1
|
James C, Whitehead A, Plummer JT, Thompson R, Badal S. Failure to progress: breast and prostate cancer cell lines in developing targeted therapies. Cancer Metastasis Rev 2024:10.1007/s10555-024-10202-w. [PMID: 39060878 DOI: 10.1007/s10555-024-10202-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024]
Abstract
Developing anticancer drugs from preclinical to clinical takes approximately a decade in a cutting-edge biomedical lab and still 97% of most fail at clinical trials. Cell line usage is critical in expediting the advancement of anticancer therapies. Yet developing appropriate cell lines has been challenging and overcoming these obstacles whilst implementing a systematic approach of utilizing 3D models that recapitulate the tumour microenvironment is prudent. Using a robust and continuous supply of cell lines representing all ethnic groups from all locales is necessary to capture the evolving tumour landscape in culture. Next, the conversion of these models to systems on a chip that can by way of high throughput cytotoxic assays identify drug leads for clinical trials should fast-track drug development while markedly improving success rates. In this review, we describe the challenges that have hindered the progression of cell line models over seven decades and methods to overcome this. We outline the gaps in breast and prostate cancer cell line pathology and racial representation alongside their involvement in relevant drug development.
Collapse
Affiliation(s)
- Chelsi James
- Department of Basic Medical Sciences, Faculty of Medical Sciences Teaching and Research Complex, The University of the West Indies, Mona, West Indies, Jamaica
| | - Akeem Whitehead
- Department of Basic Medical Sciences, Faculty of Medical Sciences Teaching and Research Complex, The University of the West Indies, Mona, West Indies, Jamaica
| | | | - Rory Thompson
- Department of Pathology, The University of the West Indies, Mona, Jamaica
| | - Simone Badal
- Department of Basic Medical Sciences, Faculty of Medical Sciences Teaching and Research Complex, The University of the West Indies, Mona, West Indies, Jamaica.
| |
Collapse
|
2
|
McGee-Avila JK, Suneja G, Engels EA, Rositch AF, Horner MJ, Luo Q, Shiels MS, Islam JY. Cancer Treatment Disparities in People With HIV in the United States, 2001-2019. J Clin Oncol 2024; 42:1810-1820. [PMID: 38513161 PMCID: PMC11095899 DOI: 10.1200/jco.23.02366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/23/2024] [Accepted: 02/21/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE People with HIV (PWH) have worse cancer outcomes, partially because of inequities in cancer treatment. We evaluated cancer treatment disparities among PWH, including an assessment of changes in disparities over time. METHODS We used data from the HIV/AIDS Cancer Match Study, a population-based HIV and cancer registry linkage to examine diffuse large B-cell lymphoma (DLBCL), Hodgkin lymphoma (HL), and cancers of the cervix, lung, anus, prostate, colon, and female breast. Outcomes included receipt of (1) any cancer treatment and (2) standard therapy among patients with local-stage cancer. We assessed associations between HIV and each outcome by estimating adjusted prevalence odds ratios (aORs) with 95% CI and trends over time. We identified predictors of nonreceipt of cancer treatment in PWH. RESULTS From 2001 to 2019, compared with people with cancer without HIV (n = 2,880,955), PWH (n = 16,334) were more likely to not receive cancer treatment for cervical cancer (aOR, 2.03 [95% CI, 1.52 to 2.70]), DLBCL (aOR, 1.53 [95% CI, 1.38 to 1.70]), HL (aOR, 1.39 [95% CI, 1.19 to 1.63]), lung cancer (aOR, 1.79 [95% CI, 1.65 to 1.93]), prostate cancer (aOR, 1.32 [95% CI, 1.21 to 1.44]), colon cancer (aOR, 1.73 [95% CI, 1.43 to 2.08]), and breast cancer (aOR, 1.38 [95% CI, 1.07 to 1.77]). Similar associations were observed in PWH with local-stage cancers although no difference was observed for anal cancers. The association between HIV and nonreceipt of cancer treatment significantly decreased over time for breast, colon, and prostate cancers (all P trend <.0001), but PWH remained less likely to receive treatment in 2014-2019 for DLBCL, cervix, and lung cancers. Among PWH, Black individuals, people who inject drugs, and those 65 years and older were less likely to receive cancer treatment. CONCLUSION Disparities in receipt of cancer treatment persist for PWH in the United States in contemporary time periods. Solutions to address inequitable receipt of cancer treatment among PWH are urgently needed.
Collapse
Affiliation(s)
- Jennifer K. McGee-Avila
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah, School of Medicine, Salt Lake City, UH
| | - Eric A. Engels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Anne F. Rositch
- Deparment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Marie-Josephe Horner
- Trans-Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Qianlai Luo
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Meredith S. Shiels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Jessica Y. Islam
- Cancer Epidemiology Program, Center for Immunization and Infection in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| |
Collapse
|
3
|
Peseski AM, Kapoor S, Kuchibhatla M, Adamski A, Abe K, Beckman MG, Reyes NL, Richardson LC, Saber I, Schulteis R, Singh BP, Sitlinger A, Thames EH, Ortel TL. An epidemiologic study comparing cancer- and noncancer-associated venous thromboembolism in a racially diverse Southeastern United States county. Res Pract Thromb Haemost 2024; 8:102420. [PMID: 38817950 PMCID: PMC11137544 DOI: 10.1016/j.rpth.2024.102420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 06/01/2024] Open
Abstract
Background Cancer-associated venous thromboembolism (CA-VTE) represents a major cause of morbidity and mortality in patients with cancer. Despite poor outcomes, there is an ongoing knowledge gap in epidemiologic data related to this association. Objectives To compare venous thromboembolism (VTE) characteristics, risk factors, and outcomes between patients with and without active cancer in a racially diverse population. Methods Our surveillance project occurred at the 3 hospitals in Durham County, North Carolina, from April 2012 through March 2014. Electronic and manual methods were used to identify unique Durham County residents with VTE. Results We identified 987 patients with VTE during the surveillance period. Of these, 189 patients had active cancer at the time of their VTE event. Patients with CA-VTE were older (median age: 69 years vs 60 years, P < .0001) and had a lower body mass index (median body mass index: 26.0 kg/m2 vs 28.4 kg/m2, P = .0001) than noncancer patients. The most common cancers in our cohort were gastrointestinal, breast, genitourinary, and lung. The proportion of VTE cases with pulmonary embolism (PE) was greater in the cancer cohort compared with that in the noncancer cohort (58.2% vs 44.0%, P = .0004). Overall survival was lower in the CA-VTE group than in patients without cancer (P < .0001). Black patients with CA-VTE had lower proportion of PE (52.3% vs 67.1%, P = .05) but had decreased survival (P < .0003) in comparison with White patients. Conclusion Future studies may be needed to continue to evaluate local and national VTE data to improve VTE prevention strategies and CA-VTE outcomes.
Collapse
Affiliation(s)
- Andrew M. Peseski
- Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Sargam Kapoor
- Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Alys Adamski
- Division of Blood Disorders and Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karon Abe
- Division of Blood Disorders and Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michele G. Beckman
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nimia L. Reyes
- Division of Blood Disorders and Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa C. Richardson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Ryan Schulteis
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Bhavana Pendurthi Singh
- Division of Hematology Oncology, Lehigh Valley Hospital Pocono, East Stroudsburg, Pennsylvania, USA
| | - Andrea Sitlinger
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, North Carolina, USA
| | - Elizabeth H. Thames
- Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Thomas L. Ortel
- Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina, USA
- Department of Pathology, Duke University, Durham, North Carolina, USA
| |
Collapse
|
4
|
Lee KT, Gonzalez BD, Geiss C, Fulton HJ, Charles D, Vadaparampil ST, Henry NL, Jim HSL, Hershman DL, Tworoger SS, Gwede CK. Barriers to endocrine therapy adherence: perspectives of Black breast cancer survivors and their providers. J Cancer Surviv 2024:10.1007/s11764-024-01574-7. [PMID: 38520598 DOI: 10.1007/s11764-024-01574-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE Adherence to oral endocrine therapy (ET) remains an issue for up to half of women prescribed these medications. There is emerging data that Black breast cancer survivors (BCS) have lower rates of ET adherence. Given the disparities in breast cancer recurrence and survival for Black BCS compared to their White counterparts, the goal of this study is to better understand barriers to ET adherence among Black BCS from the patient and provider perspectives. METHODS In this qualitative study, we conducted semi-structured interviews between October 29, 2021, and March 1, 2023. Interviews were recorded and transcribed, and coded data were organized into primary and secondary themes. Participants were recruited from a single academic cancer center. A convenience sample of 24 Black BCS and 9 medical oncology providers was included. Eligible BCS were 18 years or older, English-speaking, diagnosed with stage I-III hormone receptor-positive breast cancer, who had initiated ET. RESULTS Mean age of the BCS was 55 years (interquartile range, IQR 17 years). About one-fourth had a high school diploma or less (26.1%) and 47% completed a college education or higher. Approximately one-third of participants had annual household incomes of $40,000 or less (30.4%) or more than $100,000 (30.4%). Forty-three percent of the patient participants had private insurance; 11% were insured through Medicaid or the federal healthcare exchange; 26.1% had Medicare; and 13% were uninsured. Of the 9 medical oncology providers interviewed, 2 were advanced practice providers, and 7 were medical oncologists. We found 3 major themes: (1) Black BCS often had concerns about ET before initiation; (2) after initiation, both BCS and providers reported side effects as the most impactful barrier to ET adherence; and (3) survivors experienced challenges with managing ET side effects. CONCLUSIONS Our results suggest that multifaceted support interventions for managing ET-related symptoms may lead to improved adherence to ET among Black women and may reduce disparities in outcomes. IMPLICATIONS FOR CANCER SURVIVORS Multifaceted support interventions for managing ET-related symptoms may lead to improved adherence to ET among Black breast cancer survivors.
Collapse
Affiliation(s)
- Kimberley T Lee
- Moffitt Cancer Center and Research Institute, 10920 N Mckinley Dr, Tampa, FL, 33612, USA.
| | - Brian D Gonzalez
- Moffitt Cancer Center and Research Institute, 10920 N Mckinley Dr, Tampa, FL, 33612, USA
| | - Carley Geiss
- Moffitt Cancer Center and Research Institute, 10920 N Mckinley Dr, Tampa, FL, 33612, USA
| | - Hayden J Fulton
- Moffitt Cancer Center and Research Institute, 10920 N Mckinley Dr, Tampa, FL, 33612, USA
| | - Dannelle Charles
- Moffitt Cancer Center and Research Institute, 10920 N Mckinley Dr, Tampa, FL, 33612, USA
| | - Susan T Vadaparampil
- Moffitt Cancer Center and Research Institute, 10920 N Mckinley Dr, Tampa, FL, 33612, USA
| | - N Lynn Henry
- University of Michigan, 1500 E. Medical Center Drive, Cancer Center, Room 7216, Ann Arbor, MI, USA
| | - Heather S L Jim
- Moffitt Cancer Center and Research Institute, 10920 N Mckinley Dr, Tampa, FL, 33612, USA
| | - Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 161 Ft Washington Ave #1071, New York, NY, USA
| | - Shelley S Tworoger
- Moffitt Cancer Center and Research Institute, 10920 N Mckinley Dr, Tampa, FL, 33612, USA
| | - Clement K Gwede
- Moffitt Cancer Center and Research Institute, 10920 N Mckinley Dr, Tampa, FL, 33612, USA
| |
Collapse
|
5
|
Garrett E, Ma C, Ochoa-Dominguez CY, Navarro S, Yoon P, Hughes Halbert C, Farias AJ. Black cancer patients navigating a health-care system of racial discrimination. J Natl Cancer Inst 2024; 116:258-263. [PMID: 37849350 PMCID: PMC10852748 DOI: 10.1093/jnci/djad208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Exposure to racial discrimination may exacerbate disparities throughout the cancer care continuum. Therefore, we explored how experiences of racial discrimination in the health-care setting manifest for Black cancer patients and how it contributes to racial disparities in cancer care. METHODS This qualitative analysis used semistructured in-depth interviews with Black cancer survivors not on active treatment from May 2019 to March 2020. All interviews were audio recorded, professionally transcribed, and uploaded into Dedoose software for analysis. We identified major themes and subthemes that highlight exposure to racial discrimination and its consequences for Black cancer patients when receiving cancer care. RESULTS Participants included 18 Black cancer survivors, aged 29-88 years. Most patients experienced racial discrimination when seeking care. Participants experienced racial discrimination from their interactions with health-care staff, medical assistants, front desk staff, and health insurance administrators. Exposure to overt racial discrimination in the health-care setting was rooted in racial stereotypes and manifested through verbal insults such as physicians using phrases such as "you people." These experiences impacted the ability of the health-care delivery system to demonstrate trustworthiness. Patients noted "walking out" of their visit and not having their health issues addressed. Despite experiences with racial discrimination, patients still sought care out of necessity believing it was an inevitable part of the Black individual experience. CONCLUSION We identified that exposure to racial discrimination in the health-care setting is pervasive, affects health-seeking behaviors, and degrades the patient-clinician relationship, which may likely contribute to racial disparities in cancer care.
Collapse
Affiliation(s)
- Elleyse Garrett
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Cindy Ma
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Carol Y Ochoa-Dominguez
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Stephanie Navarro
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Paul Yoon
- Keck School of Medicine, Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
- University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Albert J Farias
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
- University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| |
Collapse
|
6
|
Drummond DK, Kaur-Gill S, Murray GF, Schifferdecker KE, Butcher R, Perry AN, Brooks GA, Kapadia NS, Barnato AE. Problematic Integration: Racial Discordance in End-of-Life Decision Making. HEALTH COMMUNICATION 2023; 38:2730-2741. [PMID: 35981599 DOI: 10.1080/10410236.2022.2111631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We describe racially discordant oncology encounters involving EOL decision-making. Fifty-eight provider interviews were content analyzed using the tenets of problematic integration theory. We found EOL discussions between non-Black providers and their Black patients were often complex and anxiety-inducing. That anxiety consisted of (1) ontological uncertainty in which providers characterized the nature of Black patients as distrustful, especially in the context of clinical trials; (2) ontological and epistemological uncertainty in which provider intercultural incompetency and perceived lack of patient health literacy were normalized and intertwined with provider assumptions about patients' religion and support systems; (3) epistemological uncertainty as ambivalence in which providers' feelings conflicted when deciding whether to speak with family members they perceived as lacking health literacy; (4) divergence in which the provider advised palliative care while the family desired surgery or cancer-directed medical treatment; and (5) impossibility when an ontological uncertainty stance of Black distrust was seen as natural by providers and therefore impossible to change. Some communication strategies used were indirect stereotyping, negotiating, asking a series of value questions, blame-guilt framing, and avoidance. We concluded that provider perceptions of Black distrust, religion, and social support influenced their ability to communicate effectively with patients.
Collapse
Affiliation(s)
| | | | | | - Karen E Schifferdecker
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College
- Center for Program Design & Evaluation, Dartmouth College
| | - Rebecca Butcher
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College
- Center for Program Design & Evaluation, Dartmouth College
| | - Amanda N Perry
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College
| | - Gabriel A Brooks
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College
- Department of Medicine, Geisel School of Medicine, Dartmouth College
| | - Nirav S Kapadia
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College
- Department of Medicine, Geisel School of Medicine, Dartmouth College
| | - Amber E Barnato
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College
- Department of Medicine, Geisel School of Medicine, Dartmouth College
| |
Collapse
|
7
|
Anderson A. "Messengers matter": Assessing the impact of racially concordant care on vaccine hesitation. Soc Sci Med 2023; 338:116335. [PMID: 37913746 DOI: 10.1016/j.socscimed.2023.116335] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/01/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023]
Abstract
With the rise in COVID-related deaths among the unvaccinated, understanding coronavirus vaccine hesitancy is critical to maintaining public health. Previous research has shown that sociodemographic factors, such as race, are essential for understanding vaccine hesitancy; yet, the specific factors driving racial disparities in vaccination continue to be a matter of intense debate. This study uses a novel survey experiment to uncover the linkages between race, physician trust, and vaccine hesitancy. Using a standard prompt on the release of the COVID-19 vaccine, it tests whether patient-physician race concordance affects the likelihood of vaccine uptake among US citizens. Analyses reveal that racially concordant care has a negligible effect on vaccine hesitancy, but does ameliorate other harmful beliefs regarding one's likelihood of experiencing discrimination and racism in healthcare more generally. These findings suggest that increasing diversity in the medical field should be paired with efforts to address systemic inequalities to promote increased vaccination.
Collapse
Affiliation(s)
- Ashley Anderson
- University of North Carolina at Chapel Hill, 205 South Building, Chapel Hill, NC, 27599, USA.
| |
Collapse
|
8
|
Manning M, Lucas T, Purrington K, Thompson H, Albrecht TL, Penner L. Moderators of the effects of perceived racism and discrimination on cancer-related health behaviors among two samples of African Americans. Soc Sci Med 2023; 316:114982. [PMID: 35484000 DOI: 10.1016/j.socscimed.2022.114982] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/02/2022] [Accepted: 04/15/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Assumptions regarding within-race variation in the associations between measures of discrimination racism and health-related behaviors among African Americans have been largely unexplored. METHODS We conducted secondary analyses of two studies to examine support for a model which describes several theoretical moderators of the effects of discrimination and racism on health behaviors. The first study examined the effects of group-based behavioral information and racial identity on the association between perceived racism and requests for at home colorectal cancer screening tests among a sample of 205 geographically diverse African Americans who participated in an online experiment from 2019 to 2020. RESULTS Group-based behavioral information attenuated the association between perceived racism and requests for at-home screening kit. In the absence of group-based behavioral information, perceived racism was positively associated with screening kit requests for African Americans with weaker racial identity and negatively associated with requests for African Americans with stronger racial identity. The second study examined the influence of personal and group-based perceived discrimination, and behavior-relevant affective information related to a breast cancer risk notification, on 89 Michigan dwelling African American women's self-reported physician communication from 2015 to 2016. Results showed that perceived group-based discrimination was positively associated with physician communication in the absence of negative affective information, and perceived personal discrimination was negatively associated with physician communication as positive affective information increased. CONCLUSIONS Together, these results support our theoretical model highlighting variation in the effects of discrimination and racism on health behaviors among African Americans, and indicates group-relevant behavioral information, racial identity, behavior relevant affective information, and target of discrimination as moderators of the effect. Implications for conceptualizing the effects of racism and discrimination and for examining racially targeted interventions are discussed.
Collapse
Affiliation(s)
- Mark Manning
- Department of Psychology, Oakland University, USA
| | - Todd Lucas
- Division of Public Health, Michigan State University, USA
| | | | - Hayley Thompson
- Department of Oncology, Wayne State University School of Medicine, USA
| | | | - Louis Penner
- Department of Oncology, Wayne State University School of Medicine, USA
| |
Collapse
|
9
|
Lou Z, Vivas-Valencia C, Shields CG, Kong N. Examining how physician factors influence patient satisfaction during clinical consultations about cancer prognosis and pain. PEC INNOVATION 2022; 1:100017. [PMID: 37213781 PMCID: PMC10194410 DOI: 10.1016/j.pecinn.2022.100017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/07/2021] [Accepted: 01/03/2022] [Indexed: 05/23/2023]
Abstract
Objective Patient-physician communication affects cancer patients' satisfaction, health outcomes, and reimbursement for physician services. Our objective is to use machine learning to comprehensively examine the association between patient satisfaction and physician factors in clinical consultations about cancer prognosis and pain. Methods We used data from audio-recorded, transcribed communications between physicians and standardized patients (SPs). We analyzed the data using logistic regression (LR) and random forests (RF). Results The LR models suggested that lower patient satisfaction was associated with more in-depth prognosis discussion; and higher patient satisfaction was associated with a greater extent of shared decision making, patient being black, and doctor being young. Conversely, the RF models suggested the opposite association with the same set of variables. Conclusion Somewhat contradicting results from distinct machine learning models suggested possible confounding factors (hidden variables) in prognosis discussion, shared decision-making, and doctor age, on the modeling of patient satisfaction. Practitioners should not make inferences with one single data-modeling method and enlarge the study cohort to help deal with population heterogeneity. Innovation Comparing diverse machine learning models (both parametric and non-parametric types) and carefully applying variable selection methods prior to regression modeling, can enrich the examination of physician factors in characterizing patient-physician communication outcomes.
Collapse
Affiliation(s)
- Zhouyang Lou
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | | | - Cleveland G. Shields
- Human Development and Family Studies, Purdue University, West Lafayette, IN, USA
| | - Nan Kong
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
- Corresponding author at: Nan Kong 206 S. Martin Jischke Dr., West Lafayette, IN 47907, USA.
| |
Collapse
|
10
|
Patient activation reduces effects of implicit bias on doctor-patient interactions. Proc Natl Acad Sci U S A 2022; 119:e2203915119. [PMID: 35914161 PMCID: PMC9371681 DOI: 10.1073/pnas.2203915119] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Disparities between Black and White Americans persist in medical treatment and health outcomes. One reason is that physicians sometimes hold implicit racial biases that favor White (over Black) patients. Thus, disrupting the effects of physicians' implicit bias is one route to promoting equitable health outcomes. In the present research, we tested a potential mechanism to short-circuit the effects of doctors' implicit bias: patient activation, i.e., having patients ask questions and advocate for themselves. Specifically, we trained Black and White standardized patients (SPs) to be "activated" or "typical" during appointments with unsuspecting oncologists and primary care physicians in which SPs claimed to have stage IV lung cancer. Supporting the idea that patient activation can promote equitable doctor-patient interactions, results showed that physicians' implicit racial bias (as measured by an implicit association test) predicted racially biased interpersonal treatment among typical SPs (but not among activated SPs) across SP ratings of interaction quality and ratings from independent coders who read the interaction transcripts. This research supports prior work showing that implicit attitudes can undermine interpersonal treatment in medical settings and provides a strategy for ensuring equitable doctor-patient interactions.
Collapse
|
11
|
Verosky A, Leonard LD, Quinn C, Vemuru S, Warncke E, Himelhoch B, Huynh V, Wolverton D, Jaiswal K, Ahrendt G, Sams S, Lin CT, Cumbler E, Schulick R, Tevis SE. Patient comprehension of breast pathology report terminology: The need for patient-centered resources. Surgery 2022; 172:831-837. [PMID: 35715235 DOI: 10.1016/j.surg.2022.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND As health care continues to evolve toward information transparency, an increasing number of patients have access to their medical records, including result reports that were not originally designed to be patient-facing. Previous studies have demonstrated that patients have poor understanding of medical terminology. However, patient comprehension of terminology specific to breast pathology reports has not been well studied. We assessed patient understanding of common medical terms found in breast pathology reports. METHODS A survey was administered electronically to patients scheduled for a screening mammogram within a multisite health care system. Participants were asked to objectively define and interpret 8 medical terms common to breast biopsy pathology reports. Patient perception of the utility of various educational tools was also assessed. Demographic information including health literacy, education level, previous cancer diagnosis, and primary language was collected. RESULTS In total, 527 patients completed the survey. Terms including "malignant" and "benign" were the most correctly defined at 80% and 73%, respectively, whereas only 1% correctly defined "high grade." Factors including race/ethnicity and education level were correlated with more correct scores. Patients preferred educational tools that were specific to their diagnosis and available at the time they were reviewing their results. CONCLUSION Patient comprehension of common medical terminology is poor. Potential assumptions of understanding based on patient factors including education, past medical history, and occupation are misinformed. With the newly mandated immediate release of information to patients, there is a pressing need to develop and integrate educational tools to support patients through all aspects of their care.
Collapse
Affiliation(s)
- Alexandra Verosky
- School of Medicine, University of Colorado, Denver, CO. https://twitter.com/veroskyalex
| | | | | | - Sudheer Vemuru
- Department of Surgery, University of Colorado, Denver, CO. https://twitter.com/sudheervemuru
| | - Emily Warncke
- Department of Radiology, University of Colorado, Denver, CO
| | - Ben Himelhoch
- Department of Radiology, University of Colorado, Denver, CO. https://twitter.com/BHimelhoch
| | - Victoria Huynh
- Department of Surgery, University of Colorado, Denver, CO. https://twitter.com/THuynhMD
| | | | - Kshama Jaiswal
- School of Medicine, University of Colorado, Denver, CO. https://twitter.com/KshamaRJaiswal
| | - Gretchen Ahrendt
- Department of Surgery, University of Colorado, Denver, CO. https://twitter.com/ahrendt50
| | - Sharon Sams
- Department of Pathology, University of Colorado, Denver, CO
| | - Chen-Tan Lin
- Department of Medicine, University of Colorado, Denver, CO. https://twitter.com/CTLin1
| | - Ethan Cumbler
- Department of Surgery, University of Colorado, Denver, CO; Department of Medicine, University of Colorado, Denver, CO. https://twitter.com/ECumbler
| | - Richard Schulick
- Department of Surgery, University of Colorado, Denver, CO. https://twitter.com/RichSchulickMD
| | - Sarah E Tevis
- Department of Surgery, University of Colorado, Denver, CO. https://twitter.com/SarahTevisMD
| |
Collapse
|
12
|
Keating NL, Landrum MB, Samuel-Ryals C, Sinaiko AD, Wright A, Brooks GA, Bai B, Zaslavsky AM. Measuring Racial Inequities In The Quality Of Care Across Oncology Practices In The US. Health Aff (Millwood) 2022; 41:598-606. [PMID: 35377762 DOI: 10.1377/hlthaff.2021.01594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Racial inequities in clinical performance diminish overall health care system performance; however, quality assessments have rarely incorporated reliable measures of racial inequities. We studied care for more than one million Medicare fee-for-service beneficiaries with cancer to assess the feasibility of calculating reliable practice-level measures of racial inequities in chemotherapy-associated emergency department (ED) visits and hospitalizations. Specifically, we used hierarchical models to estimate adjusted practice-level Black-White differences in these events and described differences across practices. We calculated reliable inequity measures for 426 and 322 practices, depending on the measure. These practices reflected fewer than 10 percent of practices treating Medicare beneficiaries with chemotherapy, but they treated approximately half of all White and Black Medicare beneficiaries receiving chemotherapy and two-thirds of Black Medicare beneficiaries receiving chemotherapy. Black patients experienced chemotherapy-associated ED visits and hospitalizations at higher rates (54.2 percent and 35.8 percent, respectively) than White patients (45.7 percent and 31.9 percent, respectively). The median within-practice Black-White difference was 8.1 percentage points for chemotherapy-associated ED visits and 2.7 percentage points for chemotherapy-associated hospitalizations. Additional research is needed to identify other reliable measures of racial inequities in health care quality, measure care inequities in smaller practices, and assess whether providing practice-level feedback could improve equity.
Collapse
Affiliation(s)
- Nancy L Keating
- Nancy L. Keating , Harvard University and Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Cleo Samuel-Ryals
- Cleo Samuel-Ryals, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Alexi Wright
- Alexi Wright, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gabriel A Brooks
- Gabriel A. Brooks, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | | |
Collapse
|
13
|
Anderson JN, Graff C, Krukowski RA, Schwartzberg L, Vidal GA, Waters TM, Paladino AJ, Jones TN, Blue R, Kocak M, Graetz I. "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. HEALTH COMMUNICATION 2021; 36:1331-1342. [PMID: 32336140 PMCID: PMC7606266 DOI: 10.1080/10410236.2020.1751383] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
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.
Collapse
Affiliation(s)
- Janeane N. Anderson
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
- University of Tennessee Health Science Center, College of Nursing, Department of Health Promotion and Disease Prevention, 920 Madison Avenue; Memphis, TN 38163
| | - Carolyn Graff
- University of Tennessee Health Science Center, College of Nursing, Department of Health Promotion and Disease Prevention, 920 Madison Avenue; Memphis, TN 38163
| | - Rebecca A. Krukowski
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
| | - Lee Schwartzberg
- West Cancer Center Research Institute, 7945 Wolf River Blvd, Germantown, TN 38138
- University of Tennessee Health Science Center, College of Medicine, Division of Hematology/Oncology; 956 Court Avenue, Memphis, TN 38163
| | - Gregory A. Vidal
- West Cancer Center Research Institute, 7945 Wolf River Blvd, Germantown, TN 38138
- University of Tennessee Health Science Center, College of Medicine, Division of Hematology/Oncology; 956 Court Avenue, Memphis, TN 38163
| | - Teresa M. Waters
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
- University of Kentucky, College of Public Health, Department of Health Management and Policy, 111 Washington Ave., Lexington, KY 40536
| | - Andrew J. Paladino
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
- West Cancer Center Research Institute, 7945 Wolf River Blvd, Germantown, TN 38138
| | - Tameka N. Jones
- West Cancer Center Research Institute, 7945 Wolf River Blvd, Germantown, TN 38138
| | - Ryan Blue
- University of Tennessee Health Science Center, College of Nursing, Department of Health Promotion and Disease Prevention, 920 Madison Avenue; Memphis, TN 38163
| | - Mehmet Kocak
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
| | - Ilana Graetz
- University of Tennessee Health Science Center, College of Medicine, Department of Preventive Medicine, 66 N. Pauline St., Ste. 633, Memphis, TN 38163
- Emory University, Rollins School of Public Health, Department of Health Policy and Management; 1518 Clifton Road NE, Atlanta, GA 30322
| |
Collapse
|
14
|
Vo JB, Gillman A, Mitchell K, Nolan TS. Health Disparities: Impact of Health Disparities and Treatment Decision-Making Biases on Cancer Adverse Effects Among Black Cancer Survivors. Clin J Oncol Nurs 2021; 25:17-24. [PMID: 34533532 DOI: 10.1188/21.cjon.s1.17-24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Health disparities affect cancer incidence, treatment decisions, and adverse effects. Oncology providers may hold biases in the decision-making process, which can perpetuate health disparities. OBJECTIVES The purpose of this article is to describe health disparities across treatment decisions and adverse effects, describe decision-making biases, and provide suggestions for nurses to mitigate adverse outcomes. METHODS A scoping review of the literature was conducted. FINDINGS Factors affecting health disparities stem, in part, from structural racism and decision-making biases, such as implicit bias, which occurs when individuals have unconscious negative thoughts or feelings toward a particular group. Other decision-making biases, seemingly unrelated to race, include default bias, delay discounting bias, and availability bias. Nurses and nurse navigators can mitigate health disparities by providing culturally appropriate care, assessing health literacy, providing education regarding adverse effects, serving as patient advocates, empowering patients, evaluating personal level of disease knowledge, and monitoring and managing cancer treatment adverse effects.
Collapse
Affiliation(s)
| | | | | | - Timiya S Nolan
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| |
Collapse
|
15
|
Diaz DA, Suneja G, Jagsi R, Barry P, Thomas CR, Deville C, Winkfield K, Siker M, Bott-Kothari T. Mitigating Implicit Bias in Radiation Oncology. Adv Radiat Oncol 2021; 6:100738. [PMID: 34381930 PMCID: PMC8339323 DOI: 10.1016/j.adro.2021.100738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 11/30/2022] Open
Abstract
Implicit bias is one of the most insidious and least recognizable mechanisms that can cause inequity and disparities. There is increasing evidence that both implicit and explicit biases have a negative effect on patient outcomes and patient-physician relationships. Given the impact of Implicit bias, a joint session between ASTROs Committee on Health Equity, Diversity, and Inclusion and the National Cancer Institute (the ASTRO-National Cancer Institute Diversity Symposium) was held during the American Society of Radiation Oncology (ASTRO) 2020 Annual Meeting, to address the effect of implicit bias in radiation oncology through real life and synthesized hypothetical scenario discussions. Given the value of this session to the radiation oncology community, the scenarios and discussion are summarized in this manuscript. Our goal is to heighten awareness of the multiple settings in which implicit bias can occur as well as discuss resources to address bias.
Collapse
Affiliation(s)
| | - Gita Suneja
- Department of Radiation Oncology University of Utah, Salt Lake city, Utah
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Parul Barry
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Charles R. Thomas
- Department of Radiation Oncology, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Curtiland Deville
- The Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karen Winkfield
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Malika Siker
- Department of Radiation Oncology Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Terri Bott-Kothari
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
16
|
Simon MS, Raychaudhuri S, Hamel LM, Penner LA, Schwartz KL, Harper FWK, Thompson HS, Booza JC, Cote M, Schwartz AG, Eggly S. A Review of Research on Disparities in the Care of Black and White Patients With Cancer in Detroit. Front Oncol 2021; 11:690390. [PMID: 34336677 PMCID: PMC8320812 DOI: 10.3389/fonc.2021.690390] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/08/2021] [Indexed: 02/01/2023] Open
Abstract
Racial disparities in cancer incidence and outcomes are well-documented in the US, with Black people having higher incidence rates and worse outcomes than White people. In this review, we present a summary of almost 30 years of research conducted by investigators at the Karmanos Cancer Institute's (KCI's) Population Studies and Disparities Research (PSDR) Program focusing on Black-White disparities in cancer incidence, care, and outcomes. The studies in the review focus on individuals diagnosed with cancer from the Detroit Metropolitan area, but also includes individuals included in national databases. Using an organizational framework of three generations of studies on racial disparities, this review describes racial disparities by primary cancer site, disparities associated with the presence or absence of comorbid medical conditions, disparities in treatment, and disparities in physician-patient communication, all of which contribute to poorer outcomes for Black cancer patients. While socio-demographic and clinical differences account for some of the noted disparities, further work is needed to unravel the influence of systemic effects of racism against Black people, which is argued to be the major contributor to disparate outcomes between Black and White patients with cancer. This review highlights evidence-based strategies that have the potential to help mitigate disparities, improve care for vulnerable populations, and build an equitable healthcare system. Lessons learned can also inform a more equitable response to other health conditions and crises.
Collapse
Affiliation(s)
- Michael S. Simon
- Department of Oncology, Wayne State University, Detroit, MI, United States
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, United States
| | - Sreejata Raychaudhuri
- Department of Hematology/Oncology, Ascension Providence Hospital/Michigan State University College of Human Medicine (MSUCHM), Southfield, MI, United States
| | - Lauren M. Hamel
- Department of Oncology, Wayne State University, Detroit, MI, United States
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, United States
| | - Louis A. Penner
- Department of Oncology, Wayne State University, Detroit, MI, United States
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, United States
| | - Kendra L. Schwartz
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, United States
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, United States
| | - Felicity W. K. Harper
- Department of Oncology, Wayne State University, Detroit, MI, United States
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, United States
| | - Hayley S. Thompson
- Department of Oncology, Wayne State University, Detroit, MI, United States
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, United States
| | - Jason C. Booza
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, United States
- Department of Academic and Student Programs, Wayne State University, Detroit, MI, United States
| | - Michele Cote
- Department of Oncology, Wayne State University, Detroit, MI, United States
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, United States
| | - Ann G. Schwartz
- Department of Oncology, Wayne State University, Detroit, MI, United States
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, United States
| | - Susan Eggly
- Department of Oncology, Wayne State University, Detroit, MI, United States
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, United States
| |
Collapse
|
17
|
Robbins MA, Awosogba OOR, Knox-Rice TK. Cancer, COVID-19, and the Black community. J Psychosoc Oncol 2021; 39:305-308. [PMID: 33687308 DOI: 10.1080/07347332.2021.1893420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Mona A Robbins
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas, USA
| | - Olufunke O R Awosogba
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Parkland Health and Hospital System, Hematology and Oncology Outpatient Clinic, Dallas, Texas, USA
| | - Tori K Knox-Rice
- The Colorado Blood Cancer Institute at Presbyterian/St. Luke's Medical Center, Denver, Colorado, USA
| |
Collapse
|
18
|
Ibilibor C, Moses KA. Putting nonverbal communication under a lens: An examination of the dynamic interplay of patient-provider interactions between Black patients and non-Black physicians. Cancer 2020; 127:1008-1009. [PMID: 33290591 DOI: 10.1002/cncr.33353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/02/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Christine Ibilibor
- Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Kelvin A Moses
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
19
|
McCall MK, Connolly M, Nugent B, Conley YP, Bender CM, Rosenzweig MQ. Symptom Experience, Management, and Outcomes According to Race and Social Determinants Including Genomics, Epigenomics, and Metabolomics (SEMOARS + GEM): an Explanatory Model for Breast Cancer Treatment Disparity. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:428-440. [PMID: 31392599 PMCID: PMC7245588 DOI: 10.1007/s13187-019-01571-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Even after controlling for stage, comorbidity, age, and insurance status, black women with breast cancer (BC) in the USA have the lowest 5-year survival as compared with all other races for stage-matched disease. One potential cause of this survival difference is the disparity in cancer treatment, evident in many population clinical trials. Specifically, during BC chemotherapy, black women receive less relative dose intensity with more dose reductions and early chemotherapy cessation compared with white women. Symptom incidence, cancer-related distress, and ineffective communication, including the disparity in patient-centeredness of care surrounding patient symptom reporting and clinician assessment, are important factors contributing to racial disparity in dose reduction and early therapy termination. We present an evidence-based overview and an explanatory model for racial disparity in the symptom experience during BC chemotherapy that may lead to a reduction in dose intensity and a subsequent disparity in outcomes. This explanatory model, the Symptom Experience, Management, Outcomes and Adherence according to Race and Social determinants + Genomics Epigenomics and Metabolomics (SEMOARS + GEM), considers essential factors such as social determinants of health, clinician communication, symptoms and symptom management, genomics, epigenomics, and pharmacologic metabolism as contributory factors.
Collapse
Affiliation(s)
- Maura K. McCall
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Mary Connolly
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Bethany Nugent
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Yvette P. Conley
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Catherine M. Bender
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Margaret Q. Rosenzweig
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| |
Collapse
|
20
|
Niranjan SJ, Martin MY, Fouad MN, Vickers SM, Wenzel JA, Cook ED, Konety BR, Durant RW. Bias and stereotyping among research and clinical professionals: Perspectives on minority recruitment for oncology clinical trials. Cancer 2020; 126:1958-1968. [PMID: 32147815 DOI: 10.1002/cncr.32755] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/21/2019] [Accepted: 12/16/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND In recent years, extensive attention has been paid to the possibility that bias among health care professionals contributes to health disparities. In its 2003 report, the Institute of Medicine concluded that bias against racial minorities may affect communication or care offered. However, to the authors' knowledge, the role of bias within the context of recruitment of racial and ethnic minorities to cancer clinical trials has not been explored to date. Therefore, the authors assessed the experiences of clinical and research personnel related to factors influencing the recruitment of racial and ethnic minorities for cancer clinical trials. METHODS A total of 91 qualitative interviews were conducted at 5 US cancer centers among 4 stakeholder groups: 1) cancer center leaders; 2) principal investigators; 3) referring clinicians; and 4) research staff. Data analysis was conducted using a content analysis approach to generate themes from the transcribed interviews. RESULTS Five prominent themes emerged: 1) recruitment interactions with potential minority participants were perceived to be challenging; 2) potential minority participants were not perceived to be ideal study candidates; 3) a combination of clinic-level barriers and negative perceptions of minority study participants led to providers withholding clinical trial opportunities from potential minority participants; 4) when clinical trial recruitment practices were tailored to minority patients, addressing research misconceptions to build trust was a common strategy; 5) for some respondents, race was perceived as irrelevant when screening and recruiting potential minority participants for clinical trials. CONCLUSIONS Not only did some respondents view racial and ethnic minorities as less promising participants, some respondents reported withholding trial opportunities from minorities based on these perceptions. Some providers endorsed using tailored recruitment strategies whereas others eschewed race as a factor in trial recruitment. The presence of bias and stereotyping among clinical and research professionals recruiting for cancer clinical trials should be considered when designing interventions to increase minority enrollment.
Collapse
Affiliation(s)
- Soumya J Niranjan
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michelle Y Martin
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mona N Fouad
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Selwyn M Vickers
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jennifer A Wenzel
- Department of Acute and Chronic Care, Johns Hopkins University, Baltimore, Maryland
| | - Elise D Cook
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Raegan W Durant
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
21
|
Editor's Choice: Deliberative and non-deliberative effects of descriptive and injunctive norms on cancer screening behaviors among African Americans. Psychol Health 2019; 35:774-794. [PMID: 31747816 DOI: 10.1080/08870446.2019.1691725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Two longitudinal studies examined whether effects of subjective norms on secondary cancer prevention behaviors were stronger and more likely to non-deliberative (i.e., partially independent of behavioral intentions) for African Americans (AAs) compared to European Americans (EAs), and whether the effects were moderated by racial identity. Design: Study 1 examined between-race differences in predictors of physician communication following receipt of notifications about breast density. Study 2 examined predictors of prostate cancer screening among AA men who had not been previously screened.Main Outcome Measures: Participants' injunctive and descriptive normative perceptions; racial identity (Study 2); self-reported physician communication (Study 1) and PSA testing (Study 2) behaviors at follow up. Results: In Study 1, subjective norms were significantly associated with behaviors for AAs, but not for EAs. Moreover, there were significant non-deliberative effects of norms for AAs. In Study 2, there was further evidence of non-deliberative effects of subjective norms for AAs. Non-deliberative effects of descriptive norms were stronger for AAs who more strongly identified with their racial group. Conclusion: Subjective norms, effects of which are non-deliberative and heightened by racial identity, may be a uniquely robust predictor of secondary cancer prevention behaviors for AAs. Implications for targeted screening interventions are discussed.
Collapse
|
22
|
Senft N, Butler E, Everson J. Growing Disparities in Patient-Provider Messaging: Trend Analysis Before and After Supportive Policy. J Med Internet Res 2019; 21:e14976. [PMID: 31593539 PMCID: PMC6803888 DOI: 10.2196/14976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Public policy introduced since 2011 has supported provider adoption of electronic medical records (EMRs) and patient-provider messaging, primarily through financial incentives. It is unclear how disparities in patients' use of incentivized electronic health (eHealth) tools, like patient-provider messaging, have changed over time relative to disparities in use of eHealth tools that were not directly incentivized. OBJECTIVE This study examines trends in eHealth disparities before and after the introduction of US federal financial incentives. We compare rates of patient-provider messaging, which was directly incentivized, with rates of looking for health information on the Web, which was not directly incentivized. METHODS We used nationally representative Health Information National Trends Survey data from 2003 to 2018 (N=37,300) to describe disparities in patient-provider messaging and looking for health information on the Web. We first reported the percentage of individuals across education and racial and ethnic groups who reported using these tools in each survey year and compared changes in unadjusted disparities during preincentive (2003-2011) and postincentive (2011-2018) periods. Using multivariable linear probability models, we then examined adjusted effects of education and race and ethnicity in 3 periods-preincentive (2003-2005), early incentive (2011-2013), and postincentive (2017-2018)-controlling for sociodemographic and health factors. In the postincentive period, an additional model tested whether internet adoption, provider access, or providers' use of EMRs explained disparities. RESULTS From 2003 to 2018, overall rates of provider messaging increased from 4% to 36%. The gap in provider messaging between the highest and lowest education groups increased by 10 percentage points preincentive (P<.001) and 22 additional points postincentive (P<.001). The gap between Hispanics and non-Hispanic whites increased by 3.2 points preincentive (P=.42) and 11 additional points postincentive (P=.01). Trends for blacks resembled those for Hispanics, whereas trends for Asians resembled those for non-Hispanic whites. In contrast, education-based disparities in looking for health information on the Web (which was not directly incentivized) did not significantly change in preincentive or postincentive periods, whereas racial disparities narrowed by 15 percentage points preincentive (P=.008) and did not significantly change postincentive. After adjusting for other sociodemographic and health factors, observed associations were similar to unadjusted associations, though smaller in magnitude. Including internet adoption, provider access, and providers' use of EMRs in the postincentive model attenuated, but did not eliminate, education-based disparities in provider messaging and looking for health information on the Web. Racial and ethnic disparities were no longer statistically significant in adjusted models. CONCLUSIONS Disparities in provider messaging widened over time, particularly following federal financial incentives. Meanwhile, disparities in looking for health information on the Web remained stable or narrowed. Incentives may have disproportionately benefited socioeconomically advantaged groups. Future policy could address disparities by incentivizing providers treating these populations to adopt messaging capabilities and encouraging patients' use of messaging.
Collapse
Affiliation(s)
- Nicole Senft
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Evan Butler
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Jordan Everson
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, United States
| |
Collapse
|
23
|
Manning M, Albrecht TL, Penner L, Purrington K. Between-Race Differences in Processes Predicting Physician Communication for African American and European American Recipients of Breast Density Notifications. Ann Behav Med 2019; 53:721-731. [PMID: 30285074 PMCID: PMC7331452 DOI: 10.1093/abm/kay079] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Breast density notification laws mandate reporting of dense breast to applicable women. The same psychological and systemic barriers that yield between-race differences in mammography use will probably yield between-race differences in women's psychological and behavioral responses to breast density notifications. PURPOSE We used the theory of planned behavior as a framework to examine between-race differences in the likelihood of following-up with physicians after receiving breast density notifications and to examine differences in African American and Caucasian American women's behavioral decision-making processes. METHODS A subset of 212 African American and Caucasian American women who participated in an initial and follow-up survey examining responses to breast density notifications were examined for this study. Participants reported background and demographic measures, psychological responses to receiving notifications, and planned behavior measures related to following up with physicians approximately 2 weeks after receiving their mammogram reports. Participants self-reported their behaviors 3 months later. RESULTS There were no between-race differences in self-reported physician communication; however, there were differences in processes that predicted behavior. For Caucasian American women, behavioral intentions, education, and income predicted behaviors. Instead of intentions, group-based medical suspicion, confusion, breast cancer worry, and breast density anxiety predicted behaviors for African American women. CONCLUSIONS Behavioral decision-making processes for Caucasian American women were in line with well-validated theoretical predictions. For African American women, race-related medical suspicion, prior breast density awareness, and emotional responses to breast density notifications predicted behavior. The results highlight the need to focus on racially distinct psychological targets when designing interventions to support guideline concordant behavioral decisions among women who receive breast density notifications.
Collapse
Affiliation(s)
- Mark Manning
- Department of Oncology, Karmanos Cancer Institute/Wayne State University School of Medicine, Detroit, MI, USA
| | - Terrance L Albrecht
- Department of Oncology, Karmanos Cancer Institute/Wayne State University School of Medicine, Detroit, MI, USA
| | - Louis Penner
- Department of Oncology, Karmanos Cancer Institute/Wayne State University School of Medicine, Detroit, MI, USA
| | - Kristen Purrington
- Department of Oncology, Karmanos Cancer Institute/Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|
24
|
Hamel LM, Moulder R, Albrecht TL, Boker S, Eggly S, Penner LA. Nonverbal synchrony as a behavioural marker of patient and physician race-related attitudes and a predictor of outcomes in oncology interactions: protocol for a secondary analysis of video-recorded cancer treatment discussions. BMJ Open 2018; 8:e023648. [PMID: 30518586 PMCID: PMC6286484 DOI: 10.1136/bmjopen-2018-023648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Racial disparities in cancer treatment contribute to racial disparities in mortality rates. The quality of patient-physician communication during clinical interactions with black patients and non-black physicians (racially discordant) is poorer than communication quality with white patients (racially concordant). Patient and physician race-related attitudes affect the quality of this communication. These attitudes are likely expressed through subtle non-verbal behaviours, but prior research has not examined these behaviours. Nonverbal synchrony, the coordination of physical movement, reflects the preinteraction attitudes of participants in interactions and predicts their postinteraction perceptions of and affect towards one another. In this study, peer reviewed and funded by the National Institute of Minority Health and Health Disparities (R21MD011766), we will investigate non-verbal synchrony in racially concordant and discordant interactions to better understand racial disparities in clinical communication. METHODS AND ANALYSIS This secondary analysis includes racially concordant (n=163) and racially discordant (n=68) video-recorded oncology interactions, patient and oncologist self-reported race-related attitudes, perceptions of the interaction and observer ratings of physician patient-centred communication and patient and physician affect and rapport. In aim 1, we will assess and compare non-verbal synchrony between physicians and patients in racially concordant and discordant interactions. In aim 2, we will determine the influence of non-verbal synchrony on patient and physician affect and communication. In aim 3, we will examine possible causes (ie, race-related attitudes) and consequences (ie, negative perceptions) of non-verbal synchrony in racially discordant interactions. In aim 4, we will develop and test a mediational model linking physician and patient race-related attitudes to non-verbal synchrony and, in turn, interaction outcomes. ETHICS AND DISSEMINATION The parent and current studies were approved by the Wayne State University Institutional Review Board. Since only archival data will be used, ethical or safety risks are low. We will disseminate our findings to relevant conferences and journals.
Collapse
Affiliation(s)
- Lauren M Hamel
- Department of Oncology, School of Medicine, Wayne State University/Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Robert Moulder
- Department of Psychology, University of Virginia, Charlottesville, Virginia, USA
| | - Terrance L Albrecht
- Department of Oncology, School of Medicine, Wayne State University/Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Steven Boker
- Department of Psychology, University of Virginia, Charlottesville, Virginia, USA
| | - Susan Eggly
- Department of Oncology, School of Medicine, Wayne State University/Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Louis A Penner
- Department of Oncology, School of Medicine, Wayne State University/Karmanos Cancer Institute, Detroit, Michigan, USA
| |
Collapse
|
25
|
Green AK, Aviki EM, Matsoukas K, Patil S, Korenstein D, Blinder V. Racial disparities in chemotherapy administration for early-stage breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 2018; 172:247-263. [PMID: 30094552 DOI: 10.1007/s10549-018-4909-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/02/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE We conducted a systematic review and meta-analysis to measure the extent to which race is associated with delayed initiation or receipt of inadequate chemotherapy among women with early-stage breast cancer. METHODS We performed a systematic search of all articles published from January 1987 until June 2017 within four databases: PubMed/Medline, EMBASE, CINAHL, and Cochrane CENTRAL. Eligible studies were US-based and examined the influence of race on chemotherapy delays, cessation, or dose reductions among women with stage I, II, or III breast cancer. Data were pooled using a random effects model. RESULTS A total of twelve studies were included in the quantitative analysis. Blacks were significantly more likely than whites to have delays to initiation of adjuvant therapy of 90 days or more (OR 1.41, 95% CI 1.06-1.87; X² = 31.05, p < 0.00001; I² = 90%). There was no significant association between race and chemotherapy dosing. Due to overlap between studies assessing the relationship between race and completion of chemotherapy, we conducted two separate analyses. Black patients were significantly more likely to discontinue chemotherapy, however, this was no longer statistically significant when larger numbers of patients with more advanced (stage III) breast cancer were included. CONCLUSIONS These results suggest that black breast cancer patients experience clinically relevant delays in the initiation of adjuvant chemotherapy more often than white patients, which may in part explain the increased mortality observed among black patients.
Collapse
Affiliation(s)
- Angela K Green
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Emeline M Aviki
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | | | - Sujata Patil
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Deborah Korenstein
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Victoria Blinder
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| |
Collapse
|
26
|
Penner LA, Dovidio JF, Hagiwara N, Foster T, Albrecht TL, Chapman RA, Eggly S. An Analysis of Race-related Attitudes and Beliefs in Black Cancer Patients: Implications for Health Care Disparities. J Health Care Poor Underserved 2018; 27:1503-20. [PMID: 27524781 DOI: 10.1353/hpu.2016.0115] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This research concerned relationships among Black cancer patients' health care attitudes and behaviors (e.g., adherence, decisional control preferences,) and their race-related attitudes and beliefs shaped by (a) general life experiences (i.e., perceived discrimination, racial identity) and (b) experiences interacting with health care systems (i.e., physician mistrust, suspicion about medical care). Perceived discrimination, racial identity, and medical suspicion correlated weakly with one another; mistrust and suspicion correlated only moderately. Race-related attitudes and beliefs were associated with health care attitudes and behavior, but patterns of association varied. Physician mistrust and medical suspicion each independently correlated with adherence and decisional control preferences, but discrimination only correlated with control preferences. Associations among patients' different racial attitudes/beliefs are more complex than previously assumed. Interventions that target patient attitudes/beliefs and health care disparities might be more productive if they focus on mistrust or suspicion specific to health care providers/systems and their correlates identified in this study.
Collapse
|
27
|
Eggly S, Hamel LM, Foster TS, Albrecht TL, Chapman R, Harper FWK, Thompson H, Griggs JJ, Gonzalez R, Berry-Bobovski L, Tkatch R, Simon M, Shields A, Gadgeel S, Loutfi R, Ali H, Wollner I, Penner LA. Randomized trial of a question prompt list to increase patient active participation during interactions with black patients and their oncologists. PATIENT EDUCATION AND COUNSELING 2017; 100:818-826. [PMID: 28073615 PMCID: PMC5400698 DOI: 10.1016/j.pec.2016.12.026] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 12/22/2016] [Accepted: 12/25/2016] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Communication during racially-discordant interactions is often of poor quality and may contribute to racial treatment disparities. We evaluated an intervention designed to increase patient active participation and other communication-related outcomes during interactions between Black patients and non-Black oncologists. METHODS Participants were 18 non-Black medical oncologists and 114 Black patients at two cancer hospitals in Detroit, Michigan, USA. Before a clinic visit to discuss treatment, patients were randomly assigned to usual care or to one of two question prompt list (QPL) formats: booklet (QPL-Only), or booklet and communication coach (QPL-plus-Coach). Patient-oncologist interactions were video recorded. Patients reported perceptions of the intervention, oncologist communication, role in treatment decisions, and trust in the oncologist. Observers assessed interaction length, patient active participation, and oncologist communication. RESULTS The intervention was viewed positively and did not increase interaction length. The QPL-only format increased patient active participation; the QPL-plus-Coach format decreased patient perceptions of oncologist communication. No other significant effects were found. CONCLUSION This QPL booklet is acceptable and increases patient active participation in racially-discordant oncology interactions. Future research should investigate whether adding physician-focused interventions might improve other outcomes. PRACTICE IMPLICATIONS This QPL booklet is acceptable and can improve patient active participation in racially-discordant oncology interactions.
Collapse
Affiliation(s)
- Susan Eggly
- Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI, USA.
| | - Lauren M Hamel
- Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI, USA
| | - Tanina S Foster
- Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI, USA
| | - Terrance L Albrecht
- Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI, USA
| | - Robert Chapman
- Henry Ford Hospital/Josephine Ford Cancer Institute, Detroit, MI, USA
| | - Felicity W K Harper
- Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI, USA
| | - Hayley Thompson
- Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI, USA
| | | | | | - Lisa Berry-Bobovski
- Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI, USA
| | - Rifky Tkatch
- Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI, USA
| | - Michael Simon
- Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI, USA
| | - Anthony Shields
- Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI, USA
| | - Shirish Gadgeel
- Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI, USA
| | - Randa Loutfi
- Henry Ford Hospital/Josephine Ford Cancer Institute, Detroit, MI, USA
| | - Haythem Ali
- Henry Ford Hospital/Josephine Ford Cancer Institute, Detroit, MI, USA
| | - Ira Wollner
- Henry Ford Hospital/Josephine Ford Cancer Institute, Detroit, MI, USA
| | - Louis A Penner
- Wayne State University/Karmanos Cancer Institute, 4100 John R, Detroit, MI, USA
| |
Collapse
|
28
|
Moses KA, Underwood W. Author Reply. Urology 2017; 99:83. [PMID: 28341021 DOI: 10.1016/j.urology.2016.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kelvin A Moses
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Willie Underwood
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY; Department of Urology, Roswell Park Cancer Institute, Buffalo, NY
| |
Collapse
|
29
|
The Effects of Race and Racial Concordance on Patient-Physician Communication: A Systematic Review of the Literature. J Racial Ethn Health Disparities 2017; 5:117-140. [PMID: 28275996 DOI: 10.1007/s40615-017-0350-4] [Citation(s) in RCA: 568] [Impact Index Per Article: 81.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 02/02/2017] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Racial disparities exist in health care, even when controlling for relevant sociodemographic variables. Recent data suggest disparities in patient-physician communication may also contribute to racial disparities in health care. This study aimed to systematically review studies examining the effect of black race and racial concordance on patient-physician communication. METHODS A comprehensive search using the PRISMA guidelines was conducted across seven online databases between 1995 and 2016. The search resulted in 4672 records for review and 40 articles for final inclusion in the review. Studies were included when the sample consisted of black patients in healthcare contexts and the communication measure was observational or patient-reported. Data were extracted by pairs of authors who independently coded articles and reconciled discrepancies. Results were synthesized according to predictor (race or racial concordance) and communication domain. RESULTS Studies were heterogeneous in health contexts and communication measures. Results indicated that black patients consistently experienced poorer communication quality, information-giving, patient participation, and participatory decision-making than white patients. Results were mixed for satisfaction, partnership building, length of visit, and talk-time ratio. Racial concordance was more clearly associated with better communication across all domains except quality, for which there was no effect. CONCLUSIONS Despite mixed results due to measurement heterogeneity, results of the present review highlight the importance of training physicians and patients to engage in higher quality communication with black and racially discordant patients by focusing on improving patient-centeredness, information-giving, partnership building, and patient engagement in communication processes.
Collapse
|
30
|
Hamel LM, Penner LA, Eggly S, Chapman R, Klamerus JF, Simon MS, Stanton SCE, Albrecht TL. Do Patients and Oncologists Discuss the Cost of Cancer Treatment? An Observational Study of Clinical Interactions Between African American Patients and Their Oncologists. J Oncol Pract 2016; 13:e249-e258. [PMID: 27960067 DOI: 10.1200/jop.2016.015859] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Financial toxicity negatively affects patients with cancer, especially racial/ethnic minorities. Patient-oncologist discussions about treatment-related costs may reduce financial toxicity by factoring costs into treatment decisions. This study investigated the frequency and nature of cost discussions during clinical interactions between African American patients and oncologists and examined whether cost discussions were affected by patient sociodemographic characteristics and social support, a known buffer to perceived financial stress. Methods Video recorded patient-oncologist clinical interactions (n = 103) from outpatient clinics of two urban cancer hospitals (including a National Cancer Institute-designated comprehensive cancer center) were analyzed. Coders studied the videos for the presence and duration of cost discussions and then determined the initiator, topic, oncologist response to the patient's concerns, and the patient's reaction to the oncologist's response. RESULTS Cost discussions occurred in 45% of clinical interactions. Patients initiated 63% of discussions; oncologists initiated 36%. The most frequent topics were concern about time off from work for treatment (initiated by patients) and insurance (initiated by oncologists). Younger patients and patients with more perceived social support satisfaction were more likely to discuss cost. Patient age interacted with amount of social support to affect frequency of cost discussions within interactions. Younger patients with more social support had more cost discussions; older patients with more social support had fewer cost discussions. CONCLUSION Cost discussions occurred in fewer than one half of the interactions and most commonly focused on the impact of the diagnosis on patients' opportunity costs rather than treatment costs. Implications for ASCO's Value Framework and design of interventions to improve cost discussions are discussed.
Collapse
Affiliation(s)
- Lauren M Hamel
- Karmanos Cancer Institute, Wayne State University and Josephine Ford Cancer Institute, Henry Ford Health System, Detroit, MI
| | - Louis A Penner
- Karmanos Cancer Institute, Wayne State University and Josephine Ford Cancer Institute, Henry Ford Health System, Detroit, MI
| | - Susan Eggly
- Karmanos Cancer Institute, Wayne State University and Josephine Ford Cancer Institute, Henry Ford Health System, Detroit, MI
| | - Robert Chapman
- Karmanos Cancer Institute, Wayne State University and Josephine Ford Cancer Institute, Henry Ford Health System, Detroit, MI
| | - Justin F Klamerus
- Karmanos Cancer Institute, Wayne State University and Josephine Ford Cancer Institute, Henry Ford Health System, Detroit, MI
| | - Michael S Simon
- Karmanos Cancer Institute, Wayne State University and Josephine Ford Cancer Institute, Henry Ford Health System, Detroit, MI
| | - Sarah C E Stanton
- Karmanos Cancer Institute, Wayne State University and Josephine Ford Cancer Institute, Henry Ford Health System, Detroit, MI
| | - Terrance L Albrecht
- Karmanos Cancer Institute, Wayne State University and Josephine Ford Cancer Institute, Henry Ford Health System, Detroit, MI
| |
Collapse
|
31
|
Manning M, Albrecht TL, Yilmaz-Saab Z, Shultz J, Purrington K. Influences of race and breast density on related cognitive and emotion outcomes before mandated breast density notification. Soc Sci Med 2016; 169:171-179. [PMID: 27733299 PMCID: PMC6816018 DOI: 10.1016/j.socscimed.2016.09.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
RATIONALE Many states have adopted laws mandating breast density (BD) notification for applicable women; however, very little is known about what women knew or felt about BD and related breast cancer (BC) risk before implementation of BD notification laws. OBJECTIVE We examined between-race differences in the extent to which having dense breasts was associated with women's related BD cognition and emotion, and with health care providers' communication about BD. METHODS We received surveys between May and October of 2015 assessing health care provider (HCP) communication about BD, BD-related knowledge, BD-related anxiety and BC worry from 182 African American (AA) and 113 European American (EA) women in the state of Michigan for whom we had radiologists' assessments of BD. RESULTS Whereas having dense breasts was not associated with any BD-related cognition or emotion, there were robust effects of race as follows: EA women were more likely to have been told about BD by a HCP, more likely to know their BD status, had greater knowledge of BD and of BC risk, and had greater perceptions of BC risk and worry; AA women had greater BD-related anxieties. EA women's greater knowledge of their own BD status was directly related to the increased likelihood of HCP communication about BD. However, HCP communication about BD attenuated anxiety for AA women only. CONCLUSION We present the only data of which we are aware that examines between-race differences in the associations between actual BD, HCP communication and BD related cognition and emotion before the implementation of BD notification laws. Our findings suggest that the BD notification laws could yield positive benefits for disparities in BD-related knowledge and anxiety when the notifications are followed by discussions with health care providers.
Collapse
Affiliation(s)
- Mark Manning
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Rd, Detroit, MI 48201, United States.
| | - Terrance L Albrecht
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Rd, Detroit, MI 48201, United States
| | - Zeynep Yilmaz-Saab
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Rd, Detroit, MI 48201, United States
| | - Julie Shultz
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Rd, Detroit, MI 48201, United States
| | - Kristen Purrington
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Rd, Detroit, MI 48201, United States
| |
Collapse
|
32
|
Penner LA, Dovidio JF, Gonzalez R, Albrecht TL, Chapman R, Foster T, Harper FWK, Hagiwara N, Hamel LM, Shields AF, Gadgeel S, Simon MS, Griggs JJ, Eggly S. The Effects of Oncologist Implicit Racial Bias in Racially Discordant Oncology Interactions. J Clin Oncol 2016; 34:2874-80. [PMID: 27325865 DOI: 10.1200/jco.2015.66.3658] [Citation(s) in RCA: 209] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE Health providers' implicit racial bias negatively affects communication and patient reactions to many medical interactions. However, its effects on racially discordant oncology interactions are largely unknown. Thus, we examined whether oncologist implicit racial bias has similar effects in oncology interactions. We further investigated whether oncologist implicit bias negatively affects patients' perceptions of recommended treatments (i.e., degree of confidence, expected difficulty). We predicted oncologist implicit bias would negatively affect communication, patient reactions to interactions, and, indirectly, patient perceptions of recommended treatments. METHODS Participants were 18 non-black medical oncologists and 112 black patients. Oncologists completed an implicit racial bias measure several weeks before video-recorded treatment discussions with new patients. Observers rated oncologist communication and recorded interaction length of time and amount of time oncologists and patients spoke. Following interactions, patients answered questions about oncologists' patient-centeredness and difficulty remembering contents of the interaction, distress, trust, and treatment perceptions. RESULTS As predicted, oncologists higher in implicit racial bias had shorter interactions, and patients and observers rated these oncologists' communication as less patient-centered and supportive. Higher implicit bias also was associated with more patient difficulty remembering contents of the interaction. In addition, oncologist implicit bias indirectly predicted less patient confidence in recommended treatments, and greater perceived difficulty completing them, through its impact on oncologists' communication (as rated by both patients and observers). CONCLUSION Oncologist implicit racial bias is negatively associated with oncologist communication, patients' reactions to racially discordant oncology interactions, and patient perceptions of recommended treatments. These perceptions could subsequently directly affect patient-treatment decisions. Thus, implicit racial bias is a likely source of racial treatment disparities and must be addressed in oncology training and practice.
Collapse
Affiliation(s)
- Louis A Penner
- Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA.
| | - John F Dovidio
- Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA
| | - Richard Gonzalez
- Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA
| | - Terrance L Albrecht
- Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA
| | - Robert Chapman
- Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA
| | - Tanina Foster
- Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA
| | - Felicity W K Harper
- Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA
| | - Nao Hagiwara
- Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA
| | - Lauren M Hamel
- Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA
| | - Anthony F Shields
- Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA
| | - Shirish Gadgeel
- Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA
| | - Michael S Simon
- Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA
| | - Jennifer J Griggs
- Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA
| | - Susan Eggly
- Louis A. Penner, Terrance L. Albrecht, Tanina Foster, Felicity W.K. Harper, Lauren M. Hamel, Anthony F. Shields, Shirish Gadgeel, Michael S. Simon, and Susan Eggly, Wayne State University; Robert Chapman, Henry Ford Health Care System, Detroit; Richard Gonzalez and Jennifer J. Griggs, University of Michigan, Ann Arbor, MI; John F. Dovidio, Yale University, New Haven, CT; and Nao Hagiwara, Virginia Commonwealth University, Richmond, VA
| |
Collapse
|
33
|
Noel L, Connors SK, Goodman MS, Gehlert S. Improving breast cancer services for African-American women living in St. Louis. Breast Cancer Res Treat 2015; 154:5-12. [PMID: 26409834 PMCID: PMC4621693 DOI: 10.1007/s10549-015-3584-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/22/2015] [Indexed: 11/25/2022]
Abstract
A mixed methods, community-based research study was conducted to understand how provider-level factors contribute to the African-American and white disparity in breast cancer mortality in a lower socioeconomic status area of North St. Louis. This study used mixed methods including: (1) secondary analysis of Missouri Cancer Registry data on all 885 African-American women diagnosed with breast cancer from 2000 to 2008 while living in the geographic area of focus; (2) qualitative interviews with a subset of these women; (3) analysis of data from electronic medical records of the women interviewed; and (4) focus group interviews with community residents, patient navigators, and other health care professionals. 565 women diagnosed with breast cancer from 2000 to 2008 in the geographic area were alive at the time of secondary data analysis; we interviewed (n = 96; 17 %) of these women. Provider-level obstacles to completion of prescribed treatment included fragmented navigation (separate navigators at Federally Qualified Health Centers, surgical oncology, and medical oncology, and no navigation services in surgical oncology). Perhaps related to the latter, women described radiation as optional, often in the same words as they described breast reconstruction. Discontinuous and fragmented patient navigation leads to failure to associate radiation therapy with vital treatment recommendations. Better integrated navigation that continues throughout treatment will increase treatment completion with the potential to improve outcomes in African Americans and decrease the disparity in mortality.
Collapse
Affiliation(s)
- Lailea Noel
- George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Shahnjayla K Connors
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave., St. Louis, MO, 63110, USA
| | - Melody S Goodman
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave., St. Louis, MO, 63110, USA
| | - Sarah Gehlert
- George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
| |
Collapse
|
34
|
Brooks SE, Muller CY, Robinson W, Walker EM, Yeager K, Cook ED, Friedman S, Somkin CP, Brown CL, McCaskill-Stevens W. Increasing Minority Enrollment Onto Clinical Trials: Practical Strategies and Challenges Emerge From the NRG Oncology Accrual Workshop. J Oncol Pract 2015; 11:486-90. [PMID: 26464496 DOI: 10.1200/jop.2015.005934] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Racial and ethnic diversity has historically been difficult to achieve in National Cancer Institute-sponsored clinical trials, even while as many as 80% of those trials have faced difficulty in meeting overall recruitment targets. In an attempt to address these issues, NRG Oncology recently convened a comprehensive workshop titled "Clinical Trials Enrollment: Challenges and Opportunities." Discussants at the workshop included representatives of the three legacy groups of the NRG (ie, Gynecologic Oncology Group, National Surgical Adjuvant Breast and Bowel Program, and Radiation Therapy Oncology Group), a minority-based community clinical oncology program, a large integrated health care system, the leadership of the National Cancer Institute, and a large patient advocacy group. This article summarizes the concepts discussed at the workshop, which included: needs assessments, infrastructural support, training of investigators and research staff, specific clinical trial recruitment strategies (both system and community based), and development and mentoring of young investigators. Many new, more specific tactics, including use of diverse cancer care settings, direct-to-consumer communication, and the need for centralized information technology such as the use of software to match trials to special populations, are presented. It was concluded that new, innovative trial designs and the realities of limited funding would require the adoption of effective and efficient recruiting strategies, specialized training, and stakeholder engagement. US clinical research programs must generate and embrace new ideas and pilot test novel recruitment strategies if they are to maintain their historic role as world leaders in cancer care innovation and delivery.
Collapse
Affiliation(s)
- Sandra E Brooks
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Carolyn Y Muller
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - William Robinson
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Eleanor M Walker
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Kate Yeager
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Elise D Cook
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Sue Friedman
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Carol P Somkin
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Carol Leslie Brown
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| | - Worta McCaskill-Stevens
- CompleteCare Health Network, Bridgeton, NJ; University of New Mexico, Albuquerque, NM; Tulane University, New Orleans, LA; Henry Ford Hospital, Detroit, MI; Emory University, Atlanta, GA; University of Texas MD Anderson Cancer Center, Houston, TX; Facing Our Risk of Cancer Empowered, Tampa, FL; Kaiser Permanente, Oakland, CA; Memorial Sloan Kettering Cancer Center, New York, NY; and National Cancer Institute, Bethesda, MD
| |
Collapse
|
35
|
Eggly S, Barton E, Winckles A, Penner LA, Albrecht TL. A disparity of words: racial differences in oncologist-patient communication about clinical trials. Health Expect 2015; 18:1316-26. [PMID: 23910630 PMCID: PMC3859820 DOI: 10.1111/hex.12108] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND African Americans are consistently underrepresented in cancer clinical trials. Minority under-enrolment may be, in part, due to differences in the way clinical trials are discussed in oncology visits with African American vs. White patients. OBJECTIVE To investigate differences in oncologist-patient communication during offers to participate in clinical trials in oncology visits with African American and White patients. METHODS From an archive of video-recorded oncology visits, we selected all visits with African American patients that included a trial offer (n = 11) and a matched sample of visits with demographically/medically comparable White patients (n = 11). Using mixed qualitative-quantitative methods, we assessed differences by patient race in (i) word count of entire visits and (ii) frequency of mentions and word count of discussions of clinical trials and key elements of consent. RESULTS Visits with African American patients, compared to visits with White patients, were shorter overall and included fewer mentions of and less discussion of clinical trials. Also, visits with African Americans included less discussion of the purpose and risks of trials offered, but more discussion of voluntary participation. DISCUSSION AND CONCLUSIONS African American patients may make decisions about clinical trial participation based on less discussion with oncologists than do White patients. Possible explanations include a less active communication style of African Americans in medical visits, oncologists' concerns about patient mistrust, and/or oncologist racial bias. Findings suggest oncologists should pay more conscious attention to developing the topic of clinical trials with African American patients, particularly purpose and risks.
Collapse
Affiliation(s)
- Susan Eggly
- Department of OncologyWayne State UniversityDetroitMIUSA
| | - Ellen Barton
- Department of EnglishWayne State UniversityDetroitMIUSA
| | | | | | | |
Collapse
|
36
|
Hamel LM, Chapman R, Malloy M, Eggly S, Penner LA, Shields AF, Simon MS, Klamerus JF, Schiffer C, Albrecht TL. Critical Shortage of African American Medical Oncologists in the United States. J Clin Oncol 2015; 33:3697-700. [PMID: 26392105 DOI: 10.1200/jco.2014.59.2493] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Lauren M Hamel
- Karmanos Cancer Institute/Wayne State University, Detroit, MI
| | - Robert Chapman
- Josephine Ford Cancer Institute/Henry Ford Health System, Detroit, MI
| | - Mary Malloy
- Michigan Society of Hematology and Oncology, Detroit, MI
| | - Susan Eggly
- Karmanos Cancer Institute/Wayne State University, Detroit, MI
| | - Louis A Penner
- Karmanos Cancer Institute/Wayne State University, Detroit, MI
| | | | - Michael S Simon
- Karmanos Cancer Institute/Wayne State University, Detroit, MI
| | | | | | | |
Collapse
|
37
|
Lucas T, Hayman LW, Blessman JE, Asabigi K, Novak JM. Gain versus loss-framed messaging and colorectal cancer screening among African Americans: A preliminary examination of perceived racism and culturally targeted dual messaging. Br J Health Psychol 2015; 21:249-67. [DOI: 10.1111/bjhp.12160] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 07/23/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Todd Lucas
- Department of Family Medicine and Public Health Sciences; Wayne State University; Detroit Michigan USA
- Department of Psychology; Wayne State University; Detroit Michigan USA
| | - Lenwood W. Hayman
- Department of Family Medicine and Public Health Sciences; Wayne State University; Detroit Michigan USA
| | - James E. Blessman
- Department of Family Medicine and Public Health Sciences; Wayne State University; Detroit Michigan USA
- Department of Health and Wellness Promotion; City of Detroit; Michigan USA
| | - Kanzoni Asabigi
- Department of Health and Wellness Promotion; City of Detroit; Michigan USA
| | - Julie M. Novak
- Department of Communication; Wayne State University; Detroit Michigan USA
| |
Collapse
|
38
|
Penner LA, Blair IV, Albrecht TL, Dovidio JF. Reducing Racial Health Care Disparities: A Social Psychological Analysis. POLICY INSIGHTS FROM THE BEHAVIORAL AND BRAIN SCIENCES 2014; 1:204-212. [PMID: 25705721 PMCID: PMC4332703 DOI: 10.1177/2372732214548430] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Large health disparities persist between Black and White Americans. The social psychology of intergroup relations suggests some solutions to health care disparities due to racial bias. Three paths can lead from racial bias to poorer health among Black Americans. First is the already well-documented physical and psychological toll of being a target of persistent discrimination. Second, implicit bias can affect physicians' perceptions and decisions, creating racial disparities in medical treatments, although evidence is mixed. The third path describes a less direct route: Physicians' implicit racial bias negatively affects communication and the patient-provider relationship, resulting in racial disparities in the outcomes of medical interactions. Strong evidence shows that physician implicit bias negatively affects Black patients' reactions to medical interactions, and there is good circumstantial evidence that these reactions affect health outcomes of the interactions. Solutions focused on the physician, the patient, and the health care delivery system; all agree that trying to ignore patients' race or to change physicians' implicit racial attitudes will not be effective and may actually be counterproductive. Instead, solutions can minimize the impact of racial bias on medical decisions and on patient-provider relationships.
Collapse
|
39
|
Skolarus TA, Wolf AMD, Erb NL, Brooks DD, Rivers BM, Underwood W, Salner AL, Zelefsky MJ, Aragon-Ching JB, Slovin SF, Wittmann DA, Hoyt MA, Sinibaldi VJ, Chodak G, Pratt-Chapman ML, Cowens-Alvarado RL. American Cancer Society prostate cancer survivorship care guidelines. CA Cancer J Clin 2014; 64:225-49. [PMID: 24916760 DOI: 10.3322/caac.21234] [Citation(s) in RCA: 297] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 04/14/2014] [Indexed: 12/15/2022] Open
Abstract
Prostate cancer survivors approach 2.8 million in number and represent 1 in 5 of all cancer survivors in the United States. While guidelines exist for timely treatment and surveillance for recurrent disease, there is limited availability of guidelines that facilitate the provision of posttreatment clinical follow-up care to address the myriad of long-term and late effects that survivors may face. Based on recommendations set forth by a National Cancer Survivorship Resource Center expert panel, the American Cancer Society developed clinical follow-up care guidelines to facilitate the provision of posttreatment care by primary care clinicians. These guidelines were developed using a combined approach of evidence synthesis and expert consensus. Existing guidelines for health promotion, surveillance, and screening for second primary cancers were referenced when available. To promote comprehensive follow-up care and optimal health and quality of life for the posttreatment survivor, the guidelines address health promotion, surveillance for prostate cancer recurrence, screening for second primary cancers, long-term and late effects assessment and management, psychosocial issues, and care coordination among the oncology team, primary care clinicians, and nononcology specialists. A key challenge to the development of these guidelines was the limited availability of published evidence for management of prostate cancer survivors after treatment. Much of the evidence relies on studies with small sample sizes and retrospective analyses of facility-specific and population databases.
Collapse
Affiliation(s)
- Ted A Skolarus
- Assistant Professor of Urology, Department of Urology, University of Michigan, Research Investigator, HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Eggly S, Tkatch R, Penner LA, Mabunda L, Hudson J, Chapman R, Griggs JJ, Brown R, Albrecht T. Development of a question prompt list as a communication intervention to reduce racial disparities in cancer treatment. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:282-9. [PMID: 23440665 PMCID: PMC3665702 DOI: 10.1007/s13187-013-0456-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Racial disparities have been found in the use of chemotherapy as cancer treatment. These disparities may be, in part, due to well-documented differences in the quality of communication during clinical interactions with oncologists and Black versus White patients. In this study using a community-based participatory research approach, academic researchers, community members, and oncologists formed a partnership to develop a communication intervention to address racial disparities in cancer care. Partners developed a question prompt list (QPL), a simple tool that can be used to improve communication, and thus treatment, during clinical interactions in which oncologists and Black patients discuss chemotherapy. Partners endorsed the use of a QPL, provided specific suggestions for content and format, conducted and analyzed qualitative interviews with Black patients receiving chemotherapy, and approved the final version. The feasibility and effectiveness of the QPL that resulted from this research process are currently under evaluation in a separate study.
Collapse
Affiliation(s)
- Susan Eggly
- Department of Oncology, Wayne State University/Karmanos Cancer Institute, 4100 John R, MM03CB, Detroit, 48201, MI, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Penner LA, Hagiwara N, Eggly S, Gaertner SL, Albrecht TL, Dovidio JF. Racial Healthcare Disparities: A Social Psychological Analysis. EUROPEAN REVIEW OF SOCIAL PSYCHOLOGY 2013; 24:70-122. [PMID: 25197206 PMCID: PMC4151477 DOI: 10.1080/10463283.2013.840973] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Around the world, members of racial/ethnic minority groups typically experience poorer health than members of racial/ethnic majority groups. The core premise of this article is that thoughts, feelings, and behaviors related to race and ethnicity play a critical role in healthcare disparities. Social psychological theories of the origins and consequences of these thoughts, feelings, and behaviors offer critical insights into the processes responsible for these disparities and suggest interventions to address them. We present a multilevel model that explains how societal, intrapersonal, and interpersonal factors can influence ethnic/racial health disparities. We focus our literature review, including our own research, and conceptual analysis at the intrapersonal (the race-related thoughts and feelings of minority patients and non-minority physicians) and interpersonal levels (intergroup processes that affect medical interactions between minority patients and non-minority physicians). At both levels of analysis, we use theories of social categorization, social identity, contemporary forms of racial bias, stereotype activation, stigma, and other social psychological processes to identify and understand potential causes and processes of health and healthcare disparities. In the final section, we identify theory-based interventions that might reduce ethnic/racial disparities in health and healthcare.
Collapse
Affiliation(s)
- Louis A. Penner
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Department of Oncology, Wayne State University
| | - Nao Hagiwara
- Department of Psychology, Virginia Commonwealth University
| | - Susan Eggly
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Department of Oncology, Wayne State University
| | | | - Terrance L. Albrecht
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Department of Oncology, Wayne State University
| | | |
Collapse
|