Racial and ethnic differences in patient perceptions of bias and cultural competence in health care

Implicit Race Bias in Pediatric Patients: Understanding Patient Perspectives

INTRODUCTION

Implicit racial bias has been well studied in adults, including among orthopaedic surgeons, through the Implicit Association Test (IAT). Recent studies suggest implicit race bias is also present among children. Explicit racial preference has been studied in children through The Clark Doll Test since the 1930s. The purpose of this study was to determine whether implicit and explicit racial biases are present among pediatric orthopaedic patients.

METHODS

A prospective, cross-sectional survey was administered to pediatric orthopaedic patients aged 7 to 18 years at clinics in a tertiary pediatric hospital setting. The survey included a Clark Doll Test to determine whether pediatric patients expressed explicit bias, followed by a race IAT to determine whether pediatric patients expressed implicit bias. Preference and magnitude of implicit bias as demonstrated on the IAT was calculated using standard D-scores.

RESULTS

A total of 96 patients were consented and included in this study. Overall, pediatric patients demonstrated a slight pro-White implicit bias (M = 0.22) on IAT testing. Pediatric patients who identified as White or European American and Hispanic or Latinx both had the strongest pro-White implicit bias (M = 0.35). Patients who identified as Black or African American demonstrated no implicit racial bias (M = -0.13) on IAT testing. No notable explicit bias was observed in participants of any racial background.

DISCUSSION

This study contributes evidence that pediatric orthopaedic patients express implicit racial bias on IAT testing, with an overall slight pro-White bias. It also provides insight into the dissociation of implicit and explicit racial bias in childhood and adolescence.

CONCLUSION

We encourage future research on implicit bias among pediatric patients in the orthopaedic community to provide a better understanding and possible solutions to bias-related challenges in health care.

Racial equity in and through medical interaction scholarship: A scoping review

OBJECTIVE

We conducted a systematic scoping review to characterize the landscape of communication scholarship within racial health equity in and through the patient-provider interaction.

METHODS

We employed three waves of data collection to identify relevant articles (N = 454) about racial equity within provider-patient interactions. We iteratively developed a codebook concerning article characteristics, coding for journal names, data source, descriptive characteristics for the study samples, and presence of theory and equity in sections of the manuscripts.

RESULTS

This search identified studies (N = 206) that were published in 76 peer-reviewed scientific journals. The majority of studies reported primary data analyses and used survey and interview methodology. Many studies examined participants as patients generally rather than in reference to particular health conditions. Among those with a specific health condition, the largest proportion focused on cancer control. Very few studies included samples with Native American and Pacific Island heritage. Most studies included cisgender men and/or women, but none included transgender men or women. The vast majority of research focused on the patient experience; few centered on providers' and caregivers' experiences. The body of scholarship was largely atheoretical; the most frequently noted constructs were patient-provider communication (including patient-centered communication and patient-centered care), implicit/explicit racial bias, shared decision-making. There was wide variation in the extent to which equity was woven through the manuscripts. Equity is typically mentioned in the literature review, and racial identity in the sample may serve as a marker of racialized experiences.

CONCLUSION

This study demonstrates the need for the development of theory that elevates the centrality of health equity to attend to the bi- or multi-directional flow of communication that shapes the quality of these interactions.

PRACTICE IMPLICATIONS

These insights can serve as a strong foundation for the development of interventions to address equity in clinical interactions.

Uncovering Structurally Differential Care: Pediatric Oncology Nurses' Perspectives Caring for African American Families

BACKGROUND

Psychosocial intervention studies aimed at reducing stress among parents of children with cancer have historically included insufficient samples of African American parents. Pediatric oncology nurses are uniquely positioned to identify and address parent psychosocial needs. However, research exploring their perspectives to serve as psychosocial interventionists specifically for African American families of children with cancer is limited.

OBJECTIVE

To explore the perspectives of pediatric oncology nurses on their role as psychosocial interventionists for African American families navigating childhood cancer.

METHODS

We conducted 32 remote individual interviews and 2 focus groups (n = 4 each) with 40 pediatric oncology nurses from three pediatric cancer centers and a large pediatric oncology nursing organization. Using Corbin and Strauss' Grounded Theory methodology, we used constant comparative analysis to generate a theory based on the nurses' perspectives.

RESULTS

Our emergent theory-Structurally Differential Care-had two major themes (psychosocial resource facilitators and psychosocial resource obstructors). Psychosocial resource facilitators: 1) appreciating families' experiences, 2) longitudinal presence, 3) open communication, 4) holistic care, and 5) safe spaces mitigated structurally differential care. Nurses also identified: 1) difficulty with serious illness conversation, 2) lack of nursing experience, and 3) competing work demands as psychosocial resource obstructors that intensify structurally differential care.

CONCLUSION

This sample of pediatric oncology nurses described experiences that either bolstered or obstructed their psychosocial care provision, signaling potential opportunities for nurse-targeted interventions that may reduce factors contributing to disparities in the psychosocial care for African American families of children with cancer.

Communication strategies to enhance organ donation requests across cultures: a review of the literature

BACKGROUND

Requesting consent for deceased organ donation is a uniquely challenging communication that has profound consequences at the individual and population level. Communication between requesters and family decision-makers who come from different cultures must be better understood. This review aims to identify communication variables that influence consent for organ donation in cross-cultural requests, with a goal of enhancing end-of - life experiences for families and increasing access to life-saving transplants.

METHODS

We conducted a MEDLINE search of English language studies from 1996-September 2022. Inclusion criteria required that studies examine in-person requests for deceased organ donation and include both cross-cultural and interpersonal factors in the study analysis. 427 titles and abstracts were assessed by author-pairs, followed by 46 full text reviews.

RESULTS

Nine studies met inclusion criteria. Study locations included the United States (5), Israel (2), and Australia (2). Communication variables were grouped into three domains: pre-request, family approach, and request. The main outcome was likelihood of family authorization. Foreign birth and language and high religiosity were associated with lower likelihood of family approach and consent. Interpreter use was negatively associated with authorization, as was lower family satisfaction of interactions with medical staff. Perceptions of family willingness to donate and communication practices of requesters differed by family race. Family ratings of requester communication skills were less favorable in racially discordant requests.

CONCLUSIONS

A small number of international quantitative studies assess the effect of cross-cultural communication on organ donation requests. Findings indicate a significant impact on the experience of family decision-makers and suggest an overall negative association with consent. Strategies to alleviate barriers to communication in cross-cultural requests are suggested along with areas for future research.

Eating disorder treatment experiences among racially/ethnically minoritized samples

Although eating disorders (EDs) affect individuals of all races and ethnicities, racially/ethnically minoritized individuals are less likely to receive ED treatment than White individuals. The present study aimed to compare ED treatment experiences in a sample of racially/ethnically minoritized individuals vs. White participants. As a secondary aim, we explored how acculturation and mental health stigma factors were associated with treatment experiences. We recruited 41 White and 27 racially/ethnically minoritized individuals with a history of EDs (with all racially/ethnically minoritized individuals having to be categorized into one group due to limited power to conduct analyses across groups). Participants completed an assessment of their treatment experiences, ratings of the helpfulness of each treatment, self-reported barriers to treatments, their level of acculturation, and their tolerance towards stigma. We found that racially/ethnically minoritized participants reported receiving a significantly lower total number of ED treatments than White participants. Second, racially/ethnically minoritized participants were significantly less likely to seek out inpatient and day treatment/partial hospitalization than White participants. Third, racially/ethnically minoritized rated nutritionists and residential treatment as significantly less helpful than White participants. Fourth, racially/ethnically minoritized participants identified the lack of cultural competence among providers as a significantly more substantial barrier to treatment than White participants. Finally, among racially/ethnically minoritized participants, higher immersion in dominant society correlated positively with perceived helpfulness of ED treatment. These insights can guide the development of targeted interventions aimed at mitigating treatment barriers and enhancing treatment outcomes for racially/ethnically minoritized individuals affected by EDs.

Ethnic identity commitment as a moderator for perceived access to health care among Latinx sexual minority men

OBJECTIVE

Gay, bisexual, and other sexual minority men (SMM) face more barriers to accessing health care compared to other men. In comparison to other SMM populations, Latinx SMM (LSMM) report having less access to health care. The purpose of the present study is to elucidate how theorized environmental-societal-level (i.e., immigration status, education level, and income level), community-interpersonal-level (i.e., social support and neighborhood collective efficacy [NCE]), and social-cognitive-behavioral-level factors (i.e., age, heterosexual self-presentation [HSP], sexual identity commitment, sexual identity exploration [SIE], and ethnic identity commitment [EIC]) may relate with perceived access to health care (PATHC) in a sample of 478 LSMM.

METHOD

We conducted a hierarchical regression analysis examining the hypothesized predictors of PATHC, as well as EIC as a moderator of the direct association between predictors and PATHC. We hypothesized that Latinx EIC would moderate relations between the aforementioned multilevel factors and PATHC.

RESULTS

LSMM perceived greater access to care when indicating the following: higher education level, more NCE, more HSP, more SIE, and more EIC. Latinx EIC acted as a moderator of four predictors of PATHC, including education, NCE, HSP, and SIE.

CONCLUSIONS

Findings inform outreach interventions of researchers and health care providers about psychosocial and cultural barriers and facilitators of health care access. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Evaluating Patient Experiences with Patient-Centered and Inclusive Care in Academic Obstetrics and Gynecology Outpatient Clinics

Ensuring patient satisfaction is crucial in obstetrics and gynecology (OB/GYN) care. This study aimed to assess patient satisfaction and experiences with respectful and culturally competent care in an institution's OB/GYN clinics following the initiation of diversity, equity, and inclusion programming. A survey was conducted from September 2021 to February 2022 among patients who had completed outpatient OB/GYN visits, focusing on staff and provider cultural competency, treatment discussion, clinic accommodations, and comfort during sensitive exams. Results from 246 participants indicated that most had positive interactions with clinic staff and healthcare providers. However, disparities emerged, with black or African American participants reporting lower satisfaction and a higher incidence of unfair treatment due to race. These findings highlight the need for additional educational endeavors to equip clinical care teams with skills for providing respectful, inclusive, and culturally competent care. Future qualitative research can further explore patient experiences with inclusive practices in OB/GYN care.

Equity in Pediatric Hospital-Based Safety and Quality Improvement

There are well-documented inequities in the quality of care and health outcomes of minoritized youth. Patient safety and quality improvement (QI) work with an equity focus has been identified as an important strategy to remedy these existing inequities. In this article, we will present evidence of inequities in pediatric hospital-based care, describe root causes with a focus on structural racism, highlight existing frameworks for applying equity principles to patient safety and QI, and provide best practices and recommendations on evaluating patient safety and QI data towards advancing equity in pediatric hospital-based care.

Healthcare Experiences Are Associated with Colorectal Cancer Mortality but only for Specific Racial Groups: a SEER-CAHPS Study

BACKGROUND

The objective of this study was to determine whether racial/ethnic disparities exist in patient-reported experiences with care after colorectal cancer diagnosis and whether they are associated with mortality.

METHODS

We conducted a retrospective cohort study of colorectal cancer patients diagnosed from 1997 to 2011, ≥ 65 years, and completed a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey at least 6 months after a cancer diagnosis. We leverage the National Cancer Institute's SEER-CAHPS dataset of Medicare beneficiaries. CAHPS survey responses were used to generate four composite measures of patient experiences with 1) getting needed care, 2) getting needed prescription drugs, 3) getting care quickly, and 4) physician communication. We used multivariable linear regression models to examine racial differences in patient experiences with aspects of their care and multivariable Cox proportional hazards models to identify the risk of mortality associated with each composite score by racial group.

RESULTS

Of the 5135 patients, 76.86% were non-Hispanic White, 7.58% non-Hispanic Black, 8.30% Hispanic, and 7.26% non-Hispanic Asian. Overall, patients reported the highest scores for composite measures regarding "getting all needed prescriptions" and the lowest score for "getting care quickly." In our adjusted models, we found that Hispanics, non-Hispanic Black, and non-Hispanic Asian patients reported significantly lower scores for getting needed prescription drugs (B = - 4.34, B = - 4.32, B = - 5.66; all p < 0.001) compared to non-Hispanic Whites. Moreover, non-Hispanic Black patients also reported lower scores for getting care quickly (B = - 3.44, p < 0.05). We only found one statistically significant association between composite scores of patient experience and mortality. For non-Hispanic Black patients, a 3-unit increase in getting needed care was associated with 0.97 times the hazard of mortality (p = 0.003).

CONCLUSION

Our research underscores that CAHPS patient experiences with care are an important patient-centered quality-of-care metric that may be associated with cancer outcomes and that there may be differences in these relationships by race and ethnicity. Thus, highlighting how patients' perceptions of their healthcare experiences can contribute to disparities in colorectal cancer outcomes.

Applying the Multicultural Orientation in Cancer Care for Sexual and Gender Minority Cancer Survivors: A Cross-Sectional Correlational Study

Purpose: Sexual and gender minority (SGM) cancer survivors report unique needs that are not met by some providers. The multicultural orientation (MCO) holds promise for creating a paradigm shift in providing affirmative cancer care, yet has not been tested empirically. This study examines the predictive strength of MCO's tenets of cultural humility and cultural opportunities for SGM cancer patient-provider relationships. Methods: In this cross-sectional study, 108 SGM cancer survivors completed surveys on perceptions of their oncology providers' cultural humility and actualization of cultural opportunities as predictors of survivors' treatment adherence and the patient-provider alliance. Hierarchical regression analyses were conducted. Results: Average participant age was 50 years (standard deviation = 15 years). Over 10 cancer types were represented and 69% of participants were in active treatment, with the remaining 31% receiving follow-up care. Age at diagnosis and not being in active treatment positively correlated with perceptions of providers' cultural humility, patient-provider alliance, and treatment adherence. Regression models explained 38% and 61%, respectively, of the variance in treatment adherence and patient-provider alliance, with cultural humility remaining a significant predictor in both models after accounting for all other variables. Conclusion: Providers' cultural humility and navigation of cultural opportunities in incorporating their patients' salient cultural identities into cancer care are strongly associated with how supported SGM cancer survivors feel by their oncology providers. The MCO is a useful framework for identifying important dimensions in SGM affirmative cancer care.

The patient perspective on diversity-sensitive care: a systematic review

BACKGROUND

The provision of diversity-sensitive care is a promising approach towards reducing health disparities. Recent criticism and a scientific gap demonstrate the need for the patient perspective on diversity-sensitive care. This systematic review aims to describe the patient perspective, including patient experiences, expectations, and satisfaction with diversity-sensitive care provided by healthcare providers.

METHODS

In December 2022 the Medline ALL, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO and additionally Google Scholar were searched for original studies that described or measured patient expectations, experiences, and/or satisfaction, specifically focusing on cultural or diversity competence of healthcare providers. Analysis of the collected data was performed using a convergent mixed-methods design based on thematic synthesis.

RESULTS

From initially 5,387 articles, 117 were selected for full-text screening, and ultimately, 34 articles were included in this study. The concept of diversity-sensitive care was observed to comprise three components. The first component is focused on patient-centered care and includes competencies such as clear and direct communication, shared decision-making, individualized care, empathy, and consideration. The second component centers on providing culturally tailored information, adjusting care to cultural needs, working with interpreters, allyship, community partnerships, self-awareness, and cultural knowledge, and builds upon the first component. Across the first two components of diversity-sensitive care, patients have reported experiencing dissatisfaction and encountering shortcomings in their healthcare providers, sometimes resulting in the third and final component pertaining to provider care. This component underscores the importance of linguistic, ethnic, cultural, and gender concordance in delivering quality care.

CONCLUSION

In conclusion, the patient perspective on diversity-sensitive care encompasses multiple components, from patient-centered care to concordant care. The components incorporate various competencies as communication skills, empathy, self-awareness and adjusting care to cultural needs. Patients reported experiencing dissatisfaction and shortcomings across all components of diversity-sensitive care provided by healthcare providers.

Disparities by Race/Ethnicity and Immigration Status in Perceived Importance of and Access to Culturally Competent Health Care in the United States

While cultural competence has been proposed as an important framework for enhancing health care equity, how members of different racial/ethnic groups consider the importance of cultural competence and their access to culturally competent health care are insufficiently understood. Despite continuously increasing immigrants into the US, it is unclear how immigration status intersects with race/ethnicity to shape individuals' perception of and access to culturally competent care in the US health care system. To fill this research gap, this study examined how the intersection of race/ethnicity and immigration status is associated with people's perception of and access to culturally competent health care and among immigrants, whether their length of stay matters, using data from the 2017 National Health Interview Survey. The results show that while racial and ethnic minority members reported greater importance of culturally competent care than non-Hispanic whites, Asian, black and other-race immigrants reported even greater importance than their US-born counterparts. Additionally, although racial/ethnic minorities reported greater limited access to culturally competent care than their white peers, this gap in access was observed primarily among US-born racial/ethnic minorities. Shorter length of residence (fewer than 15 years) was associated with greater perceived importance than residence of at least 15 years among immigrants, but access to culturally competent care did not differ by length of residence. The findings speak to racial/ethnic minorities' greater desire for culturally competent care and their unmet needs.

Relationships among race, ethnicity, and gender and whole health among U.S. veterans

Racial, ethnic, and gender health care disparities in the United States are well-documented and stretch across the lifespan. Even in large integrated health care systems such as Veteran Health Administration, which are designed to provide equality in care, social and economic disparities persist, and limit patients' achievement of health goals across multiple domains. We explore Veterans' Whole Health priorities among Veteran demographic groups. Participants who were enrolling in Veteran Health Administration provided demographics and Whole Health priorities using eScreening, a web-based self-assessment tool. Veterans had similar health care goals regardless of demographic characteristics but differences were noted in current health appraisals. Non-White and women Veterans reported worse health-relevant functioning. Black Veterans were more likely to endorse a low rating for their personal development/relationships. Multiracial Veterans were more likely to endorse a low rating of their surroundings. Asian Veterans were less likely to provide a high rating of their surroundings. Women Veterans reported lower appraisals for body and personal development but higher appraisals of professional care. Results indicated that demographic factors such as race and gender, and to a lesser extent ethnicity, were associated with health disparities. The Whole Health model provides a holistic framework for addressing these disparities. These findings may inform more culturally sensitive care and enhance Veteran Health Administration equal access initiatives. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Who should decide how limited healthcare resources are prioritized? Autonomous technology as a compelling alternative to humans

Who should decide how limited resources are prioritized? We ask this question in a healthcare context where patients must be prioritized according to their need and where advances in autonomous artificial intelligence-based technology offer a compelling alternative to decisions by humans. Qualitative (Study 1a; N = 50) and quantitative (Study 1b; N = 800) analysis identified agency, emotional experience, bias-free, and error-free as four main qualities describing people's perceptions of autonomous computer programs (ACPs) and human staff members (HSMs). Yet, the qualities were not perceived to be possessed equally by HSMs and ACPs. HSMs were endorsed with human qualities of agency and emotional experience, whereas ACPs were perceived as more capable than HSMs of bias- and error-free decision-making. Consequently, better than average (Study 2; N = 371), or relatively better (Studies 3, N = 181; & 4, N = 378), ACP performance, especially on qualities characteristic of ACPs, was sufficient to reverse preferences to favor ACPs over HSMs as the decision makers for how limited healthcare resources should be prioritized. Our findings serve a practical purpose regarding potential barriers to public acceptance of technology, and have theoretical value for our understanding of perceptions of autonomous technologies.

Parent Perceptions of Trainees in Pediatric Care: Cross-Sectional Study

BACKGROUND

Clinical experience and progressive autonomy are essential components of medical education and must be balanced with patient comfort. While previous studies have suggested that most patients accept trainee involvement in their care, few studies have focused specifically on the views of parents of pediatric patients or examined groups who may not report acceptance.

OBJECTIVE

This study aims to understand parental profiles of resident and medical student involvement in pediatric care and to use latent class analysis (LCA) methodology to identify classes of responses associated with parent demographic characteristics.

METHODS

We used data from a national cross-sectional web-based survey of 3000 parents. The survey used a 5-point Likert scale to assess 8 measures of parent perceptions of residents and medical students. We included participants who indicated prior experience with residents or medical students. We compared responses about resident involvement in pediatric care with responses about student involvement, used LCA to identify latent classes of parent responses, and compared demographic features between the latent classes.

RESULTS

Of the 3000 parents who completed the survey, 1543 met the inclusion criteria for our study. Participants reported higher mean scores for residents than for medical students for perceived quality of care, comfort with autonomously performing an examination, and comfort with autonomously giving medical advice. LCA identified 3 latent classes of parent responses: Trainee-Hesitant, Trainee-Neutral, and Trainee-Supportive. Compared with the Trainee-Supportive and Trainee-Neutral classes, the Trainee-Hesitant class had significantly more members reporting age <30 years, household income < US $50,000, no college degree, and lesser desire to receive future care at a teaching hospital (all P<.05).

CONCLUSIONS

Parents may prefer greater clinical autonomy for residents than medical students. Importantly, views associated with the Trainee-Hesitant class may be held disproportionately by members of historically and currently socially marginalized demographic groups. Future studies should investigate underlying reasons for trainee hesitancy in these groups, including the possibility of mistrust in medicine.

Understanding the experiences of Black Nova Scotians with community pharmacists

Background

A history of medical abuse and social inequality confounded by persistent racial discrimination in health care has triggered mistrust between Black patients and health care providers. Although the consequences of systemic racism on health outcomes are well understood, little is known about how they manifest in pharmacy practice. The objective of this study was to explore the experiences of Black Nova Scotians with community pharmacists.

Methods

This was a qualitative study that used focus groups and one-on-one interviews. Black Nova Scotians 18 years of age and older who have had interactions with community pharmacists were invited to participate. Focus groups and interviews were audio-recorded, transcribed and analyzed thematically.

Results

Two focus groups (n = 10) and 6 one-on-one interviews were held between May and June 2021. Three major themes were identified: 1) difficulties navigating a pharmacy as a Black person, 2) lack of inclusivity and cultural competence in the pharmacy and 3) transactional relationships with pharmacists.

Discussion

Most participants felt their race negatively affected the quality of care they received from the pharmacist and that pharmacists were not culturally competent. Most participants did not consider pharmacists to be part of their health care team and described feeling unsafe or uncomfortable in the pharmacy.

Conclusions

Pharmacists have an important role in closing the health equity gap. This research highlights the need for pharmacy education to include cultural competence and will be used to guide strategies to improve access to culturally safe pharmacy services for Black Nova Scotians.

Providing culturally responsive care in a pediatric setting: are our trainees ready?

BACKGROUND

Extensive data consistently demonstrates inequities in access and delivery of healthcare for patients from historically marginalized populations, resulting in poorer health outcomes. To address this systemic oppression in healthcare, it is necessary to embed principles of equity, diversity, and inclusion (EDI) at an early stage within medical education. This study aimed to assess pediatric trainees' perceived interest in EDI curricula as well as their confidence in applying this knowledge to provide culturally responsive care.

METHODS

An anonymous online survey was distributed to pediatric trainees at the University of Toronto. Closed-ended questions used a Likert scale to assess respondents' confidence and interest in providing culturally responsive care to patients. Open-ended questions explored trainees' perceptions of effective EDI learning modalities. A mixed methods approach was utilized, where quantitative data was summarized using descriptive statistics and descriptive content analysis was used to highlight themes within qualitative data.

RESULTS

116 pediatric trainees completed the survey, of which 72/116 (62%) were subspecialty residents/fellows and 44/116 (38%) were core residents. 97% of all responses agreed or strongly agreed that it was important to learn about providing culturally responsive care to patients from historically marginalized communities; however, many trainees lacked confidence in their knowledge of providing culturally responsive care (42%) and applying their knowledge in clinical practice (47%). Respondents identified direct clinical exposure through rotations, immersive experiences, and continuity clinics as effective EDI teaching modalities. Identified barriers included time constraints in the clinical environment, burnout, and lack of exposure to diverse patient populations.

CONCLUSION

Most pediatric trainees want to provide culturally responsive care to patients from historically marginalized communities, but do not feel confident in their knowledge to do so. Trainees value learning about EDI through direct clinical exposure and immersive experiences, rather than didactic lectures or modules. These study findings will be utilized to develop and implement an enhanced EDI education curriculum for pediatric trainees at the University of Toronto and other postgraduate residency programs.

Veterans' views of PARTNER-MH, a peer-led patient navigation intervention, to improve patient engagement in care and patient-clinician communication: A qualitative study

OBJECTIVE

In this study, we report on participants' experiences of PARTNER-MH, a peer-led, patient-navigation intervention for racially and ethnically minoritized patients in Veterans Health Administration mental health services aimed at improving patient engagement in care and patient-clinician communication. Participants described their views of PARTNER-MH, barriers and facilitators to the intervention's implementation, and their application of varied intervention concepts to improve engagement in care and communication with their mental health clinicians.

METHODS

This is a qualitative analysis of the PARTNER-MH pilot randomized controlled trial. Participants participated in semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR). Rapid data analysis approach was used to analyze the data.

RESULTS

Participants (n = 13) perceived PARTNER-MH as an acceptable intervention, and viewed use of peers as interventionists, long-term outreach and engagement efforts, and navigation services favorably. Barriers to implementation included limited flexibility in peers' schedules and lack of peer/participant gender concordance, as well as limited options for program delivery modality. Three main themes summarized participants' views and perceived benefits of PARTNER-MH that contributed to improved patient-clinician communication: 1) increased patient engagement, 2) improved patient-clinician relationship, and 3) enhanced communication self-efficacy.

CONCLUSIONS

Participants viewed PARTNER-MH as beneficial and identified several intervention components that contributed to improved engagement in care, communication self-efficacy, and patient-clinician communication.

PRACTICE IMPLICATION

Some patients, especially minoritized patients and those who have been disenfranchised from healthcare systems may benefit from peer-led interventions that facilitate engagement in care and communication self-efficacy to improve patient-clinician communication and healthcare outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04515771.

Addressing chronic pain disparities between Black and White people: a narrative review of socio-ecological determinants

A 2019 review article modified the socio-ecological model to contextualize pain disparities among different ethnoracial groups; however, the broad scope of this 2019 review necessitates deeper socio-ecological inspection of pain within each ethnoracial group. In this narrative review, we expanded upon this 2019 article by adopting inclusion criteria that would capture a more nuanced spectrum of socio-ecological findings on chronic pain within the Black community. Our search yielded a large, rich body of literature composed of 174 articles that shed further socio-ecological light on how chronic pain within the Black community is influenced by implicit bias among providers, psychological and physical comorbidities, experiences of societal and institutional racism and biomedical distrust, and the interplay among these factors. Moving forward, research and public-policy development must carefully take into account these socio-ecological factors before scaling up pre-existing solutions with questionable benefit for the chronic pain needs of Black individuals.

Understanding the Role of Urology Practice Organization and Racial Composition in Prostate Cancer Treatment Disparities

PURPOSE

Black men have a higher risk of prostate cancer diagnosis and mortality but are less likely to receive definitive treatment. The impact of structural aspects on treatment is unknown but may lead to actionable insights to mitigate disparities. We sought to examine the associations between urology practice organization and racial composition and treatment patterns for Medicare beneficiaries with incident prostate cancer.

METHODS

Using a 20% sample of national Medicare data, we identified beneficiaries diagnosed with prostate cancer between January 2010 and December 2015 and followed them through 2016. We linked urologists to their practices with tax identification numbers. We then linked patients to practices on the basis of their primary urologist. We grouped practices into quartiles on the basis of their proportion of Black patients. We used multilevel mixed-effects models to identify treatment associations.

RESULTS

We identified 54,443 patients with incident prostate cancer associated with 4,194 practices. Most patients were White (87%), and 9% were Black. We found wide variation in racial practice composition and practice segregation. Patients in practices with the highest proportion of Black patients had the lowest socioeconomic status (43.1%), highest comorbidity (9.9% with comorbidity score ≥ 3), and earlier age at prostate cancer diagnosis (33.5% age 66-69 years; P < .01). Black patients had lower odds of definitive therapy (adjusted odds ratio, 0.87; 95% CI, 0.81 to 0.93) and underwent less treatment than White patients in every practice context. Black patients in practices with higher proportions of Black patients had higher treatment rates than Black patients in practices with lower proportions. Black patients had lower predicted probability of treatment (66%) than White patients (69%; P < .05).

CONCLUSION

Despite Medicare coverage, we found less definitive treatment among Black beneficiaries consistent with ongoing prostate cancer treatment disparities. Our findings are reflective of the adverse effects of practice segregation and structural racism, highlighting the need for multilevel interventions.

Health disparities in pediatric sleep-disordered breathing

Sleep-disordered breathing reflects a continuum of overnight breathing difficulties, ranging from mild snoring to obstructive sleep apnea syndrome. Sleep-disordered breathing in childhood is associated with significant adverse outcomes in multiple domains of functioning. This review summarizes the evidence of well-described ethnic, racial, and socioeconomic disparities in pediatric sleep-disordered breathing, from its prevalence to its treatment-related outcomes. Research on potential socio-ecological contributors to these disparities is also reviewed. Critical future research directions include the development of interventions that address the modifiable social and environmental determinants of these health disparities.

An exploratory qualitative study of pharmacy student perspectives of implicit bias in pharmacy practice

INTRODUCTION

Implicit biases can contribute to unfair treatment in healthcare and exacerbate healthcare disparities. Little is known about the implicit biases that exist within pharmacy practice and their behavioral manifestations. The purpose of this study was to explore pharmacy student perspectives about implicit bias in pharmacy practice.

METHODS

Sixty-two second-year pharmacy students attended a lecture on implicit bias in healthcare and engaged in an assignment designed to explore their thoughts about how implicit bias manifests or may manifest within pharmacy practice. Students' qualitative responses were content analyzed.

RESULTS

Students reported several examples in which implicit bias may emerge in pharmacy practice. Various forms of potential bias were identified including bias associated with patients' race, ethnicity, and culture, insurance/financial status, weight, age, religion, physical appearance and language, lesbian, gay, bisexual, transgender, queer/questioning and gender identity, and prescriptions filled. Students identified several potential implications of implicit bias in pharmacy practice including unwelcoming non-verbal behavior on the part of providers, differences in time devoted to interacting with patients, differences in empathy and respect, inadequate counseling, and (un)willingness to provide services. Students also identified factors that could precipitate biased behaviors such as fatigue, stress, burnout, and multiple demands.

CONCLUSIONS

Pharmacy students believed that implicit biases manifested in many different ways and were potentially associated with behaviors that resulted in unequal treatment in pharmacy practice. Future studies should explore the effectiveness of implicit bias trainings on reducing the behavioral implications of bias in pharmacy practice.

Community-Level Characteristics of Timely PCP Follow-Up Care and Post-Discharge ER Usage

Achieving equitable access has been a central goal in healthcare for years; access by low-income Americans is a major concern for policymakers. We examined the differences in post-discharge primary care follow-up visits and 30-day post discharge ER visits across several characteristics. The results suggest that higher housing density, percent minority population, percent unemployed, and percent uninsured point to lower rates of PCP follow-up care and higher rates of post-discharge ER visits. These findings have implications for developing cost-effective programs targeting hospital to PCP communication, especially in densely populated areas.

Racial and Ethnic Differences in Communication Quality During Family-Centered Rounds

OBJECTIVES

To evaluate racial and ethnic differences in communication quality during family centered rounds.

METHODS

We conducted an observational study of family-centered rounds on hospital day 1. All enrolled caregivers completed a survey following rounds and a subset consented to audio record their encounter with the medical team. We applied a priori defined codes to transcriptions of the audio-recorded encounters to assess objective communication quality, including medical team behaviors, caregiver participatory behaviors, and global communication scores. The surveys were designed to measure subjective communication quality. Incident Rate Ratios (IRR) were calculated with regression models to compare the relative mean number of behaviors per encounter time minute by race and ethnicity.

RESULTS

Overall, 202 of 341 eligible caregivers completed the survey, and 59 had accompanying audio- recorded rounds. We found racial and ethnic differences in participatory behaviors: English-speaking Latinx (IRR 0.5; 95% confidence interval [CI] 0.3-0.8) Black (IRR 0.6; 95% CI 0.4-0.8), and Spanish-speaking Latinx caregivers (IRR 0.3; 95% CI 0.2-0.5) participated less than white caregivers. Coder-rated global ratings of medical team respect and partnership were lower for Black and Spanish-speaking Latinx caregivers than white caregivers (respect 3.1 and 2.9 vs 3.6, P values .03 and .04, respectively: partnership 2.4 and 2.3 vs 3.1, P values .03 and .04 respectively). In surveys, Spanish-speaking caregivers reported lower subjective communication quality in several domains.

CONCLUSIONS

In this study, Black and Latinx caregivers were treated with less partnership and respect than white caregivers.

Association of Patient and Family Reports of Hospital Safety Climate With Language Proficiency in the US

IMPORTANCE

Patients with language barriers have a higher risk of experiencing hospital safety events. This study hypothesized that language barriers would be associated with poorer perceptions of hospital safety climate relating to communication openness.

OBJECTIVE

To examine disparities in reported hospital safety climate by language proficiency in a cohort of hospitalized children and their families.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study conducted from April 29, 2019, through March 1, 2020, included pediatric patients and parents or caregivers of hospitalized children at general and subspecialty units at 21 US hospitals. Randomly selected Arabic-, Chinese-, English-, and Spanish-speaking hospitalized patients and families were approached before hospital discharge and were included in the analysis if they provided both language proficiency and health literacy data. Participants self-rated language proficiency via surveys. Limited English proficiency was defined as an answer of anything other than "very well" to the question "how well do you speak English?"

MAIN OUTCOMES AND MEASURES

Primary outcomes were top-box (top most; eg, strongly agree) 5-point Likert scale ratings for 3 Children's Hospital Safety Climate Questionnaire communication openness items: (1) freely speaking up if you see something that may negatively affect care (top-box response: strongly agree), (2) questioning decisions or actions of health care providers (top-box response: strongly agree), and (3) being afraid to ask questions when something does not seem right (top-box response: strongly disagree [reverse-coded item]). Covariates included health literacy and sociodemographic characteristics. Logistic regression was used with generalized estimating equations to control for clustering by site to model associations between openness items and language proficiency, adjusting for health literacy and sociodemographic characteristics.

RESULTS

Of 813 patients, parents, and caregivers who were approached to participate in the study, 608 completed surveys (74.8% response rate). A total of 87.7% (533 of 608) of participants (434 [82.0%] female individuals) completed language proficiency and health literacy items and were included in the analyses; of these, 14.1% (75) had limited English proficiency. Participants with limited English proficiency had lower odds of freely speaking up if they see something that may negatively affect care (adjusted odds ratio [aOR], 0.26; 95% CI, 0.15-0.43), questioning decisions or actions of health care providers (aOR, 0.19; 95% CI, 0.09-0.41), and being unafraid to ask questions when something does not seem right (aOR, 0.44; 95% CI, 0.27-0.71). Individuals with limited health literacy (aOR, 0.66; 95% CI, 0.48-0.91) and a lower level of educational attainment (aOR, 0.59; 95% CI, 0.36-0.95) were also less likely to question decisions or actions.

CONCLUSIONS AND RELEVANCE

This cohort study found that limited English proficiency was associated with lower odds of speaking up, questioning decisions or actions of providers, and being unafraid to ask questions when something does not seem right. This disparity may contribute to higher hospital safety risk for patients with limited English proficiency. Dedicated efforts to improve communication with patients and families with limited English proficiency are necessary to improve hospital safety and reduce disparities.

Systematic review: sleep health in the US Latinx population

Sleep disturbances are a common and unmet health problem in Latinx. While Latinx report similar sleep disturbances as non-Hispanic Whites [NHW], Latinx suffer from these disturbances to a greater degree than their NHW counterparts. Sleep disturbances are associated with increased risk of chronic health conditions, which Latinx experience at high rates. Research also points to significant sleep differences within Latinx. Given that Latinx are a rapidly growing population in the United States, sleep disparities between Latinx and NHWs and sleep differences within Latinx warrant further investigation. While research on Latinx sleep is growing, the last narrative review on US Latinx sleep health was published by Loredo and colleagues in 2010. Our narrative review expands on Loredo et al.'s work, adding the literature on Latinx sleep published since 2010 (N = 70). A total of 78 peer-reviewed articles related to young to middle-aged (i.e., 18-65 years) healthy Latinx adult sleep were identified in three databases-PsycInfo, PubMed/Medline, and Web of Science. With the socioecological model as framework, this review (1) summarizes current evidence pertaining to sleep health in healthy, community dwelling, urban Latinx adults; (2) discusses measurement challenges related to investigating Latinx sleep disparities and differences; and (3) discusses potential contributors to Latinx sleep. The prevalence of short sleep duration, long sleep duration, and poor sleep quality is high among Latinx; there are differences by Latinx subgroup. Our review identifies several multi-level influences associated with poor sleep: SES, sexual minority status, racial discrimination, access to care, neighborhood environment, and shift work. N = 250/250.

Lung Cancer Mortality Racial/Ethnic Disparities in Patient Experiences with Care: a SEER-CAHPS Study

BACKGROUND

To determine whether there are racial/ethnic disparities in patient experiences with care among lung cancer survivors, whether they are associated with mortality.

METHODS

A retrospective cohort study of lung cancer survivors > 65 years old who completed a CAHPS survey > 6 months after the date of diagnosis. We used data from the SEER-Consumer Assessment of Healthcare Providers Systems (SEER-CAHPS®) database from 2000 to 2013 to assess racial/ethnic differences in patient experiences with care multivariable Cox proportional hazards models to assess the association between patient experience with care scores mortality in each racial/ethnic group.

RESULTS

Within our cohort of 2603 lung cancer patients, Hispanic patients reported lower adjusted mean score with their ability to get needed care compared to white patients (B: - 5.21, 95% CI: - 9.03, - 1.39). Asian patients reported lower adjusted mean scores with their ability to get care quickly (- 4.25 (- 8.19, - 0.31)), get needed care (- 7.06 (- 10.51, - 3.61)), get needed drugs (- 9.06 (- 13.04, - 5.08)). For Hispanic patients, a 1-unit score increase in their ability to get all needed care (HR: 1.02, 1.00-1.03) care coordination (1.06, 1.02-1.09) was associated with higher risk of mortality. Among black patients, a 1-unit score increase in their ability to get needed care (HR: 0.99, 95% CI 0.98-0.99) care coordination (0.97, 0.94-0.99) was associated with lower risk mortality.

CONCLUSIONS

There are racial/ethnic disparities in lung cancer patient experiences with care that may impact mortality. Patient experiences with care are important risk factors of mortality for certain racial/ethnic groups.

Triage Errors in Primary and Pre-Primary Care

Triage errors are a major concern in health care due to resulting harmful delays in treatments or inappropriate allocation of resources. With the increasing popularity of digital symptom checkers in pre–primary care settings, and amid claims that artificial intelligence outperforms doctors, the accuracy of triage by digital symptom checkers is ever more scrutinized. This paper examines the context and challenges of triage in primary care, pre–primary care, and emergency care, as well as reviews existing evidence on the prevalence of triage errors in all three settings. Implications for development, research, and practice are highlighted, and recommendations are made on how digital symptom checkers should be best positioned.

Nurses Cultural Competence in Southwest Ethiopia: A Cross-Sectional Study

Background

Diversity is a challenge and an opportunity, resulting in a change toward providing services suited to clients' cultural needs and desires. Nurses working with culturally diverse populations face unique challenges because of the coexistence of diverse cultural and ethnic societies. Hence, the study's purpose has been to evaluate the current state of cultural competence and the factors that influence it among nurses in Southwest Ethiopia.

Methods

From December 1 to December 30, 2021, nurses at eight public healthcare facilities in southwest Ethiopia were enrolled in a facility-based cross-sectional study. Participants were selected using a simple random sampling. A self-administered questionnaire was used to collect the data. Epi data 4.1 was used to enter the data, and SPSS version 26 was used for analysis. To identify factors associated with cultural competence, bivariate and multivariable linear regression analyses were performed. The significance level was set at p < 0.05.

Results

Two hundred thirty-seven nurses took part in the study, yielding an 86.1% response rate. The mean age was 28.83 years (standard deviation = ±5.48). The mean cultural competence score among healthcare professionals was 1.95 ± 0.32. Marital status (p < 0.05) and the use of healthcare interpreters (p < 0.05) were significantly associated with cultural competence.

Conclusion

Nurses had a low level of cultural competence. Cultural competence varies according to a number of factors, including marital status and the use of healthcare interpreters. Nurses are better suited to focus on the ethnic diversity of their patients, which necessitates the provision of cultural competence training for nurses.

Physicians' Speech Complexity and Interrupting Behavior in Pediatric Consultations

Pediatricians' communication behavior affects a variety of outcomes in both children and their parents. This study analyzes how speech complexity and interruptions as indicators of accommodative behaviors relate to parental recall of medical information and to their satisfaction with the medical encounter. We recruited 19 pediatricians and 68 parents at pediatric inpatient and outpatient consultations in two Swiss clinics. All medical interactions were videotaped and transcripts were analyzed to assess pediatricians' speech complexity and interrupting behavior was coded from the videos. At the end of the encounter, parents rated their satisfaction with the medical encounter and were probed regarding their recall of medical information. Our results show recall of medical information to be unrelated to pediatricians' speech complexity and negatively associated with their interrupting behavior for parents who report low positive mood. We also found less educated parents to report lower satisfaction when pediatricians employed more complex language. Furthermore, parental satisfaction was negatively associated with pediatricians' interrupting behavior, especially when displayed by male pediatricians. Overall, these findings suggest that pediatricians' speech complexity and interruptions indicate a nonaccommodative stance reducing advantageous parent outcomes.

Do Patients Continue to Use Video Visits? Factors Related to Continued Video Visit Use

Many studies have assessed the factors associated with overall video visit use during the COVID-19 pandemic, but little is known about who is most likely to continue to use video visits and why. The authors combined a survey with electronic health record data to identify factors affecting the continued use of video visit. In August 2020, a stratified random sample of 20,000 active patients from a large health care system were invited to complete an email survey on health care seeking preferences during the COVID. Weighted logistic regression models were applied, adjusting for sampling frame and response bias, to identify factors associated with video visit experience, and separately for preference of continued use of video visits. Actual video visit utilization was also estimated within 12 months after the survey. Three thousand three hundred fifty-one (17.2%) patients completed the survey. Of these, 1208 (36%) reported having at least 1 video visit in the past, lowest for African American (33%) and highest for Hispanic (41%). Of these, 38% would prefer a video visit in the future. The strongest predictors of future video visit use were comfort using video interactions (odds ratio [OR] = 5.30, 95% confidence interval [95% CI]: 3.57-7.85) and satisfaction with the overall quality (OR = 3.94, 95% CI: 2.66-5.86). Interestingly, despite a significantly higher satisfaction for Hispanic (40%-55%) and African American (40%-50%) compared with Asian (29%-39%), Hispanic (OR = 0.46, 95% CI: 0.12-0.88) and African American (OR = 0.54, 95% CI: 0.16-0.90) were less likely to prefer a future video visit. Disparity exists in the use of video visit. The association between patient satisfaction and continued video visit varies by race/ethnicity, which may change the future long-term video visit use among race/ethnicity groups.

Racial disparities in health care utilization, the affordable care act and racial concordance preference

The Affordable Care Act was implemented with the aim of increasing coverage and affordable access with hopes of improving health outcomes and reducing costs. Yet, disparities persist. Coverage and affordable access alone cannot explain the health care gap between racial/ethnic minorities and white patients. Instead, the focus has turned to other factors affecting utilization rates such as the patient-provider relationship. Data from nationally represented U.S. households in 2009-2017 were used to study the association between patient-provider social distance as measured by "racial/ethnic concordance" and health care utilization rates for periods covering pre- and post-ACA. Despite the reduction in financial barriers to health access with the implementation of the ACA, the correlation between racial/ethnic concordance and utilization remains positive and significant. The results suggest that while the ACA may have improved coverage and affordability, other dimensions of access, particularly acceptability, as measured by patient-provider clinical interaction experience, remains a factor in the decision to utilize care.

Hospital revisits after paediatric tonsillectomy: a cohort study

BACKGROUND

Tonsillectomy, with or without adenoidectomy, is the leading reason for paediatric unplanned hospital readmission, some of which are potentially avoidable. Reducing unplanned hospital revisits would improve patient safety and decrease use of healthcare resources. This study aimed to describe the incidence, timing and risk factors for any surgery-related hospital revisits (both emergency presentation and readmission) following paediatric tonsillectomy and adenotonsillectomy in a large state-wide cohort.

METHODS

We conducted a population-based cohort study using linked administrative datasets capturing all paediatric tonsillectomy and adenotonsillectomy surgeries performed between 2010 and 2015 in the state of Victoria, Australia. The primary outcome was presentation to the emergency department or hospital readmission within 30-day post-surgery.

RESULTS

Between 2010 and 2015, 46,583 patients underwent 47,054 surgeries. There was a total of 4758 emergency department presentations (10.11% total surgeries) and 2750 readmissions (5.84% total surgeries). Haemorrhage was the most common reason for both revisit types, associated with 33.02% of ED presentations (3.34% total surgeries) and 67.93% of readmissions (3.97% total surgeries). Day 5 post-surgery was the median revisit time for both ED presentations (IQR 3-7) and readmission (IQR 3-8). Predictors of revisit included older age, public and metropolitan hospitals and peri-operative complications during surgery.

CONCLUSIONS

Haemorrhage was the most common reason for both emergency department presentation and hospital readmission. The higher risk of revisits associated with older children, surgeries performed in public and metropolitan hospitals, and in patients experiencing peri-operative complications, suggest the need for improved education of postoperative care for caregivers, and avoidance of inappropriate early discharge.

The Stereotype Content Model as an Explanation of Biased Perceptions in a Medical Interaction: Implications for Patient-Provider Relationship

This experimental investigation uses the stereotype content model (SCM) to explain the biases associated with the perceptions of healthcare providers and the subsequent impact of such biased perceptions. Specifically, the 2 (gender: male, female) by 2 (race: Arab, Caucasian) between-subjects experiment examined the impact of physician race and gender on people's perceptions regarding physician's communication competence, trust, and intentions to visit. The findings indicate that female physicians are considered not only warmer but also more competent than male physicians. White physicians are considered less competent overall than their minority counterparts, though no differences in perceived patient-centered communication behaviors were observed. In addition, perceived competence and warmth mediated the effect of physician gender and race (only warmth) on the perceptions of trust, physician's use of patient-centered communication, and intentions to visit. The theoretical and practical implications of the study are discussed.

Perceptions of Respect From Clinicians by Patients in Racial and Ethnic Minority Groups With Eye Disease

Importance

The perception of being treated with respect by clinicians may be a driver of disparities in individuals in racial and ethnic minoritie groups with eye diseases. Understanding these drivers may help identify potential interventions to reduce eye health disparities to prevent vision loss and blindness.

Objective

To evaluate the association between racial and ethnic minority status and the perception of being treated with respect by clinicians.

Design, Setting, and Participants

This cross-sectional analysis of a nationally representative cohort study using data from the National Health Interview Survey (NHIS) included participants in the 2017 survey with complete data on outcomes, associated factors, and covariates. Data analysis took place from January 2021 to February 2021. Using a population-based survey conducted in the US in 2017 by the US census bureau on behalf of the National Center for Health Statistics, NHIS study participants (age ≥18 years) who self-reported having an eye disease (macular degeneration, diabetic retinopathy [DR], glaucoma, cataracts) were included, and patients who self-reported as Black, Asian, other/multiple races, or Hispanic ethnicity were considered to be in racial and ethnic minority groups.

Main Outcomes and Measures

Multivariable logistic regression models were used to evaluate the association of minority status with self-reported "always" being treated with respect by clinicians and self-reported "always" being asked about opinions/beliefs about medical care.

Results

Participants in racial and ethnic minority groups had 23% lower odds of reporting being treated with respect compared with non-Hispanic White patients (adjusted odds ratio [AOR], 0.77; 95% CI, 0.61-0.97; P = .03). A minority of participants had 66% higher odds of reporting being asked about their beliefs (AOR, 1.66; 95% CI, 1.39-1.98; P < .001). For all patients, being asked about opinions/beliefs by their clinician was associated with a 5.8 times higher odds of reporting being treated with respect (AOR, 5.80; 95% CI, 4.35-7.74; P < .001).

Conclusions and Relevance

In this nationally representative US population of patients with eye diseases, being a patient in a racial or ethnic minority group was associated with feeling less respected by health care professionals compared with non-Hispanic White patients. Asking about opinions and beliefs, regardless of race or ethnicity, is associated with patients feeling that they are treated with respect.

An equity-based narrative review of barriers to timely postoperative radiation therapy for patients with head and neck squamous cell carcinoma

OBJECTIVES

The majority of patients with head and neck squamous cell carcinoma (HNSCC) do not commence postoperative radiation treatment (PORT) within the recommended 6 weeks. We explore how delayed PORT affects survival outcomes, what factors are associated with delayed PORT initiation, and what interventions exist to reduce delays in PORT initiation.

METHODS

We conducted a PubMed search to identify articles discussing timely PORT for HNSCC. We performed a narrative review to assess survival outcomes of delayed PORT as well as social determinants of health (SDOH) and clinical factors associated with delayed PORT, using the PROGRESS-Plus health equity framework to guide our analysis. We reviewed interventions designed to reduce delays in PORT.

RESULTS

Delayed PORT is associated with reduced overall survival. Delays in PORT disproportionately burden patients of racial/ethnic minority backgrounds, Medicaid or no insurance, low socioeconomic status, limited access to care, more comorbidities, presentation at advanced stages, and those who experience postoperative complications. Delays in PORT initiation tend to occur during transitions in head and neck cancer care. Delays in PORT may be reduced by interventions that identify patients who are most likely to experience delayed PORT, support patients according to their specific needs and barriers to care, and streamline care and referral processes.

CONCLUSIONS

Both SDOH and clinical factors are associated with delays in timely PORT. Structural change is needed to reduce health disparities and promote equitable access to care for all. When planning care, providers must consider not only biological factors but also SDOH to maximize care outcomes.

Effectiveness of the Body Project eating disorder prevention program for different racial and ethnic groups and an evaluation of the potential benefits of ethnic matching

OBJECTIVE

Provide an adequately powered tests of whether a group-delivered dissonance-based eating disorder prevention program (Body Project) is similarly effective for different racial and ethnic groups and evaluate whether an improved match between minority participant race/ethnicity and fellow group members is associated with larger effects.

METHOD

Study 1 examined data from 539 young women from seven high schools and four universities and Study 2 examined data from 1,195 young women and men from 50 universities who completed the Body Project, focusing on pretest-to-posttest reductions in outcomes.

RESULTS

In Study 1, reductions in thin-ideal internalization, body dissatisfaction, dieting, negative affect, and eating disorder symptoms did not significantly differ for White versus Asian, Black, and Native Americans, though we did not have power to contrast racial and ethnic minority groups. In Study 2, only one intervention effect was weaker for a minority group relative to Whites (Black vs. White participants showed smaller reductions in thin-ideal internalization), but there was evidence that intervention effects were significantly larger for Hispanic versus White and Black participants, and to a lesser extent for Hispanic versus Asian and Native Americans; these differences were partially driven by differences in pretest risk across ethnic groups. Ethnic/racial matching was not associated with larger effects.

CONCLUSIONS

Results suggest that the Body Project produced relatively similar effects for racial/ethnic minority groups relative to White participants, that the effects were sometimes larger for Asian and Hispanic participants, and that recruiting Black participants at higher risk may contribute to larger effects for this racial group. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Evaluating the Contribution of Patient-Provider Communication and Cancer Diagnosis to Racial Disparities in End-of-Life Care Among Medicare Beneficiaries

BACKGROUND

The quality of end-of-life (EOL) care in the USA remains suboptimal, with significant variations in care by race and across disease subgroups. Patient-provider communication may contribute to racial and disease-specific variations in EOL care outcomes.

OBJECTIVE

We examined racial disparities in EOL care, by disease group (cancer vs. non-cancer), and assessed whether racial differences in patient-provider communication accounted for observed disparities.

DESIGN

Retrospective cohort study using the 2001-2015 Surveillance, Epidemiology, and End Results - Consumer Assessment of Healthcare Providers and Systems data linked with Medicare claims (SEER-CAHPS). We employed stratified propensity score matching and modified Poisson regression analyses, adjusting for clinical and demographic characteristics PARTICIPANTS: Black and White Medicare beneficiaries 65 years or older with cancer (N=2000) or without cancer (N=11,524).

MAIN MEASURES

End-of-life care measures included hospice use, inpatient hospitalizations, intensive care unit (ICU) stays, and emergency department (ED) visits, during the 90 days prior to death.

KEY RESULTS

When considering all conditions together (cancer + non-cancer), Black beneficiaries were 26% less likely than their Whites counterparts to enroll in hospice (adjusted risk ratio [ARR]: 0.74, 95%CI: 0.66-0.83). Among beneficiaries without cancer, Black beneficiaries had a 32% lower likelihood of enrolling in hospice (ARR: 0.68, 95%CI: 0.59-0.79). There was no racial difference in hospice enrollment among cancer patients. Black beneficiaries were also at increased risk for ED use (ARR: 1.12, 95%CI: 1.01-1.26). Patient-provider communication did not explain racial disparities in hospice or ED use. There were no racial differences in hospitalizations or ICU admissions.

CONCLUSION

We observed racial disparities in hospice use and ED visits in the 90 days prior to death among Medicare beneficiaries; however, hospice disparities were largely driven by patients without cancer. Condition-specific differences in palliative care integration at the end-of-life may partly account for variations in EOL care disparities across disease groups.

Predictors for participation in DNA self-sampling of childhood cancer survivors in Switzerland

BACKGROUND

Research on germline genetic variants relies on enough eligible participants which is difficult to achieve for rare diseases such as childhood cancer. With self-collection kits, participants can contribute genetic samples conveniently from their home. Demographic and clinical factors were identified previously that influenced participation in mailed self-collection. People with pre-existing heritable diagnoses might participate differently in germline DNA collection which might render sampling biased in this group. In this nationwide cross-sectional study, we analysed predictive factors of participation in DNA self-collection including heritable diagnoses.

METHODS

We identified childhood cancer survivors from the Swiss Childhood Cancer Registry for invitation to germline DNA self-sampling in September 2019. Participants received saliva sampling kits by postal mail at their home, were asked to fill them, sign an informed consent, and send them back by mail. Two reminders were sent to non-participants by mail. We compared demographic, clinical, and treatment information of participants with non-participants using univariable and multivariable logistic regression models.

RESULTS

We invited 928 childhood cancer survivors in Switzerland with a median age of 26.5 years (interquartile range 19-37), of which 463 (50%) participated. After the initial send out of the sampling kit, 291 (63%) had participated, while reminder letters led to 172 additional participants (37%). Foreign nationality (odds ratio [OR] 0.5; 95%-confidence interval [CI] 0.4-0.7), survivors aged 30-39 years at study versus other age groups (OR 0.5; CI 0.4-0.8), and survivors with a known cancer predisposition syndrome (OR 0.5; CI 0.3-1.0) were less likely to participate in germline DNA collection. Survivors with a second primary neoplasm (OR 1.9; CI 1.0-3.8) or those living in a French or Italian speaking region (OR 1.3; CI 1.0-1.8) tended to participate more.

CONCLUSIONS

We showed that half of childhood cancer survivors participated in germline DNA self-sampling relying completely on mailing of sample kits. Written reminders increased the response by about one third. More targeted recruitment strategies may be advocated for people of foreign nationality, aged 30-39 years, and those with cancer predisposition syndromes. Perceptions of genetic research and potential barriers to participation of survivors need to be better understood.

TRIAL REGISTRATION

Biobank: https://directory.bbmri-eric.eu/#/collection/bbmri-eric:ID:CH_HopitauxUniversitairesGeneve:collection:CH_BaHOP Research project : Clinicaltrials.gov: NCT04702321 .

Perception and Experience of Transcultural Care of Stakeholders and Health Service Users with a Migrant Background: A Qualitative Study

INTRODUCTION

While European health policies do frequently take into consideration the ideas and experiences of their users, the voices of minority and marginalized communities are not often heard. European healthcare services must address this issue as the number of healthcare users with an MM background increases.

AIM

To explore the perspectives of key stakeholders and healthcare users with an MM background on transcultural care in four European countries.

DESIGN

Qualitative phenomenological study.

METHODS

Semi-structured, individual interviews were conducted with stakeholders and MM users. Interviews were translated and transcribed verbatim and were carried out from February to May 2021. Descriptive statistics was used to describe the characteristics of the sample; qualitative data were analyzed thematically following Braun and Clarke's phases, resulting in 6 themes and 18 subthemes.

RESULTS

For stakeholders and MM users with long-established residence in their respective countries, cultural differences involve different family and community norms, religious beliefs, lifestyles, and habits. These components are perceived as in tension with healthcare norms and values, and they mediate in two key and related aspects of the relationship between MM users and healthcare providers: accessibility and communication.

CONCLUSIONS

Communication and access to healthcare are key to MM health service users, and they are the most frequent sources of misunderstanding and conflict between them and healthcare professionals.

IMPACT

It is important to extend the investigation of cultural issues in healthcare to stakeholders and MM users. There is no doubt that healthcare professionals should be trained in cultural competence; however, cultural competence training is not the only area for improvement. There should be a change in paradigm in healthcare services across Europe: from individual to organizational integration of culture and diversity.

"Nobody Will Tell You. You've Got to Ask!": An Examination of Patient-Provider Communication Needs and Preferences among Black and White Women with Early-Stage Breast Cancer

Patient-provider communication is a critical component of healthcare and is associated with treatment quality and outcomes for women with breast cancer. This qualitative study examines similarities and differences in patient perspectives of communication needs between Black and White breast cancer survivors. We conducted four focus groups (N = 28) involving women with early-stage breast cancer on adjuvant endocrine therapy (AET), stratified by race and length of time on AET (< 6 months and >6 months). Each group was moderated by a race-concordant moderator and analyzed by emergent themes. Participants expressed common patient-provider communication needs, namely increased sensitivity from oncologists during the initial cancer diagnosis, personalized information to facilitate treatment decisions, emotional support during the transition from active treatment to maintenance, and rapid provider responses to mobile app-based queries. Communication differences by race also emerged. Black women were less likely than White women to describe having their informational needs met. White women praised longstanding relationships with providers, while Black women shared personal stories of disempowered interactions and noted the importance of patient advocates. White women more often reported privacy concerns about technology use. Unlike White women, Black women reported willingness to discuss sensitive topics, both online and offline, but believed those discussions made their providers feel uncomfortable. Early-stage breast cancer patients on AET, regardless of race, have similar needs for patient-centered communication with their oncologists. However, Black women were more likely to report experiencing poorer communication with providers than White women, which may be improved by technology and advocates.

Providers PrEP: Identifying Primary Health care Providers' Biases as Barriers to Provision of Equitable PrEP Services

BACKGROUND

Despite their disparately high HIV incidence and voiced willingness to use pre-exposure prophylaxis (PrEP), Black cisgender women's knowledge and uptake of PrEP are low, especially relative to White cisgender women and men who have sex with men. Mounting evidence demonstrates that health care provider recommendations are a critical factor in women's awareness, willingness, and ability to uptake PrEP. Health care providers may make clinical judgments about who is (not) a good candidate for PrEP based on unconscious and conscious stereotypes and prejudice.

SETTING

We conducted an online experiment among N = 160 health care providers with prescribing privileges in the 48 HIV hotspot counties.

METHOD

Providers received 1 of 4 vignettes about a PrEP eligible woman. Vignettes varied by patient race and substance use status. Then, providers reported their willingness to discuss PrEP with the patient and willingness to prescribe PrEP to her.

RESULTS

We tested 2 models predicting providers (1) willingness to discuss and (2) willingness to prescribe PrEP, contingent on their racial attitudes. Providers who scored high on a modern racism measure were less willing to discuss and prescribe PrEP to the Black patient. These effects were mediated by provider perceptions of patients' abilities to adhere to PrEP, but not their expectations of risk compensatory behaviors.

CONCLUSIONS

Our findings highlight the importance of applying an intersectional lens in documenting the processes that exacerbate inequities in PrEP use. This study provides evidence to support the development of interventions that address the mechanisms that work to thwart optimal care.

The influence of culture on care receivers' satisfaction and aggressive tendencies in the emergency department

Introduction

Reducing aggressive tendencies among care receivers in the emergency department has great economic and psychological benefits for care receivers, staff, and health care organizations. In a study conducted in a large multicultural hospital emergency department, we examined how cultural factors relating to ethnicity interact to enhance care receivers’ satisfaction and reduce their aggressive tendencies. Specifically, we explored how care receivers’ cultural affiliation, individual cultural characteristics, and the cultural situational setting interact to increase care receivers’ satisfaction and reduce their aggressive tendencies.

Method

Data were collected using survey responses from 214 care receivers. We use structural equation models and the bootstrap method to analyze the data.

Results

Care receivers’ openness to diversity (an individual cultural characteristic) was positively related to their satisfaction that was associated with lower aggressive tendencies, only when they were affiliated with a cultural minority group and when the cultural situational setting included language accessibility.

Conclusion

Our results demonstrate that cultural affiliation, individual cultural characteristics, and cultural situational setting can affect care receivers’ satisfaction and aggressive tendencies in a multicultural emergency department context. In particular, high cultural openness of care receivers, and making information accessible in their native language, increased satisfaction and reduced aggressive tendencies among cultural minority care receivers in our study.

Health care Affordability and Associated Concerns Among Adults Aged 65 and above in Florida

OBJECTIVE

This study assessed affordability of care in a diverse sample of Floridians aged ≥ 65 to ascertain concerns about health care costs.

METHODS

We surveyed 170 adults (40.6% white, 27.6% black, and 31.8% Hispanic) and conducted three race/ethnic-stratified focus groups (n = 27).

RESULTS

Most participants had Medicare (97.1%). Among whites, 11.6% reported problems paying medical bills in the past 12 months versus 14.9% of blacks and 24.1% of Hispanics. In addition, 13% of whites, 19.2% of blacks, and 20.4% of Hispanics reported not getting needed prescription drugs because of costs. The most frequently identified concerns from the focus groups were the cost of prescription drugs, out-of-pocket expenses, and medical billing. Concerns about medical billing included understanding bills, transparency, timely postings, and uncertainty about who to contact about problems.

DISCUSSION

Our findings suggest that practices that help older adults effectively manage medical bills and costs may alleviate their concerns and guard against financial burdens.

An Examination of History for Promoting Diversity in Neuroscience

Purpose of Review

A review of American history is presented to understand how public policy has contributed to a disproportionate burden of disease in members of underrepresented groups. A review of research conducted in the Stroke Belt provides an opportunity to examine more closely traditional and non-traditional risk factors in an effort to consider strategies for change.

Recent Findings

A diverse physician workforce has been offered as a way of improving care for our increasingly diverse populace. Given the expected increased prevalence of stroke in communities of color and the impact of stress from discrimination on health, proactive strategies to promote inclusion and equity to support diversity in perioperative neuroscience is warranted.

Summary

Public policy rooted in structural racism has left marginalized groups economically and educationally disadvantaged with less access to health care. Mistrust and fear from ongoing discrimination compels the neuroscience community to broaden their approach for developing a more reassuring and supportive educational environment for patients and trainees.

Racial differences in patient perception of interactions with providers are associated with health outcomes in type II diabetes

OBJECTIVES

Examine the association of patient perceptions of care with hemoglobin A1c (HbA1c), medication adherence, and missed appointments in non-Hispanic Black (NHB) and White (NHW) patients with type 2 diabetes (T2DM).

METHODS

We used linear and logistic regression models to analyze the association of the Interpersonal Processes of Care survey (IPC) with HbA1c, medication adherence, and missed appointments. We then examined how these associations differed by race.

RESULTS

There was no overall association between IPC subdomains and HbA1c in our sample (N = 221). NHB patients perceiving their provider always explained results and medications had a HbA1c on average 0.59 (-1.13, -0.04; p = 0.04) points lower than those perceiving their provider sometimes explained results and medications. No effect was observed in NHWs. Never perceiving disrespect from office staff was associated with an average 0.67 (-1.1, -0.24; p = 0.002) point improvement in medication adherence for all patients. Never perceiving discrimination from providers was associated with a 0.44 (-0.63, -0.25; p < 0.0001) decrease in the probability of missing an appointment for NHB patients.

CONCLUSIONS

These results demonstrate that particular aspects of communication in the patient-provider interaction may contribute to racial disparities in T2DM.

PRACTICE IMPLICATIONS

Communication training for both providers and staff may reduce disparities in T2DM.