percent wanted children at diagnosis, but one half these women never received fertility information. One third reported sexual problems, but 73% never discussed sexuality with providers. Fifty-two percent lacked information about cancer-related sexual dysfunction. The strength and spirituality of African American women may facilitate cancer adjustment, but cultural taboos surrounding women's health issues may interfere with successful coping.
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Affiliation(s)
- Pamela E Lewis
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX 77230-1439, USA
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Vina ER, Masi CM, Green SL, Utset TO. A study of racial/ethnic differences in treatment preferences among lupus patients. Rheumatology (Oxford) 2012; 51:1697-706. [PMID: 22653381 PMCID: PMC3418647 DOI: 10.1093/rheumatology/kes128] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objectives. To determine whether there are racial/ethnic differences in the willingness of SLE patients to receive CYC or participate in clinical trials, and whether demographic, psychosocial and clinical characteristics contribute to these differences. Methods. Data from 120 African-American and 62 white lupus patients were evaluated. Structured telephone interviews were conducted to determine treatment preferences, as well as to study characteristics and beliefs that may affect these preferences. Data were analysed using serial hierarchical multivariate logistic regression and deviances were calculated from a saturated model. Results. Compared with their white counterparts, African-American SLE patients expressed less willingness to receive CYC (67.0% vs 84.9%, P = 0.02) if their lupus worsened. This racial/ethnic difference remained significant after adjusting for socioeconomic and psychosocial variables. Logistic regression analysis showed that African-American race [odds ratio (OR) 0.29, 95% CI 0.10, 0.80], physician trust (OR 1.05, 95% CI 1.00, 1.12) and perception of treatment effectiveness (OR 1.40, 95% CI 1.22, 1.61) were the most significant determinants of willingness to receive CYC. A trend in difference by race/ethnicity was also observed in willingness to participate in a clinical trial, but this difference was not significant. Conclusion. This study demonstrated reduced likelihood of accepting CYC in African-American lupus patients compared with white lupus patients. This racial/ethnic variation was associated with belief in medication effectiveness and trust in the medical provider, suggesting that education about therapy and improved trust can influence decision-making among SLE patients.
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Affiliation(s)
- Ernest R Vina
- Arthritis Research Center, 3347 Forbes Ave., Pittsburgh, PA 15213, USA.
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James A, Daley CM, Greiner KA. "Cutting" on cancer: attitudes about cancer spread and surgery among primary care patients in the U.S.A. Soc Sci Med 2011; 73:1669-73. [PMID: 22005317 DOI: 10.1016/j.socscimed.2011.09.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 09/02/2011] [Accepted: 09/08/2011] [Indexed: 11/24/2022]
Abstract
Many underserved groups in the United States experience disparities in cancer survival. Part of the disparity may be due to differences in treatment or treatment uptake. Previous studies uncovered patient beliefs that surgery could cause cancer to spread and have suggested that this belief may affect uptake of cancer treatment. We explored patients' explanations about surgical treatment of cancer and cancer spread, as well as the perceived impact on decision-making among primary care patients from an underserved area. Focus groups and interviews were conducted with patients (n = 42) at a primary care federally qualified health center in 2006 and 2007. Focus groups/interviews were semi-structured and were audio-taped and transcribed. An inductive text analysis with multiple coders was used to analyze the data and extract themes. We found that nearly all respondents had heard that surgery ("cutting") and exposing cancer to the air would hasten cancer spread and result in worse outcomes. Most participants expressed agreement with this belief. Many participants said this concern would influence their decision about whether to have surgery and/or reported that a family member had refused surgery for this reason. A smaller group of respondents disagreed with this belief and offered experiential evidence to the contrary or hypotheses about its origination. The idea that "cutting" and "air" during surgery can cause cancer to spread may be more prevalent among patients than suspected, based on this sample of predominantly African American patients. While we were unable to disentangle the ideas about "cutting" from those about "exposure to air", this set of beliefs, when held strongly, can negatively influence patients' or family members' decisions to seek surgical care and, if it is more prevalent in underserved groups, may contribute to cancer disparities.
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Affiliation(s)
- Aimee James
- Washington University in Saint Louis, Department of Surgery, Division of Public Health Sciences, 660 South Euclid Ave., Box 8100, Saint Louis, MO 63110, USA.
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Wiltshire JC, Person SD, Allison J. Exploring Differences in Trust in Doctors Among African American Men and Women. J Natl Med Assoc 2011; 103:845-51. [DOI: 10.1016/s0027-9684(15)30439-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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The import of trust in regular providers to trust in cancer physicians among white, African American, and Hispanic breast cancer patients. J Gen Intern Med 2011; 26:51-7. [PMID: 20811783 PMCID: PMC3024096 DOI: 10.1007/s11606-010-1489-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 06/07/2010] [Accepted: 08/06/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Interpersonal trust is an important component of the patient-doctor relationship. Little is known about patients' trust in the multiple providers seen when confronting serious illness. OBJECTIVES To characterize breast cancer patients' trust in their regular providers, diagnosing physicians, and cancer treatment team and examine whether high trust in one's regular provider confers high trust to cancer physicians. DESIGN In-person interviews. PARTICIPANTS 704 white, black, and Hispanic breast cancer patients, age 30 to 79, with a first primary in situ or invasive breast cancer who reported having a regular provider. MEASURES We measure trust in: (1) regular provider, (2) diagnosing doctors, and (3) cancer treatment team. Other variables include demographic variables, preventive health care, comorbidities, time with regular provider, time since diagnosis, cancer stage, and treatment modality. RESULTS Sixty-five percent of patients reported high trust in their regular provider, 84% indicated high trust in their diagnosing doctors, and 83% reported high trust in their treatment team. Women who reported high trust in their regular provider were significantly more likely to be very trusting of diagnosing doctors (OR: 3.44, 95% CI: 2.27-5.21) and cancer treatment team (OR: 3.09, 95% CI: 2.02-4.72 ). Black women were significantly less likely to be very trusting of their regular doctor (OR: 0.58, 95% CI: 0.38-0.88) and cancer treatment team (OR: 0.45, 95% CI: 0.25-0.80). English-speaking Hispanic women were significantly less trusting of their diagnosing doctors (OR: 0.29, 95% CI: 0.11-0.80). CONCLUSIONS Our results suggest that patients are very trusting of their breast cancer providers. This is an important finding given that research with other populations has shown an association between trust and patient satisfaction and treatment adherence. Our findings also suggest that a trusting relationship with a regular provider facilitates trusting relationships with specialists. Additional work is needed to increase interpersonal trust among black women.
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Gehlert S, Coleman R. Using community-based participatory research to ameliorate cancer disparities. HEALTH & SOCIAL WORK 2010; 35:302-309. [PMID: 21171537 PMCID: PMC3016944 DOI: 10.1093/hsw/35.4.302] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Although much attention has been paid to health disparities in the past decades, interventions to ameliorate disparities have been largely unsuccessful. One reason is that the interventions have not been culturally tailored to the disparity populations whose problems they are meant to address. Community-engaged research has been successful in improving the outcomes of racial and ethnic minority groups and thus has great potential for decreasing between-group health disparities. In this article, the authors argue that a type of community-engaged research, community-based participatory research (CBPR), is particularly useful for social workers doing health disparities research because of its flexibility and degree of community engagement. After providing an overview of community research, the authors define the parameters of CBPR, using their own work in African American and white disparities in breast cancer mortality as an example of its application. Next, they outline the inherent challenges of CBPR to academic and community partnerships. The authors end with suggestions for developing and maintaining successful community and academic partnerships.
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Affiliation(s)
- Sarah Gehlert
- George Warren Brown School of Social Work, Washington University, St. Louis, MO, USA.
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Freedman RA, Virgo KS, He Y, Pavluck AL, Winer EP, Ward EM, Keating NL. The association of race/ethnicity, insurance status, and socioeconomic factors with breast cancer care. Cancer 2010; 117:180-9. [PMID: 20939011 DOI: 10.1002/cncr.25542] [Citation(s) in RCA: 159] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 05/14/2010] [Accepted: 06/11/2010] [Indexed: 11/07/2022]
Abstract
BACKGROUND Few data are available on how race/ethnicity, insurance, and socioeconomic status (SES) interrelate to influence breast cancer treatment. The authors examined care for a national cohort of breast cancer patients to assess whether insurance and SES were associated with racial/ethnic differences in care. METHODS The authors used multivariate logistic regression to assess the probability of definitive locoregional therapy, hormone receptor testing, and adjuvant systemic therapy among 662,117 white, black, and Hispanic women diagnosed with invasive breast cancer during 1998-2005 at National Cancer Data Base hospitals. In additional models, the authors included insurance and area-level SES to determine whether these variables were associated with observed racial/ethnic disparities. RESULTS Most women were white (86%), 10% were black, and 4% were Hispanic. Most had private insurance (51%) or Medicare (41%). Among eligible patients, 80.0% (stage I/II) had definitive locoregional therapy, 98.5% (stage I-IV) had hormone receptor testing, and 53.1% and 50.2% (stage I-III) received adjuvant hormonal therapy and chemotherapy, respectively. After adjustment, black (vs white) women had less definitive locoregional therapy (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.88-0.94), hormonal therapy (OR, 0.90; 95% CI, 0.87-0.93), and chemotherapy (OR, 0.87; 95% CI, 0.84-0.91). Hispanic (vs white) women were also less likely to receive hormonal therapy. Hormone receptor testing did not differ by race/ethnicity. Racial disparities persisted despite adjusting for insurance and SES. CONCLUSIONS The modest association between black (vs white) race and guideline-recommended breast cancer care was insensitive to adjustment for insurance and area-level SES. Further study is required to better understand disparities and to ensure receipt of care.
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Affiliation(s)
- Rachel A Freedman
- Harvard Medical School, Dana Farber Cancer Institute, Boston, Massachusetts 02115, USA.
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Treatment disparities following the diagnosis of an astrocytoma. J Neurooncol 2010; 101:67-74. [PMID: 20495849 DOI: 10.1007/s11060-010-0223-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Accepted: 05/04/2010] [Indexed: 10/19/2022]
Abstract
Post-operative radiation and chemotherapy following diagnosis of astrocytoma are standard care. No research has examined racial or insurance-based disparities in treatment receipt. The purpose of this study was to evaluate whether African Americans and patients with dual eligibility in Medicare and Medicaid (DE), compared to Caucasians and patients with Medicare alone, experienced differences in (1) seeing a radiation oncologist, (2) receiving radiation or chemotherapy, and (3) overall survival. Using a retrospective descriptive design, statewide Medicaid and Medicare data were merged with the Michigan Tumor Registry to extract a sample of patients (n = 604) ≥ 65 years old with a first primary astrocytoma diagnosis in Michigan between 1996 and 2000. There were no racial or insurance-based differences in reporting a claim for a radiation oncologist. Controlling for age, income, surgical intervention, residence population, comorbidities, gender, and stage, African Americans were less likely to report radiation claims than Caucasians (OR = 0.20; 95% CI = 0.07-0.54). DE patients were less likely to report radiation claims (OR = 0.50; 95% CI = 0.26-0.94) than those with Medicare only. These differences were not seen with chemotherapy. When only those with a glioblastoma multiforme were examined, DE patients (OR = 0.47; 95% CI = 0.24-0.92) and African Americans (OR = 0.13; 95% CI = 0.04-0.44) were much less likely to report radiation claims. Race and insurance status did not significantly affect survival, although income did. Data suggest disparities in race and insurance status may exist in receiving standard of care for astrocytomas. Further research is warranted to replicate the data and determine potential sources for these disparities.
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Ashing-Giwa KT, Lim JW. Predicting physical quality of life among a multiethnic sample of breast cancer survivors. Qual Life Res 2010; 19:789-802. [DOI: 10.1007/s11136-010-9642-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2010] [Indexed: 12/24/2022]
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Dhand A, Dhaliwal G. Examining patient conceptions: a case of metastatic breast cancer in an African American male to female transgender patient. J Gen Intern Med 2010; 25:158-61. [PMID: 19898907 PMCID: PMC2837485 DOI: 10.1007/s11606-009-1159-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 08/10/2009] [Accepted: 09/26/2009] [Indexed: 10/27/2022]
Abstract
An African American male to female transgender patient treated with estrogen detected a breast lump that was confirmed by her primary care provider. The patient refused mammography and 14 months later she was diagnosed with metastatic breast cancer with spinal cord compression. We used ethnographic interviews and observations to elicit the patient's conceptions of her illness and actions. The patient identified herself as biologically male and socially female; she thought that the former protected her against breast cancer; she had fears that excision would make a breast tumor spread; and she believed injectable estrogens were less likely than oral estrogens to cause cancer. Analysis suggests dissociation between the patient's social and biological identities, fear and fatalism around cancer screening, and legitimization of injectable hormones. This case emphasizes the importance of eliciting and interpreting a patient's conceptions of health and illness when discordant understandings develop between patient and physician.
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Affiliation(s)
- Amar Dhand
- Department of Neurology, University of California San Francisco, San Francisco, CA USA
| | - Gurpreet Dhaliwal
- Department of Medicine, San Francisco Veterans Affairs Medical Center and University of California San Francisco, San Francisco, CA USA
- Medical Service (111), San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121 USA
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Trends in Disparities in Receipt of Adjuvant Therapy for Elderly Stage III Colon Cancer Patients. Med Care 2009; 47:1229-36. [DOI: 10.1097/mlr.0b013e3181b58a85] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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