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Harik L, Yamamoto K, Kimura T, Rong LQ, Vogel B, Mehran R, Bairey-Merz CN, Gaudino M. Patient-physician sex concordance and outcomes in cardiovascular disease: a systematic review. Eur Heart J 2024; 45:1505-1511. [PMID: 38551446 DOI: 10.1093/eurheartj/ehae121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 05/09/2024] Open
Abstract
The sex disparity in outcomes of patients with cardiovascular disease is well-described and has persisted across recent decades. While there have been several proposed mechanisms to explain this disparity, there are limited data on female patient-physician sex concordance and its association with outcomes. The authors review the existing literature on the relationship between patient-physician sex concordance and clinical outcomes in patients with cardiovascular disease, the evidence of a benefit in clinical outcomes with female patient-physician sex concordance, and the possible drivers of such a benefit and highlight directions for future study.
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Affiliation(s)
- Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, USA
| | - Ko Yamamoto
- Department of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan
| | - Takeshi Kimura
- Department of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan
| | - Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Birgit Vogel
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - C Noel Bairey-Merz
- Barbara Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai, Los Angeles, CA, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, USA
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2
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Miyawaki A, Jena AB, Rotenstein LS, Tsugawa Y. Comparison of Hospital Mortality and Readmission Rates by Physician and Patient Sex. Ann Intern Med 2024; 177:598-608. [PMID: 38648639 DOI: 10.7326/m23-3163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Little is known as to whether the effects of physician sex on patients' clinical outcomes vary by patient sex. OBJECTIVE To examine whether the association between physician sex and hospital outcomes varied between female and male patients hospitalized with medical conditions. DESIGN Retrospective observational study. SETTING Medicare claims data. PATIENTS 20% random sample of Medicare fee-for-service beneficiaries hospitalized with medical conditions during 2016 to 2019 and treated by hospitalists. MEASUREMENTS The primary outcomes were patients' 30-day mortality and readmission rates, adjusted for patient and physician characteristics and hospital-level averages of exposures (effectively comparing physicians within the same hospital). RESULTS Of 458 108 female and 318 819 male patients, 142 465 (31.1%) and 97 500 (30.6%) were treated by female physicians, respectively. Both female and male patients had a lower patient mortality when treated by female physicians; however, the benefit of receiving care from female physicians was larger for female patients than for male patients (difference-in-differences, -0.16 percentage points [pp] [95% CI, -0.42 to 0.10 pp]). For female patients, the difference between female and male physicians was large and clinically meaningful (adjusted mortality rates, 8.15% vs. 8.38%; average marginal effect [AME], -0.24 pp [CI, -0.41 to -0.07 pp]). For male patients, an important difference between female and male physicians could be ruled out (10.15% vs. 10.23%; AME, -0.08 pp [CI, -0.29 to 0.14 pp]). The pattern was similar for patients' readmission rates. LIMITATION The findings may not be generalizable to younger populations. CONCLUSION The findings indicate that patients have lower mortality and readmission rates when treated by female physicians, and the benefit of receiving treatments from female physicians is larger for female patients than for male patients. PRIMARY FUNDING SOURCE Gregory Annenberg Weingarten, GRoW @ Annenberg.
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Affiliation(s)
- Atsushi Miyawaki
- Department of Health Services Research and Department of Public Health, Graduate School of Medicine, and Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan (A.M.)
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Department of Medicine, Massachusetts General Hospital, Boston, and National Bureau of Economic Research, Cambridge, Massachusetts (A.B.J.)
| | - Lisa S Rotenstein
- Divisions of General Internal Medicine and Clinical Informatics, University of California at San Francisco, San Francisco, California, and Center for Physician Experience and Practice Excellence, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts (L.S.R.)
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, and Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California (Y.T.)
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Tan JH, McGrath CL, Brothers AW, Fatemi Y, Konold V, Pak D, Weissman SJ, Zerr DM, Kronman MP. Race and Antibiotic Use for Children Hospitalized With Acute Respiratory Infections. J Pediatric Infect Dis Soc 2024; 13:237-241. [PMID: 38456844 DOI: 10.1093/jpids/piae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/06/2024] [Indexed: 03/09/2024]
Abstract
We sought to evaluate whether children hospitalized with acute respiratory infections experienced differences in antibiotic use by race and ethnicity. We found that likelihood of broad-spectrum antibiotic receipt differed across racial and ethnic groups. Future work should confirm this finding, evaluate causes, and ensure equitable antibiotic use.
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Affiliation(s)
- Jenna H Tan
- Department of Pediatrics, Division of Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Caitlin L McGrath
- Department of Pediatrics, Division of Infectious Diseases, University of Washington, Seattle, WA, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Adam W Brothers
- Department of Pharmacy, Seattle Children's Hospital, Seattle, WA, USA
| | - Yasaman Fatemi
- Department of Pediatrics, Division of Infectious Diseases, University of Washington, Seattle, WA, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Victoria Konold
- Department of Pediatrics, Division of Infectious Diseases, University of Washington, Seattle, WA, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Daniel Pak
- Department of Pharmacy, Seattle Children's Hospital, Seattle, WA, USA
| | - Scott J Weissman
- Department of Pediatrics, Division of Infectious Diseases, University of Washington, Seattle, WA, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Danielle M Zerr
- Department of Pediatrics, Division of Infectious Diseases, University of Washington, Seattle, WA, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Matthew P Kronman
- Department of Pediatrics, Division of Infectious Diseases, University of Washington, Seattle, WA, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
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Allar BG, Torres M, Mahmood R, Ortega G, Himmelstein J, Weissmann L, Sheth K, Rayala HJ. Unique Breast Cancer Screening Disparities in a Safety-Net Health System. Am J Prev Med 2024; 66:473-482. [PMID: 37844709 DOI: 10.1016/j.amepre.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Breast cancer screening (BCS) disparities leave historically underserved groups more vulnerable to adverse outcomes. This study explores granular associations between BCS and patient sociodemographic factors in a large urban safety-net health system. METHODS A retrospective review among female patients ages 50-74 within an urban safety-net health system was conducted in 2019. All patients had a primary care visit in the past 2 years. Multiple patient health and sociodemographic characteristics were reviewed, as well as provider gender and specialty. Bivariate analyses and multivariable logistic regression were performed in 2022. RESULTS The BCS rate among 11,962 women was 69.7%. Over half of patients were non-White (63.6%) and had public insurance (72.3%). Patients with limited English proficiency made up 44.3% of the cohort. Compared to their sociodemographic counterparts, patients with White race, English proficiency, and Medicare insurance had the lowest rates of BCS. Serious mental illness and substance use disorder were associated with lower odds of BCS. In multivariable analysis, when using White race and English speakers as a reference, most other races (Black, Hispanic, and Other) and languages (Spanish, Portuguese, and Other) had significantly higher odds of screening ranging from 8% to 63% higher, except Asian race and Haitian Creole language. Female (versus male) and internal medicine-trained providers were associated with higher screening odds. CONCLUSIONS Multiple unique variables contribute to BCS disparities, influenced by patient and health system factors. Defining and understanding the interplay of these variables can guide policymaking and identify avenues to improve BCS for vulnerable or traditionally under-resourced populations.
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Affiliation(s)
- Benjamin G Allar
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Micaela Torres
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Rumel Mahmood
- Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
| | - Gezzer Ortega
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jessica Himmelstein
- Department of Internal Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
| | - Lisa Weissmann
- Department of Hematology/Oncology, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
| | - Ketan Sheth
- Department of Surgery, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
| | - Heidi J Rayala
- Department of Surgery, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts; Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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Khan MMM, Munir MM, Woldesenbet S, Endo Y, Rawicz-Pruszyński K, Katayama E, Ejaz A, Cloyd J, Dilhoff M, Pawlik TM. Association of surgeon-patient sex concordance with postoperative outcomes following complex cancer surgery. J Surg Oncol 2024; 129:489-498. [PMID: 37990862 DOI: 10.1002/jso.27527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/21/2023] [Accepted: 10/28/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Sex concordance may impact the therapeutic relationship and provider-patient interactions. We sought to define the association of surgeon-patient sex concordance on postoperative patient outcomes following complex cancer surgery. METHODS Patients who underwent surgery for lung, breast, hepato-pancreato-biliary, or colorectal cancer between 2014 and 2020 were identified from the Medicare Standard Analytic Files. The impact of surgeon-patient sex concordance or discordance on achieving an optimal postoperative textbook outcome (TO) was assessed using multivariable logistic regression. RESULTS Among 495 628 patients, 241 938 (48.8%) patients were sex concordant with their surgeon while 253 690 (51.2%) patients were sex discordant. Sex discordance between surgeon and patient was associated with a decreased likelihood to achieve a postoperative TO (odds ratio [OR]: 0.95, 95% CI: 0.93-0.97; p < 0.001). Sex discordance was associated with a higher risk of complications (OR: 1.05, 95% CI: 1.03-1.07; p < 0.001) and 90-day mortality (OR: 1.05, 95% CI: 1.01-1.09; p = 0.011). Of note, male patients treated by female surgeons (OR: 0.96, 95% CI: 0.93-0.99; p = 0.017) had a similar lower likelihood to achieve a TO as female patients treated by male surgeons (OR: 0.90, 95% CI: 0.86-0.93; p < 0.001). CONCLUSIONS Sex discordance was associated with a reduced likelihood of achieving an "optimal" postoperative course following complex cancer surgery.
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Affiliation(s)
- Muhammad Muntazir Mehdi Khan
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Muhammad M Munir
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Selamawit Woldesenbet
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Yutaka Endo
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Karol Rawicz-Pruszyński
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Erryk Katayama
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Aslam Ejaz
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Jordan Cloyd
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Mary Dilhoff
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
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Wallis CJ, Jerath A, Ikesu R, Satkunasivam R, Dimick JB, Orav EJ, Maggard-Gibbons M, Li R, Salles A, Klaassen Z, Coburn N, Bass BL, Detsky AS, Tsugawa Y. Association between patient-surgeon gender concordance and mortality after surgery in the United States: retrospective observational study. BMJ 2023; 383:e075484. [PMID: 37993130 PMCID: PMC10664070 DOI: 10.1136/bmj-2023-075484] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To determine whether patient-surgeon gender concordance is associated with mortality of patients after surgery in the United States. DESIGN Retrospective observational study. SETTING Acute care hospitals in the US. PARTICIPANTS 100% of Medicare fee-for-service beneficiaries aged 65-99 years who had one of 14 major elective or non-elective (emergent or urgent) surgeries in 2016-19. MAIN OUTCOME MEASURES Mortality after surgery, defined as death within 30 days of the operation. Adjustments were made for patient and surgeon characteristics and hospital fixed effects (effectively comparing patients within the same hospital). RESULTS Among 2 902 756 patients who had surgery, 1 287 845 (44.4%) had operations done by surgeons of the same gender (1 201 712 (41.4%) male patient and male surgeon, 86 133 (3.0%) female patient and female surgeon) and 1 614 911 (55.6%) were by surgeons of different gender (52 944 (1.8%) male patient and female surgeon, 1 561 967 (53.8%) female patient and male surgeon). Adjusted 30 day mortality after surgery was 2.0% for male patient-male surgeon dyads, 1.7% for male patient-female surgeon dyads, 1.5% for female patient-male surgeon dyads, and 1.3% for female patient-female surgeon dyads. Patient-surgeon gender concordance was associated with a slightly lower mortality for female patients (adjusted risk difference -0.2 percentage point (95% confidence interval -0.3 to -0.1); P<0.001), but a higher mortality for male patients (0.3 (0.2 to 0.5); P<0.001) for elective procedures, although the difference was small and not clinically meaningful. No evidence suggests that operative mortality differed by patient-surgeon gender concordance for non-elective procedures. CONCLUSIONS Post-operative mortality rates were similar (ie, the difference was small and not clinically meaningful) among the four types of patient-surgeon gender dyads.
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Affiliation(s)
- Christopher Jd Wallis
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Angela Jerath
- Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Ryo Ikesu
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Justin B Dimick
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - E John Orav
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Ruixin Li
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Arghavan Salles
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Zachary Klaassen
- Division of Urology, Medical College of Georgia-Augusta University, Augusta, GA, USA
| | - Natalie Coburn
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Barbara L Bass
- George Washington University, School of Medicine and Health Sciences, Washington, DC, USA
| | - Allan S Detsky
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, ON, Canada
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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7
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Gitau K, Huang A, Isenberg SR, Stall N, Ailon J, Bell CM, Quinn KL. Association of patient sex with use of palliative care in Ontario, Canada: a population-based study. CMAJ Open 2023; 11:E1025-E1032. [PMID: 37935486 PMCID: PMC10635704 DOI: 10.9778/cmajo.20220232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND It is unclear whether there are sex-based differences in use of palliative care near the end of life. The objective of this study was to measure the association between sex and palliative care use. METHODS We performed a population-based retrospective cohort study of all patients aged 18 years or older in the last year of life who died in Ontario, Canada, between 2010 and 2018. The primary exposure was patient biologic sex (male or female). The primary outcome was receipt of physician-delivered palliative care; secondary outcomes were approach to in-hospital palliative care and sex concordance of the patient and referring physician. We used multivariable modified Poisson regression to measure the association between patient sex and palliative care receipt, as well as patient-physician sex concordance. RESULTS There were 706 722 patients (354 657 females [50.2%], median age 80 yr [interquartile range 69-87 yr]) in the study cohort, 377 498 (53.4%) of whom received physician-delivered palliative care. After adjustment for age and selected comorbidities, female sex was associated with a 9% relative increase (adjusted relative risk [RR] 1.09, 95% CI 1.08-1.10) in receipt of physician-delivered palliative care. Female patients were 16% more likely than male patients (adjusted RR 1.14, 95% CI 1.14-1.18) to have had their first hospital admission in their final year of life categorized as having a likely palliative intent. Female patients were 18% more likely than male patients (RR 1.18, 95% CI 1.17-1.19) to have had a female referring physician, and male patients were 20% more likely than female patients (adjusted RR 1.20, CI 1.19-1.21) to have had a male referring physician. INTERPRETATION After adjustment for age and comorbidities, male patients were slightly less likely than female patients to have received physician-delivered palliative care, and female patients were more likely than male patients to have had their first hospital admission in their final year of life categorized as having a likely palliative care intent. These results may reflect a between-sex difference in overall end-of-life care preferences or sex differences in decision-making influenced by patient-specific factors; further studies exploring how these factors affect end-of-life decision-making are required.
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Affiliation(s)
- Kevin Gitau
- Departments of Medicine (Gitau, Stall, Ailon, Bell, Quinn) and Family and Community Medicine (Isenberg), University of Toronto; ICES (Huang, Stall, Bell, Quinn); Department of Medicine (Stall, Bell, Quinn), Sinai Health System; Temmy Latner Centre for Palliative Care (Quinn), Sinai Health System, Toronto, Ont.; Department of Medicine (Isenberg), University of Ottawa; Bruyère Research Institute (Isenberg, Ailon), Ottawa, Ont.; Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Anjie Huang
- Departments of Medicine (Gitau, Stall, Ailon, Bell, Quinn) and Family and Community Medicine (Isenberg), University of Toronto; ICES (Huang, Stall, Bell, Quinn); Department of Medicine (Stall, Bell, Quinn), Sinai Health System; Temmy Latner Centre for Palliative Care (Quinn), Sinai Health System, Toronto, Ont.; Department of Medicine (Isenberg), University of Ottawa; Bruyère Research Institute (Isenberg, Ailon), Ottawa, Ont.; Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Sarina R Isenberg
- Departments of Medicine (Gitau, Stall, Ailon, Bell, Quinn) and Family and Community Medicine (Isenberg), University of Toronto; ICES (Huang, Stall, Bell, Quinn); Department of Medicine (Stall, Bell, Quinn), Sinai Health System; Temmy Latner Centre for Palliative Care (Quinn), Sinai Health System, Toronto, Ont.; Department of Medicine (Isenberg), University of Ottawa; Bruyère Research Institute (Isenberg, Ailon), Ottawa, Ont.; Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Nathan Stall
- Departments of Medicine (Gitau, Stall, Ailon, Bell, Quinn) and Family and Community Medicine (Isenberg), University of Toronto; ICES (Huang, Stall, Bell, Quinn); Department of Medicine (Stall, Bell, Quinn), Sinai Health System; Temmy Latner Centre for Palliative Care (Quinn), Sinai Health System, Toronto, Ont.; Department of Medicine (Isenberg), University of Ottawa; Bruyère Research Institute (Isenberg, Ailon), Ottawa, Ont.; Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Jonathan Ailon
- Departments of Medicine (Gitau, Stall, Ailon, Bell, Quinn) and Family and Community Medicine (Isenberg), University of Toronto; ICES (Huang, Stall, Bell, Quinn); Department of Medicine (Stall, Bell, Quinn), Sinai Health System; Temmy Latner Centre for Palliative Care (Quinn), Sinai Health System, Toronto, Ont.; Department of Medicine (Isenberg), University of Ottawa; Bruyère Research Institute (Isenberg, Ailon), Ottawa, Ont.; Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Chaim M Bell
- Departments of Medicine (Gitau, Stall, Ailon, Bell, Quinn) and Family and Community Medicine (Isenberg), University of Toronto; ICES (Huang, Stall, Bell, Quinn); Department of Medicine (Stall, Bell, Quinn), Sinai Health System; Temmy Latner Centre for Palliative Care (Quinn), Sinai Health System, Toronto, Ont.; Department of Medicine (Isenberg), University of Ottawa; Bruyère Research Institute (Isenberg, Ailon), Ottawa, Ont.; Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Kieran L Quinn
- Departments of Medicine (Gitau, Stall, Ailon, Bell, Quinn) and Family and Community Medicine (Isenberg), University of Toronto; ICES (Huang, Stall, Bell, Quinn); Department of Medicine (Stall, Bell, Quinn), Sinai Health System; Temmy Latner Centre for Palliative Care (Quinn), Sinai Health System, Toronto, Ont.; Department of Medicine (Isenberg), University of Ottawa; Bruyère Research Institute (Isenberg, Ailon), Ottawa, Ont.; Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.
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8
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Divakaran S, Krawisz AK, Secemsky EA, Kant S. Sex and Racial Disparities in Peripheral Artery Disease. Arterioscler Thromb Vasc Biol 2023; 43:2099-2114. [PMID: 37706319 PMCID: PMC10615869 DOI: 10.1161/atvbaha.123.319399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
Several studies have shown that women and racial and ethnic minority patients are at increased risk of developing lower extremity peripheral artery disease and suffering adverse outcomes from it, but a knowledge gap remains regarding the underlying causes of these increased risks. Both groups are more likely to be underdiagnosed, have poorly managed contributory comorbidities, and incur disparities in treatment and management postdiagnosis. Opportunities for improvement in the care of women and racial and ethnic minorities with peripheral artery disease include increased rates of screening, higher rates of clinical suspicion (particularly in the absence of typical symptoms of intermittent claudication), and more aggressive risk factor management before and after the diagnosis of peripheral artery disease.
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Affiliation(s)
- Sanjay Divakaran
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Anna K Krawisz
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Eric A Secemsky
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Shashi Kant
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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9
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Yabroff KR, Boehm AL, Nogueira LM, Sherman M, Bradley CJ, Shih YCT, Keating NL, Gomez SL, Banegas MP, Ambs S, Hershman DL, Yu JB, Riaz N, Stockler MR, Chen RC, Franco EL. An essential goal within reach: attaining diversity, equity, and inclusion for the Journal of the National Cancer Institute journals. J Natl Cancer Inst 2023; 115:1115-1120. [PMID: 37806780 DOI: 10.1093/jnci/djad177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | | | - Leticia M Nogueira
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Mark Sherman
- Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | - Cathy J Bradley
- University of Colorado Comprehensive Cancer Center and Colorado School of Public Health, Aurora, CO, USA
| | - Ya-Chen Tina Shih
- University of California Los Angeles Jonsson Comprehensive Cancer Center and Department of Radiation Oncology, School of Medicine, Los Angeles, CA, USA
| | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, and Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Scarlett L Gomez
- Department of Urology and Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Matthew P Banegas
- Department of Radiation Medicine and Applied Sciences, University of California at San Diego, San Diego, CA, USA
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Dawn L Hershman
- Division of Hematology/Oncology, Columbia University, New York, NY, USA
| | - James B Yu
- Department of Radiation Oncology, St. Francis Hospital and Trinity Health of New England, Hartford, CT, USA
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Stockler
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wells, Australia
| | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
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10
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Si Y, Chen G, Su M, Zhou Z, Yip W, Chen X. The Impact of Physician-Patient Gender Match on Healthcare Quality: An Experiment in China. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.03.23296202. [PMID: 37873451 PMCID: PMC10592995 DOI: 10.1101/2023.10.03.23296202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Despite growing evidence of gender disparities in healthcare utilization and health outcomes, there is a lack of understanding of what may drive such differences. Designing and implementing an experiment using the standardized patients' approach, we present novel evidence on the impact of physician-patient gender match on healthcare quality in a primary care setting in China. We find that, compared with female physicians treating female patients, the combination of female physicians treating male patients resulted in a 23.0 percentage-point increase in correct diagnosis and a 19.4 percentage-point increase in correct drug prescriptions. Despite these substantial gains in healthcare quality, there was no significant increase in medical costs and time investment. Our analyses suggest that the gains in healthcare quality were mainly attributed to better physician-patient communications, but not the presence of more clinical information. This paper has policy implications in that improving patient centeredness and incentivizing physicians' efforts in consultation (as opposed to treatment) can lead to significant gains in the quality of healthcare with modest costs, while reducing gender differences in care.
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Affiliation(s)
- Yafei Si
- School of Risk & Actuarial Studies, University of New South Wales, Australia
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Australia
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Australia
| | - Min Su
- School of Public Administration, Inner Mongolia University, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, China
| | - Winnie Yip
- Harvard T.H. Chan School of Public Health, Harvard University, USA
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, USA
- Department of Economics, Yale University, USA
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11
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Fisher MW, Askew M, Baird M, Ozdemir S, Williams S, Ramirez V, Kilcoyne K, Dingle M. Pipeline to Military Orthopaedic Leadership: 20 Years of Race and Gender Diversity Trends Within Military Orthopaedic Surgery Fellowship Training. JB JS Open Access 2023; 8:e23.00019. [PMID: 37850210 PMCID: PMC10578742 DOI: 10.2106/jbjs.oa.23.00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Background The lack of trainees from underrepresented race and gender backgrounds in orthopaedic surgery fellowship training has been well reported in the literature. The purpose of this study was to investigate the demographic trends of federally sponsored military orthopaedic surgery fellows in the Army, Navy, and Air Force. We hypothesize that there has been an increase in women selected for fellowship but that there has been no change in the race demographics of military fellows over the past 2 decades. Methods A retrospective review of all available demographic data collected by the Army, Air Force, and Navy since the beginning of tracking federally funded fellowship training in orthopaedic surgery was completed (1998-2021). Data were grouped into 4-year periods for analysis to closely mirror the military assignment cycle. Results Three hundred sixty-two military orthopaedic surgery fellowship board selectees were included in our analysis. The proportion of women fellows increased from 3% (n = 2/69) over 2001 to 2004 to 21% (n = 17/82) during 2017 to 2020 (p < 0.05). Fellows who identified as White comprised 82% (n = 297) of the cohort during the study period. Individuals who identified as Asian were the next highest proportion of fellows at 4% (n = 16), followed by Black (n = 14, 4%) and Hispanic (n = 13, 3%). Individuals who identified as Native Hawaiian/Pacific Islander represented 1% (n = 3), and an additional 6% (n = 20) fellows identified as "other" or "undeclared." Over the 20-year study period, representation of Asian, Black, Native Hawaiian, and Hispanic fellows did not increase (p = 0.79, 0.81, 0.45, 0.34, respectively). Conclusions Within military orthopaedics, there has been increased representation of women in fellowship training over the past 20 years. However, the proportion of fellows from underrepresented racial and ethnic groups has remained stagnant. One barrier to improving gender and race representation is the currently imprecise and inconsistent collection of demographic information. Importantly, fellowship training has a direct effect on future leadership opportunities within the military orthopaedic surgery community. A more diverse leadership may help to inspire future generations of military orthopaedic surgeons. Level of Evidence IV.
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Affiliation(s)
- Miles W.A. Fisher
- Department of Orthopedic Surgery San Antonio Military Medical Center Fort Sam Houston, Texas
| | - Morgan Askew
- Alpert Medical School at Brown University, Providence, Rhode Island
| | - Michael Baird
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Sevil Ozdemir
- Michigan State University College of Human Medicine, East Lansing, Michigan
| | - Shaun Williams
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Valentina Ramirez
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kelly Kilcoyne
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Marvin Dingle
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland
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12
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Napit K, Ratnapradipa KL, King KM, Ramos AK, Luma LBL, Dinkel D, Robinson T, Schabloske L, Tchouankam T, Watanabe-Galloway S. Qualitative Analysis of Colorectal Cancer Screening for African American and Hispanic Populations in Nebraska: an Application of the PRECEDE Framework. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1767-1776. [PMID: 37466902 DOI: 10.1007/s13187-023-02343-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 07/20/2023]
Abstract
Nationally and in Nebraska, African Americans (AA) and Hispanics have lower colorectal cancer (CRC) screening rates compared to non-Hispanic Whites. We aimed to obtain perspectives from AA and Hispanic cancer survivors and caregivers in Nebraska about CRC screening to improve outreach efforts. Data from four virtual focus groups (AA female, AA male, Hispanic rural, and Hispanic urban) conducted between April-August 2021 were analyzed using a directed content approach based on the Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model. Most of the 19 participants were female (84%) and survivors (58%). Across groups, awareness of colonoscopy was high, but awareness of fecal testing needed to be higher, with confusion about different types of fecal tests. Predisposing factors were trust in the health system; awareness of CRC screening; machismo; fear of cancer; embarrassment with screening methods; and negative perceptions of CRC screening. Enabling factors included provider recommendations, healthcare access, and insurance. Reinforcing factors included prioritizing personal health and having a support system. Suggestions to improve screening included increasing healthcare access (free or low-cost care), increasing provider diversity, health education using various methods and media, and enhancing grassroots health promotion efforts. Lack of awareness, accessibility issues, attitudes and perceptions of CRC and CRC screening, trust, and cultural and linguistic concerns are major issues that need to be addressed to reduce CRC screening disparities among AA and Hispanic adults.
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Affiliation(s)
- Krishtee Napit
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Kendra L Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Keyonna M King
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Athena K Ramos
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lady Beverly L Luma
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, Omaha, NE, USA
| | - Danae Dinkel
- School of Health & Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
| | | | | | - Tatiana Tchouankam
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, Omaha, NE, USA
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Kindratt TB, Brannon GE, Boateng GO, Brown KK. The Influence of Racial/Ethnic and Gender Concordance on Care Among Non-Pregnant Women of Childbearing Age with Diabetes Mellitus: an Analysis of the Medical Expenditure Panel Survey, 2010-2019. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01779-z. [PMID: 37707662 DOI: 10.1007/s40615-023-01779-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023]
Abstract
INTRODUCTION This study examined associations between patient-provider race/ethnicity concordance and gender concordance on overall healthcare ratings, self-efficacy, and diabetes care monitoring in non-pregnant women of childbearing age with diabetes mellitus before and after adjusting for sociodemographic factors. METHODS We analyzed longitudinal data from the 2010-2019 Medical Expenditure Panel Survey. The sample was limited to non-pregnant women of childbearing age (18-45 years) diagnosed with diabetes (unweighted n = 327; weighted n = 566,504). Bivariate analysis, logistic regression, and latent variable modeling were performed. RESULTS Few racially minoritized women reported racial/ethnic and gender concordance with their healthcare provider. Only 2.9% of Hispanic women reported having a Hispanic provider and 12.1% of non-Hispanic Black women reported seeing a non-Hispanic Black provider compared to 81.1% of non-Hispanic White women who reported seeing a non-Hispanic White provider (p < .0001). Among Hispanic women, 15.3% reported seeing a female provider compared to 25.2% of non-Hispanic Black and 53.5% of non-Hispanic White women. Patient-provider race/ethnicity and gender concordance were not statistically significantly associated with overall healthcare ratings, self-efficacy, or diabetes care monitoring. CONCLUSIONS This study revealed a large disparity in race/ethnicity and gender concordance among minority women of reproductive age with diabetes compared to their non-Hispanic White counterparts. There is a need for larger, more robust studies to examine the influence of provider and other healthcare characteristics on diabetes-related outcomes in this understudied population.
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Affiliation(s)
- Tiffany B Kindratt
- Department of Kinesiology, The University of Texas at Arlington, 500 W. Nedderman Drive, Arlington, TX, 76019, USA.
| | - Grace Ellen Brannon
- Department of Communication, The University of Texas at Arlington, 700 W. Greek Row Drive, Arlington, TX, 76019, USA
| | - Godfred O Boateng
- Department of Kinesiology, The University of Texas at Arlington, 500 W. Nedderman Drive, Arlington, TX, 76019, USA
- School of Global Health, York University, 4700 Keele St, Toronto, M3J 1P3, Canada
| | - Kyrah K Brown
- Department of Kinesiology, The University of Texas at Arlington, 500 W. Nedderman Drive, Arlington, TX, 76019, USA
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Wheless M, Lee JJ, Domenico HJ, Martin BJ, Bennett ML, Martin SF, Berlin J, Green JK, Agarwal R. Factors and Barriers to Goals-of-Care Conversations for Patients With Cancer and Inpatient Mortality. JCO Oncol Pract 2023; 19:767-776. [PMID: 37390380 PMCID: PMC10538893 DOI: 10.1200/op.23.00095] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/02/2023] [Accepted: 05/25/2023] [Indexed: 07/02/2023] Open
Abstract
PURPOSE Conversations about personal values and goals of care (GOC) at the end of life are essential in caring for patients with advanced cancer. However, GOC conversations may be influenced by patient and oncologist factors during transitions of care. METHODS We electronically administered surveys to medical oncologists of inpatients who died from May 1, 2020, to May 31, 2021. Primary outcomes included oncologists' knowledge of inpatient death, anticipation of patient death, and recollection of GOC discussions. Secondary outcomes, including GOC documentation and advance directives (ADs), were collected retrospectively from electronic health records. Outcomes were analyzed for association with patient, oncologist, and patient-oncologist relationship factors. RESULTS For 75 patients who died, 104/158 (66%) surveys were completed by 40 inpatient and 64 outpatient oncologists. Eighty-one oncologists (77.9%) were aware of patients' deaths, 68 (65.4%) anticipated patients' deaths within 6 months, and 67 (64.4%) recalled having GOC discussions before or during the terminal hospitalization. Outpatient oncologists were more likely to report knowledge of patient death (P < .001), as were those with longer therapeutic relationships (P < .001). Inpatient oncologists were more likely to correctly anticipate patient death (P = .014). Secondary outcomes revealed 21.3% of patients had documented GOC discussions before admission and 33.3% had ADs; patients with a longer duration of cancer diagnosis were more likely to have ADs (P = .003). Oncologist-reported barriers to GOC included unrealistic expectations from patients or family (25%) and decreased patient participation because of clinical conditions (15%). CONCLUSION Most oncologists recalled having GOC discussions for patients with inpatient mortality, yet documentation of serious illness conversations remained suboptimal. Further studies are needed to examine barriers to GOC conversations and documentation during transitions of care and across health care settings.
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Affiliation(s)
- Margaret Wheless
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Julie J. Lee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Henry J. Domenico
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Office of Quality, Safety, and Risk Prevention, Vanderbilt University Medical Center, Nashville, TN
| | - Barbara J. Martin
- Vanderbilt Office of Quality, Safety, and Risk Prevention, Vanderbilt University Medical Center, Nashville, TN
| | - Marc L. Bennett
- Vanderbilt Office of Quality, Safety, and Risk Prevention, Vanderbilt University Medical Center, Nashville, TN
- Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Sara F. Martin
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Jordan Berlin
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Jennifer K. Green
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Office of Quality, Safety, and Risk Prevention, Vanderbilt University Medical Center, Nashville, TN
| | - Rajiv Agarwal
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt-Ingram Cancer Center, Nashville, TN
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Yabroff KR, Boehm AL, Nogueira LM, Sherman M, Bradley CJ, Shih YCT, Keating NL, Gomez SL, Banegas MP, Ambs S, Hershman DL, Yu JB, Riaz N, Stockler MR, Chen RC, Franco EL. An essential goal within reach: attaining diversity, equity, and inclusion for the Journal of the National Cancer Institute journals. JNCI Cancer Spectr 2023; 7:pkad063. [PMID: 37806772 PMCID: PMC10560610 DOI: 10.1093/jncics/pkad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | | | - Leticia M Nogueira
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Mark Sherman
- Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Jacksonville, FL, USA
| | - Cathy J Bradley
- University of Colorado Comprehensive Cancer Center and Colorado School of Public Health, Aurora, CO, USA
| | - Ya-Chen Tina Shih
- University of California Los Angeles Jonsson Comprehensive Cancer Center and Department of Radiation Oncology, School of Medicine, Los Angeles, CA, USA
| | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, and Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Scarlett L Gomez
- Department of Urology and Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Matthew P Banegas
- Department of Radiation Medicine and Applied Sciences, University of California at San Diego, San Diego, CA, USA
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Dawn L Hershman
- Division of Hematology/Oncology, Columbia University, New York, NY, USA
| | - James B Yu
- Department of Radiation Oncology, St. Francis Hospital and Trinity Health of New England, Hartford, CT, USA
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Stockler
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wells, Australia
| | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Canada
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16
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Wünscher SV, Spendel S, Nischwitz SP, Gualdi A, Avian A, Kamolz LP, Cambiaso-Daniel J. Do Sex-Specific Factors Influence the Surgical Treatment of Facial Skin Cancer? J Pers Med 2023; 13:1193. [PMID: 37623444 PMCID: PMC10456042 DOI: 10.3390/jpm13081193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
Facial skin cancer (FSC) is prone to incomplete excision due to the sophisticated anatomy and the aesthetic importance of the face. In this study, we sought to investigate to what extent sex-specific differences and other operation-, patient-, and cancer-specific factors influence the re-resection rate in FSC surgery, in order to provide personalized treatment strategies to patients. In this retrospective study, patients (>18 years) undergoing surgical excision of an FSC were enrolled. Each patient's demographic data, cancer location, the surgical team, primary and secondary surgeries were analyzed. Overall, 469 patients (819 surgeries) were included. The mean age was 69 ± 15 years. No significant association between sex-specific factors (surgeon's sex (OR: 1.09, 95% CI: 0.76-1.56) or patient's sex (OR: 0.85, 95% CI: 0.62-1.17), surgeon-patient sex concordance and discordance) and the likelihood of secondary surgery were found. However, healing by secondary intention (OR: 4.28; 95% CI: 1.94-9.45) and cancer location showed an increased re-resection rate. In conclusion, FSC surgery is a safe method unaffected by sex-specific factors, which had no impact on the re-resection rate. However, in further analysis, the likelihood of a re-resection was influenced by other factors such as healing by secondary intention and cancer location. This knowledge might be useful to provide an algorithm for personalized treatment strategies in the future.
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Affiliation(s)
- Sarah Victoria Wünscher
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Stephan Spendel
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Sebastian P Nischwitz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Alessandro Gualdi
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Vita-Salute San Raffaele, 20132 Milan, Italy
- Milano Face Institute, 20146 Milan, Italy
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8036 Graz, Austria
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
- COREMED-Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, 8036 Graz, Austria
| | - Janos Cambiaso-Daniel
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
- Milano Face Institute, 20146 Milan, Italy
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Althans AR, Byrd T, Suppok R, Lee KK, Rosengart MR, Myers SP. Impact of holistic review on diversity of interviewed and matriculating residents in graduate medical education: a systematic review protocol. BMJ Open 2023; 13:e074118. [PMID: 37438073 PMCID: PMC10347482 DOI: 10.1136/bmjopen-2023-074118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/20/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Diversity in the physician workforce improves patient-centred outcomes. Patients are more likely to trust in and comply with care when seeing gender/racially concordant providers. A current emphasis on standardised metrics in academic achievement often serves as a barrier to the recruitment and retention of gender and racial minorities in medicine. Holistic review of residency applicants has been supported as a means of encouraging diversification but is not yet standardised. The current body of evidence examining the effects of holistic review on the recruitment of racial and gender minorities in surgical residencies is small. We therefore propose a systematic review to summarise the state of holistic review in graduate medical education in the USA and its impact on diversification. METHODS AND ANALYSIS Our systematic review protocol has been designed with plans to report our review findings in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. PubMed and Embase will be searched with the assistance of a health sciences librarian with expertise in systematic review. We will include studies of graduate medical education programmes that describe the implementation of holistic review, outline the components of their holistic review process and compare proportions of under-represented minorities (URM) and women interviewed and matriculating before and after holistic review implementation. We will first report a summary of the findings regarding the operationalisation of holistic review as described by studies included. We will then pool the percentages of URM and women for interviewee and matriculant populations from each study and report the collective odds ratios of each for holistic review compared with traditional review as our primary outcome. ETHICS AND DISSEMINATION This study is a protocol for systematic review, and therefore does not involve any human subjects. Findings will be published in the form of a manuscript submitted to a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42023401389.
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Affiliation(s)
- Alison R Althans
- Department of Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Tamara Byrd
- Department of Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Rachel Suppok
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kenneth K Lee
- Department of Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Matthew R Rosengart
- Department of Surgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Sara P Myers
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Patel H, Breeding T, Inouye M, Hoops H, Elkbuli A. Breaking barriers and advancing diversity, equity, and inclusion in trauma and acute care surgery: A current perspective. J Trauma Acute Care Surg 2023; 94:e42-e45. [PMID: 36941230 DOI: 10.1097/ta.0000000000003966] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
ABSTRACT The importance of diversity, equity, and inclusion (DEI) in trauma and acute care surgery (ACS) has become increasingly apparent in the field of medicine. Despite the growing diversity of the patient population, the surgical specialty has traditionally been dominated by White males. This involves increasing the representation of diverse individuals in leadership positions, professional societies, scholarships, graduate education, and practicing physicians. This opinion piece aims to address the gaps in the literature regarding DEI in trauma and acute care surgery and highlight the issues related to the workforce, gender gap, patient outcomes, and health services. To effectively guide DEI interventions, it is essential to capture patient-reported experience data and stratify outcomes by factors including race, ethnicity, ancestry, language, sexual orientation, and gender identity. Only then can generalizable findings effectively inform DEI strategies. Using validated measurement tools, it is essential to conduct these assessments with methodological rigor. Collaboration between health care institutions can also provide valuable insights into effective and ineffective intervention practices through information exchange and constructive feedback. These recommendations aim to address the multifactorial nature of health care inequities in trauma and ACS. However, successful DEI interventions require a deeper understanding of the underlying mechanisms driving observed disparities, necessitating further research. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Heli Patel
- From the NOVA Southeastern University, Kiran Patel College of Allopathic Medicine (H.P., T.B.), Fort Lauderdale, Florida; John A. Burns School of Medicine (M.I.), Honolulu, Hawaii; Division of Trauma, Critical Care, Department of Surgery, (H.H.), and Acute Care Surgery, Oregon Health & Sciences University, Portland, Oregon; Division of Trauma and Surgical Critical Care, Department of Surgery, (A.E.), Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education (A.E.), Orlando Regional Medical Center, Orlando, Florida
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19
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O'Sullivan L, Kagabo W, Prasad N, Laporte D, Aiyer A. Racial and Ethnic Bias in Medical School Clinical Grading: A Review. JOURNAL OF SURGICAL EDUCATION 2023; 80:806-816. [PMID: 37019709 DOI: 10.1016/j.jsurg.2023.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/26/2023] [Accepted: 03/17/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Improving diversity in healthcare is a widely recognized national goal. The diversity of medical student matriculants has increased, yet this trend is not seen in the composition of competitive residency programs. In this review, we examine racial and ethnic disparities in medical student grading during clinical years and explore the consequences of how this may exclude minority students from accessing competitive residency positions. DESIGN Following PRISMA guidelines, we searched PubMed, Embase, Scopus, and ERIC databases using variations of the terms "race," "ethnicity," "clerkship," "rotation," "grade," "evaluation", or "shelf exam." Of 391 references found using the criteria, 29 were related to clinical grading and race/ethnicity and included in the review. The GRADE criteria were used to determine the quality of evidence. SETTING Johns Hopkins School of Medicine, Baltimore MD. RESULTS Five studies examining a total of 107,687 students from up to 113 different schools found racial minority students receive significantly fewer Honors grades in core clerkships compared to White students. Three studies examining 94,814 medical student evaluations from up to 130 different schools found significant disparities in the wording of written clerkship evaluations based on race and/or ethnicity. CONCLUSIONS A large body of evidence suggests the presence of racial bias in subjective clinical grading and written clerkship evaluations of medical students. Grading disparities can disadvantage minority students when applying to competitive residency programs and may contribute to a lack of diversity in these fields. As low minority representation has a negative impact on patient care and research advancement, strategies to resolve this issue must be further explored.
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Affiliation(s)
- Lucy O'Sullivan
- Johns Hopkins Orthopedics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Whitney Kagabo
- Department of Orthopedics, Johns Hopkins Orthopedics, Johns Hopkins Medicine, Baltimore, Maryland
| | - Niyathi Prasad
- Department of Orthopedics, Johns Hopkins Orthopedics, Johns Hopkins Medicine, Baltimore, Maryland
| | - Dawn Laporte
- Department of Orthopedics, Johns Hopkins Orthopedics, Johns Hopkins Medicine, Baltimore, Maryland
| | - Amiethab Aiyer
- Department of Orthopedics, Johns Hopkins Orthopedics, Johns Hopkins Medicine, Baltimore, Maryland
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Paradis KC, Franco I, Beltrán Ponce S, Chaurasia A, Laucis AM, Venkat P, Siker M, Suneja G, Deville C, Munbodh R, Mattes MD. The Current State of Departmental Diversity, Equity, and Inclusion Efforts Within US Academic Radiation Oncology Departments. Int J Radiat Oncol Biol Phys 2023; 116:219-228. [PMID: 36306980 DOI: 10.1016/j.ijrobp.2022.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/13/2022] [Accepted: 06/05/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Promoting a diverse workforce of health care professionals that delivers equitable patient care is an important goal in oncology, as in all of medicine. Although most medical schools have a diversity office and associated initiatives, little is known about radiation oncology (RO) department-level efforts to promote diversity, equity, and inclusion (DEI). We describe the current state of DEI leadership and initiatives in RO departments in the US to guide future policies and programs. METHODS AND MATERIALS A total of 124 US RO departments affiliated with a medical school were contacted to identify departmental DEI leadership. Identified DEI leaders were asked to complete an anonymous survey assessing characteristics of their departmental DEI leadership, committee/organizational structure, activities, and perceived barriers to, and effect of, their work. Descriptive statistics are reported. RESULTS Among 85 RO departments that responded (68.5% response rate), 48 (56.5%) reported having a departmental DEI leader. Thirty-four DEI leaders completed the survey (70.8%). Of those who answered each survey question, most DEI leaders were assistant or associate professors (n = 24, 82.8%), women (n = 19, 73.1%), and identified with at least one non-White race or Hispanic ethnicity (n = 15, 53.6%). Nineteen (57.6%) had an associated departmental DEI committee; with 10 of these starting in 2020 or later. Few DEI leaders had administrative support (38.2%), funding (29.4%), protected time (23.5%), or increased compensation for added duties Fifteen (50.0%) believed their DEI-focused efforts were considered for promotion. The most reported initiatives included offering programming/education, supporting students from backgrounds underrepresented in medicine, improving recruitment practices/hiring, and implementing pipeline/pathway projects. The perceived impact of DEI initiatives included an increased culture of respect (89.7%), improved health care disparity awareness (75.9%), and improved systemic/structural racism awareness (79.3%). CONCLUSIONS Departmental DEI efforts are increasingly common within RO, however, the structure, resources, and recognition associated with DEI work are variable. Additional dedicated resources and recognition for these efforts will help ensure a culture of inclusive excellence for the RO workforce and patients.
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Affiliation(s)
- Kelly C Paradis
- Department of Radiation Oncology, Michigan Medicine, Ann Arbor, Michigan.
| | - Idalid Franco
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Sara Beltrán Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Avinash Chaurasia
- National Capital Consortium Radiation Oncology Residency, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Puja Venkat
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Malika Siker
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Reshma Munbodh
- Department of Radiation Oncology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Malcolm D Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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Mendulo R, Chiumia IK. The state of cervical cancer screening in imprisoned women in Malawi: a case of Maula Prison. BMC Womens Health 2023; 23:198. [PMID: 37118738 PMCID: PMC10142221 DOI: 10.1186/s12905-023-02349-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/11/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Malawi is one of the countries with the highest burden of cervical cancer in the world with less than ten percent of women screened for cervical cancer annually. The study aimed to investigate the state of cervical cancer screening among incarcerated women at Maula prison. The study highlights key challenges that women in prison face to access cervical cancer screening to inform policies and strategies to address them. METHODS The study employed a cross-sectional qualitative study design. A total of 31 prisoners aged between 18 to 49 participated in the study. Among these, 15 women participated in in-depth interviews, while 16 women participated in two focus group discussions consisting of 8 women per group. All interviews were recorded and transcribed verbatim. Data was analysed using inductive content analysis. FINDINGS Majority of women at Maula prison demonstrated knowledge of cervical cancer, its associated risk factors and the benefits of cervical cancer screening. Most women also expressed willingness to undergo cervical cancer screening. However, the following were identified as factors that hinder women from accessing cervical cancer screening services at the prison:-limited availability of the services, pain during the screening process, the presence of male practitioners conducting screening, poor treatment by authorities and health workers and favouritism. CONCLUSION To improve cervical cancer screening and its uptake at Maula prison there is a need to ensure unlimited availability of the screening services which should be conducted by female health practitioners. There is also a need to include this service as part of the mandatory health screening exercise that is conducted upon entry into the prison by all prisoners. Conducting in-depth awareness and sensitization with participants before screening would help to eradicate fear, provide assurance and clarification of the screening process. Prison officers and health workers should also be sensitised to improve prisoners' access to healthcare during incarceration.
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Affiliation(s)
- Regina Mendulo
- Department of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
| | - Isabel Kazanga Chiumia
- Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
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Beaulieu-Jones BR, Shewmaker G, Fefferman A, Kenzik K, Zhang T, Drake FT, Sachs TE, Hirsch AE, Merrill A, Ko NY, Cassidy MR. Mitigating disparities in breast cancer treatment at an academic safety-net hospital. Breast Cancer Res Treat 2023; 198:597-606. [PMID: 36826701 DOI: 10.1007/s10549-023-06875-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/01/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE Among women with non-metastatic breast cancer, marked disparities in stage at presentation, receipt of guideline-concordant treatment and stage-specific survival have been shown in national cohorts based on race, ethnicity, insurance and language. Little is published on the performance of safety-net hospitals to achieve equitable care. We evaluate differences in treatment and survival by race, ethnicity, language and insurance status among women with non-metastatic invasive breast cancer at a single, urban academic safety-net hospital. METHODS We conducted a retrospective study of patients with invasive ductal or lobular breast cancer, diagnosed and treated between 2009 and 2014 at an urban, academic safety-net hospital. Demographic, tumor and treatment characteristics were obtained. Stage at presentation, stage-specific overall survival, and receipt of guideline-concordant surgical and adjuvant therapies were analyzed. Chi-square analysis and ANOVA were used for statistical analysis. Unadjusted survival analysis was conducted by Kaplan-Meier method using log-rank test; adjusted 5 year survival analysis was completed stratified by early and late stage, using flexible parametric survival models incorporating age, race, primary language and insurance status. RESULTS 520 women with stage 1-3 invasive breast cancer were identified. Median age was 58.5 years, 56.1% were non-white, 31.7% were non-English-speaking, 16.4% were Hispanic, and 50.1% were Medicaid/uninsured patients. There were no statistically significant differences in stage at presentation between age group, race, ethnicity, language or insurance. The rate of breast conserving surgery (BCS) among stage 1-2 patients did not vary by race, insurance or language. Among patients indicated for adjuvant therapies, the rates of recommendation and completion of therapy did not vary by race, ethnicity, insurance or language. Unadjusted survival at 5 years was 93.7% for stage 1-2 and 73.5% for stage 3. Adjusting for age, race, insurance status and primary language, overall survival at 5 years was 93.8% (95% CI 86.3-97.2%) for stage 1-2 and 83.4% (95% CI 35.5-96.9%) for stage 3 disease. Independently, for patients with early- and late-stage disease, age, race, language and insurance were not associated with survival at 5-years. CONCLUSION Among patients diagnosed and treated at an academic safety-net hospital, there were no differences in the stage at presentation or receipt of guideline-concordant treatment by race, ethnicity, insurance or language. Overall survival did not vary by race, insurance or language. Additional research is needed to assess how hospitals and healthcare systems mitigate breast cancer disparities.
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Affiliation(s)
- Brendin R Beaulieu-Jones
- Department of Surgery, Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | | | - Ann Fefferman
- Boston University School of Medicine, Boston, MA, USA
| | - Kelly Kenzik
- Department of Surgery, Boston Medical Center, Boston, MA, USA
| | - Tina Zhang
- Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - F Thurston Drake
- Boston University School of Medicine, Boston, MA, USA
- Section of Surgical Oncology, Boston Medical Center, Boston University, 820 Harrison Avenue, FGH 5006, Boston, MA, 02118, USA
| | - Teviah E Sachs
- Boston University School of Medicine, Boston, MA, USA
- Section of Surgical Oncology, Boston Medical Center, Boston University, 820 Harrison Avenue, FGH 5006, Boston, MA, 02118, USA
| | - Ariel E Hirsch
- Boston University School of Medicine, Boston, MA, USA
- Department of Radiation Oncology, Boston Medical Center, Boston University, Boston, MA, USA
| | - Andrea Merrill
- Boston University School of Medicine, Boston, MA, USA
- Section of Surgical Oncology, Boston Medical Center, Boston University, 820 Harrison Avenue, FGH 5006, Boston, MA, 02118, USA
| | - Naomi Y Ko
- Boston University School of Medicine, Boston, MA, USA
- Section of Hematology & Oncology, Boston Medical Center, Boston University, Boston, MA, USA
| | - Michael R Cassidy
- Boston University School of Medicine, Boston, MA, USA.
- Section of Surgical Oncology, Boston Medical Center, Boston University, 820 Harrison Avenue, FGH 5006, Boston, MA, 02118, USA.
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23
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Patient-Physician Relationships and Mammography Use in Korean American Women. J Immigr Minor Health 2023; 25:129-135. [PMID: 35779153 DOI: 10.1007/s10903-022-01375-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 01/07/2023]
Abstract
Breast cancer is prevalent and fatal in Korean American women (KAW) and KAW report low screening rates. This study examined the impact of patient-physician relationships on mammography use in KAW, focusing on patient-physician ethnic and gender concordance, distrust in health professionals, and accessibility to health care. Cross-sectional survey data were collected from 340 KAW in North Carolina, and logistic regression was conducted to identify factors associated with mammography use. Having a non-Korean physician, regular check-ups, and physician recommendations were positively associated with getting mammography. Neither gender concordance nor distrust in health professionals predicted adherence to breast cancer screening guidelines. The findings highlight the critical roles of routine health care practice and usual source of care in compliance with the screening guidelines in KAW. Additional research is warranted to explore breast cancer screening recommendation behaviors and patterns of Korean American physicians compared to non-Korean counterparts.
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Dingle M, Galvez MG. The Underrepresented Minority in Hand Surgery: Challenges and Strategy for Success. Hand Clin 2023; 39:73-78. [PMID: 36402528 DOI: 10.1016/j.hcl.2022.08.004] [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] [Indexed: 11/17/2022]
Abstract
Hand surgery is a subspecialty that requires additional fellowship training after a primary residency; a long and competitive journey to achieve success. An underrepresented in medicine (UIM) student's journey to becoming a hand surgeon in the United States adds another level of challenge given several defined obstacles. Despite the lack of representation, the chances of becoming a hand surgeon are difficult but not impossible. A comprehensive strategy for an UIM student to become a hand surgeon is outlined in detail.
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Affiliation(s)
- Marvin Dingle
- Department of Surgery, Uniformed Services University of Health Sciences, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
| | - Michael G Galvez
- Division of Plastic and Hand Surgery, Pediatric Hand and Upper Extremity Surgery, Valley Children's Healthcare, 9300 Valley Children's Place GE07, Madera, CA 93636, USA.
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Mazilescu LI, Bernheim I, Treckmann J, Radunz S. Donor, Recipient and Surgeon Sex and Sex-Concordance and their Impact on Liver Transplant Outcome. J Pers Med 2023; 13:jpm13020281. [PMID: 36836516 PMCID: PMC9959865 DOI: 10.3390/jpm13020281] [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: 12/23/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
(1) Background: Patient sex is associated with differential outcome of many procedures although the exact mechanisms remain unknown. Especially in transplant surgery, surgeon-patient sex-concordance is rarely present for female patients and outcome may be negatively affected. (2) Methods: In this single-center retrospective cohort study, recipient, donor, and surgeon sex were evaluated and short- and long-term outcome was analyzed with regards to sex and sex-concordance of patients, donors, and surgeons. (3) Results: We included 425 recipients in our study; 50.1% of organ donors, 32.7% of recipients, and 13.9% of surgeons were female. Recipient-donor sex concordance was present in 82.7% of female recipients and in 65.7% of male recipients (p = 0.0002). Recipient-surgeon sex concordance was present in 11.5% of female recipients and in 85.0% of male recipients (p < 0.0001). Five-year patient survival was comparable between female and male recipients (70.0% vs. 73.3%, p = 0.3978). Five-year patient survival of female recipients treated by female surgeons was improved without reaching significance (81.3% vs. 68.4%, p = 0.3621). (4) Conclusions: Female recipients and female surgeons are underrepresented in liver transplant surgery. Societal factors influencing outcome of female patients suffering from end-stage organ failure need to be further examined and acted upon to possibly improve the outcome of female liver transplant recipients.
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Brown KK, Kindratt TB, Brannon GE, Sankuratri BYV, Boateng GO. Patient Experience with Their Health Care Provider Among Non-Pregnant Women of Childbearing Age with Diabetes Mellitus by Race and Ethnicity in the United States. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:20-30. [PMID: 36727093 PMCID: PMC9883667 DOI: 10.1089/whr.2022.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/26/2023]
Abstract
Objectives The study objective was to investigate differences in patient experiences with health care providers among non-pregnant women of childbearing age with diabetes mellitus (DM) by race/ethnicity. Design This study used cross-sectional data from the 2012-2018 Medical Expenditure Panel Survey. The sample was limited to women of childbearing age (18-45 years) who have ever been told they had diabetes (n = 763; weighted n = 903,670). The key independent variable was race/ethnicity. The variables of interest included patient experiences with health care in the past 12 months: patient-provider communication (PPC); patient-provider racial/ethnic concordance; patient-provider gender concordance; and satisfaction. Results After adjusting for age, marital status, education, poverty level, health insurance, and perceived health status, non-Hispanic (NH) Black women had lower odds (adjusted odds ratio [aOR] = 0.04; 95% confidence interval [CI] = 0.01-0.11) of receiving care from a health care provider of the same race compared with NH white women. Similar results were found among Hispanic and NH women of other or multiple races. Hispanic women had lower odds (aOR = 0.18; 95% CI = 0.06-0.50) of seeing a health care provider of the same race/ethnicity compared with NH white women in adjusted models. There were no statistically significant differences in PPC, patient-provider gender concordance, and satisfaction with their health care provider among Hispanic, NH Black, or NH women of other or multiple races in comparison to NH White women. Conclusion There is a need to improve PPC quality and satisfaction in this patient population. Patient-provider racial/ethnic discordance among women of color with DM is concerning given the existing diabetes-related disparities. More research on women with DM is needed to inform and improve patient experience and health outcomes.
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Affiliation(s)
- Kyrah K. Brown
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA.,Address correspondence to: Kyrah K. Brown, PhD, Department of Kinesiology, University of Texas at Arlington, 500 W. Nedderman Drive, Arlington, TX 76019, USA,
| | - Tiffany B. Kindratt
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA
| | - Grace Ellen Brannon
- Department of Communication, University of Texas at Arlington, Arlington, Texas, USA
| | | | - Godfred O. Boateng
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA
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Perrigino MB, Jenkins M. Unlocking the benefits of diversity among healthcare workforces: a holistic view. J Health Organ Manag 2023; ahead-of-print. [PMID: 36642984 DOI: 10.1108/jhom-06-2022-0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE The increasing diversity among workforces - as well as the increasing diversity among patient populations served - offers a variety of opportunities and potential pitfalls for healthcare organizations and leaders. To unravel this complexity, the authors aim to holistically understand how to maximize provider and patient experiences regardless of (1) the degree to which diversity is present or lacking, and (2) the type(s) of diversity under consideration. DESIGN/METHODOLOGY/APPROACH This conceptual paper develops a framework that combines three organizational behavior theories - emotional labor theory, similarity-attraction theory and climate theory - with evidence from the broader healthcare literature. FINDINGS Authentic interactions yield positive outcomes for providers (i.e. improved job attitudes and work-related well-being) and patients (i.e. patient satisfaction) and acts as a mediator between demographic diversity and positive outcomes. Demographic similarity facilitates authentic interactions, whereas demographic diversity creates an initial barrier to engaging authentically with others. However, the presence of a positive diversity climate eliminates this barrier. ORIGINALITY/VALUE The authors offer a conceptual model to unlock positive outcomes - including reduced absenteeism, better morale and improved patient satisfaction - regardless of the level and types of diversity present within the workforce. In addition to deriving an agenda for future research, the authors offer practical applications regarding how diversity can be more effectively managed and promoted within healthcare organizations.
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Tsai LL, Ha JS. Commentary: Mentorship based on authentic connection. J Thorac Cardiovasc Surg 2023; 165:406-407. [PMID: 34872763 DOI: 10.1016/j.jtcvs.2021.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 11/14/2021] [Accepted: 11/17/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Lillian L Tsai
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md
| | - Jinny S Ha
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.
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Adegboyega A, Desmennu AT, Dignan M. Qualitative assessment of attitudes toward cervical cancer (CC) screening and HPV self-sampling among African American (AA) and Sub Saharan African Immigrant (SAI) women. ETHNICITY & HEALTH 2022; 27:1769-1786. [PMID: 34538150 PMCID: PMC9204130 DOI: 10.1080/13557858.2021.1980771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Despite the availability of preventive methods for cervical cancer (CC), uptake has been low among African American and Sub-Saharan Immigrant (AA/SAI) women. The purpose of this study was to understand AA/SAI women's values and beliefs of CC screening and explore willingness, acceptability, and concerns related to the HPV self-sampling method for CC. DESIGN Thirty AA/SAI women participated in one of six focus groups, each lasted 60-90 min, and were held over Zoom video conferencing. The sessions were audio-recorded, transcribed verbatim, and checked for accuracy by research staff prior to data analysis. Transcripts were content analyzed by two qualitatively trained research staff. NVivo software was used for data management and analysis. RESULTS The average age of participants was 33.67 ± 9.03, more than half were not married (53.3%), and less than half reported having health insurance coverage (46.7%). Participants included 16 AA and 14 SAI. Three main themes emerged from data analysis. (1) Beliefs and values related to CC Screening, (2) perceived barriers to attending CC screening, (3) recommendations to motivate regular CC screening. In addition, three factors emerged in the discussion on the HPV self-sampling method: confidence in ability to self-sample for CC, willingness to use HPV self-sampling kit, and result delivery. CONCLUSIONS This study identified a variety of reasons for the disproportionately low utilization of CC prevention services among AA/SAI women. Multidimensional approaches including educational and community engagement programs for this population could improve CC screening uptake and adoption of HPV self-sampling among AA/SAI women.
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Affiliation(s)
| | - Adeyimika T. Desmennu
- Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Mark Dignan
- Prevention Research Center, University of Kentucky College of Medicine, Lexington, United States
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Jacobson M, Chang TY, Shah M, Pramanik R, Shah SB. Can financial incentives and other nudges increase COVID-19 vaccinations among the vaccine hesitant? A randomized trial. Vaccine 2022; 40:6235-6242. [PMID: 36137900 PMCID: PMC9424519 DOI: 10.1016/j.vaccine.2022.08.060] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 12/04/2022]
Abstract
Despite rapid initial uptake, COVID-19 vaccinations in the United States stalled within a few months of widespread rollout in 2021. In response, many state and local governments, employers and health systems used public health messaging, financial incentives and creative scheduling tools to increase vaccine uptake. Although these approaches drew on evidence from influenza and other vaccination efforts, they were largely untested in the context of SARS-CoV-2. In mid-2021, months after vaccines were widely available, we evaluated vaccination intentions and vaccine uptake using a randomized control trial. To do this, we recruited unvaccinated members of a Medicaid managed care plan in California (n = 2,701) and randomly assigned them to different public health messages, $10 or $50 financial incentives for vaccination, a simple vaccination appointment scheduler, or control. While messages increased vaccination intentions, none of the interventions increased vaccination rates. Estimates for financial incentives rule out even relatively small increases in vaccination rates. Small financial incentives and other behavioral nudges do not meaningfully increase COVID-19 vaccination rates amongst the vaccine hesitant.
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Affiliation(s)
- Mireille Jacobson
- Leonard Davis School of Gerontology, University of Southern California & NBER, 3715 McClintock Ave, Los Angeles, CA 90230, United States; Leonard Schaeffer Center for Health Policy & Economics, University of Southern California, United States.
| | - Tom Y Chang
- Marshall School of Business, University of Southern California, United States
| | - Manisha Shah
- Department of Public Policy, University of California, Los Angeles & NBER, United States
| | - Rajiv Pramanik
- Contra Costa Regional Medical Center & Health Centers, Contra Costa Health Services, United States
| | - Samir B Shah
- Contra Costa Regional Medical Center & Health Centers, Contra Costa Health Services, United States
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Rowell-Cunsolo TL, Bellerose M, Haile R. Hazards of Anti-Blackness in the United States. INTERNATIONAL JOURNAL OF SOCIAL WELFARE 2022; 31:520-528. [PMID: 36337765 PMCID: PMC9632408 DOI: 10.1111/ijsw.12547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 06/14/2022] [Indexed: 06/16/2023]
Abstract
On February 26, 2012, a Black child, Trayvon Martin, was executed in Sanford, Florida. Seventeen months later his killer was found not guilty. This is but one example of the state's brazen disregard for Black life, rooted in the kidnapping and enslavement of Africans more than 400 years ago, and the ways in which they and their descendants were systematically tortured. Trayvon Martin's murder catalyzed the Black Lives Matter (BLM) movement, which names and resists deeply entrenched state violence and inequities against Black people in the U.S. In this manuscript we: (1) summarize examples of structural disregard for Black lives in the U.S.; (2) describe how this disregard is reflected in differential patterns of social inequities, morbidity, and mortality; and (3) discuss how we can better employ the BLM perspective to frame a more historicized understanding of patterns in population health and to envision ways to resist health inequities.
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Affiliation(s)
| | - Meghan Bellerose
- Columbia University, Mailman School of Public Health, 722 West 168th Street, New York, NY 10032
| | - Rahwa Haile
- State University of New York- College at Old Westbury, Department of Public Health, Natural Sciences Building, Old Westbury, NY 11568
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Grimm LJ, Knight JR, Maxfield CM. Patient and radiologist demographics influence perceptions of screening mammogram reports. J Am Coll Radiol 2022; 19:1088-1097. [PMID: 35973651 DOI: 10.1016/j.jacr.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 06/25/2022] [Accepted: 07/01/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To test whether patient and radiologist demographics influence perceptions of screening mammogram reports and the interpreting radiologist. METHODS Patients presenting for breast imaging were surveyed. Demographics were collected and each participant was shown five mock screening mammogram reports with BI-RADS 2 findings, each with a recommendation for one year screening. Each report included a picture of the interpreting radiologist who was Black or white and male or female. Participants were asked seven Likert questions about understanding, satisfaction, and trust in the report and radiologist. Generalized estimating equation ordinal logistic regression compared responses based on participant and radiologist demographics. RESULTS There were 178 women who participated with a mean age of 55.1 ± 10.2 years. Most participants self-identified as white (71%) or Black (20%) and non-Hispanic (98%) with broad educational representation (28% Bachelor's and 28% Master's degree). After controlling for demographics, Black participants reported greater agreement regarding trust in the report's finding (p=0.037) if the radiologist was also Black. Black participants were less likely to be satisfied in the report quality (p=0.043). Additionally, participants without any college education reported lower agreement that they were satisfied with the report quality (p=0.020) and felt the radiologist cares about his/her patients (p=0.037). There were no significant associations for radiologist gender or participant age. DISCUSSION Participant perceptions of screening mammograms and the interpreting radiologist can be influenced by participant and provider race as well as participant education. These findings could have implications for mammography adherence, breast radiologist recruitment, and developing patient centric reports.
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Batra S, Orban J, Raichur S, Jennings N, Trivedi C, Naik N, Bogucki C, Haywood Y. Association of the COVID-19 Pandemic With Medical School Diversity Pathway Programs. JAMA Netw Open 2022; 5:e2229086. [PMID: 36036934 PMCID: PMC9425144 DOI: 10.1001/jamanetworkopen.2022.29086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Medical school pathway programs are a strategy to increase the diversity of the physician workforce. The COVID-19 pandemic may have negatively affected pathway programs, further challenging efforts to increase diversity. OBJECTIVES To describe the changes in medical school pathway programs during the COVID-19 pandemic and identify methods for sustaining and supporting these programs during and after the pandemic. DESIGN, SETTING, AND PARTICIPANTS A survey study using an exploratory sequential mixed-method design was conducted from January 4 to August 3, 2021. Semistructured interviews with a sample of medical school pathway program administrators and academic leaders of US allopathic and osteopathic medical school diversity pathway programs identified themes and patterns of change to pathway programs since the onset of the pandemic compared with previous years. These themes were used to develop a survey that was sent to medical schools to assess the association between COVID-19 and their programs. MAIN OUTCOMES AND MEASURES The association between the COVID-19 pandemic and medical school diversity pathway programs was explored using interview and survey data assessing respondent characteristics; changes in the scope, size, and funding of programs in 2020 compared with previous years; and respondents' perceptions of future needs for pathway programs. RESULTS Twelve program administrators and academic leaders were interviewed. Interviews revealed challenges and benefits of virtual programming in engaging and reaching students and speakers, the value of community partnerships to sustaining programming, and the importance of psychosocial support to mediating students' mental health challenges due to COVID-19 and remote learning. Of 198 schools surveyed in the quantitative phase, 112 responded (56.6%), 106 (94.6%) of which had been sponsoring or assisting with pathway programs during the COVID-19 pandemic. Forty-two respondents (39.6%) had reduced pathway programs since the onset of the COVID-19 pandemic compared with the previous year. Program cancellations were more likely to be noted in elementary school-aged (50.0% decrease in programming; P = .01) and middle school-aged (32.6%; P = .02) students compared with older groups. CONCLUSIONS AND RELEVANCE In this survey study, schools indicated that pathway programs were disrupted by COVID-19. Ongoing and flexible supports may be needed to sustain these programs. These findings are timely given recent investments in equity-focused programs to diversify the health workforce.
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Affiliation(s)
- Sonal Batra
- Department of Emergency Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Julie Orban
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | | | - Nicholas Jennings
- School of Medicine and Health Sciences, The George Washington University, Washington, DC
| | - Charmi Trivedi
- School of Medicine and Health Sciences, The George Washington University, Washington, DC
| | - Nehal Naik
- Department of Emergency Medicine, School of Medicine and Health Sciences, The George Washington University, Washington, DC
| | - Colleen Bogucki
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Yolanda Haywood
- School of Medicine and Health Sciences, The George Washington University, Washington, DC
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Ponce SEB, Thomas CR, Diaz DA. Social determinants of health, workforce diversity, and financial toxicity: A review of disparities in cancer care. Curr Probl Cancer 2022; 46:100893. [DOI: 10.1016/j.currproblcancer.2022.100893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
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Dee EC, Pierce LJ, Winkfield KM, Lam MB. In pursuit of equity in cancer care: moving beyond the Affordable Care Act. Cancer 2022; 128:3278-3283. [PMID: 35818772 DOI: 10.1002/cncr.34346] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/25/2022] [Accepted: 05/19/2022] [Indexed: 11/10/2022]
Abstract
Although Medicaid Expansion under the Patient Protection and Affordable Care Act (ACA) has been associated with many improvements for patients with cancer, Snyder et al. provide evidence demonstrating the persistence of racial disparities in cancer. This Editorial describes why insurance coverage alone does not ensure access to health care, highlights various manifestations of structural racism that constitute barriers to access beyond the direct costs of care, and calls for not just equality, but equity, in cancer care.
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Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lori J Pierce
- Department of Radiation Oncology, Rogel Comprehensive Cancer Center, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Karen M Winkfield
- Meharry-Vanderbilt Alliance, Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Miranda B Lam
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
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Balan N, Petrie BA, Chen KT. Racial Disparities in Colorectal Cancer Care for Black Patients: Barriers and Solutions. Am Surg 2022; 88:2823-2830. [PMID: 35757937 DOI: 10.1177/00031348221111513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Racial disparities in colorectal cancer for Black patients have led to a significant mortality difference when compared to White patients, a gap which has remained to this day. These differences have been linked to poorer quality insurance and socioeconomic status in addition to lower access to high-quality health care resources, which are emblematic of systemic racial inequities. Disparities impact nearly every point along the colorectal cancer care continuum and include barriers to screening, surgical care, oncologic care, and surveillance. These critical faults are the driving forces behind the mortality difference Black patients face. Health care systems should strive to correct these disparities through both cultural competency at the provider level and public policy change at the national level.
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Affiliation(s)
- Naveen Balan
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Beverley A Petrie
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kathryn T Chen
- Department of Surgery, 21640Harbor-UCLA Medical Center, Torrance, CA, USA
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Otte SV. Improved Patient Experience and Outcomes: Is Patient–Provider Concordance the Key? J Patient Exp 2022; 9:23743735221103033. [PMID: 35664933 PMCID: PMC9158407 DOI: 10.1177/23743735221103033] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Health disparities remain ubiquitous in the United States despite initiatives by the federal government and other organizations. A long-term solution for health inequity is needed in order to help improve patient outcomes for all. The purpose of this review is to examine if racial, gender, or multifactorial concordance (eg, race, age, gender, education, language) between patient and provider leads to a better patient experience and improved health outcomes. A PubMed search for articles published between 2016 and 2021 resulted in 23 separate studies that met inclusion criteria. The results from these studies were inconclusive in determining an association between patient–provider concordance and patient outcomes. Further research is needed to evaluate the positive, neutral, and sometimes negative impact of patient–provider concordance. By diversifying healthcare professions and improving cultural competency and communication training programs, providers may be better prepared to care for diverse populations in both concordant and discordant patient relationships.
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Acoba JD, Sumida K, Berenberg J. Overcoming racial disparities in cancer clinical trial enrollment of Asians and Native Hawaiians. Contemp Clin Trials Commun 2022; 28:100933. [PMID: 36688088 PMCID: PMC9846448 DOI: 10.1016/j.conctc.2022.100933] [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: 11/24/2021] [Revised: 03/22/2022] [Accepted: 05/25/2022] [Indexed: 01/25/2023] Open
Abstract
Background Asians and Native Hawaiians are two of the fastest growing minority populations in the United States, however these racial minority groups are severely underrepresented in clinical trials. This study looks at cancer clinical trial accrual among Asians and Native Hawaiians in a community-based network with a mission of increasing minority accrual to studies. Methods The University of Hawaii Cancer Center (UHCC) network enrolls patients to treatment and non-treatment cancer studies. Enrollment on studies opened between 2009 and 2013 were obtained from UHCC's clinical trial management system. Incidence of cancer by race was acquired from the Hawaii Tumor Registry. Enrollment fractions were compared for the most common races in the state: White, Asian (specifically Chinese, Filipino, Japanese), and Native Hawaiian. Results Whites comprised the largest proportion of cancer patients and participants in trials. Asians and Native Hawaiians were enrolled into cancer clinical trials at the same or higher enrollment fraction compared to Whites. Chinese, Japanese, and Native Hawaiian patients participated in treatment trials significantly more often than Whites (p < 0.05). Similarly, Chinese and Native Hawaiians enrolled in non-treatment trials at a significantly higher rate compared to Whites (p < 0.05). Conclusions The UHCC network has instituted many strategies to increase minority accrual that have likely led to Asian and Native Hawaiian patients participating in studies at least as often as White patients. The strategies implemented at UHCC may benefit similar communities with a high number of minority cancer patients.
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Affiliation(s)
- Jared D. Acoba
- University of Hawaii Cancer Center, Honolulu, HI, USA,John A. Burns School of Medicine, Honolulu, HI, USA,Corresponding author. 701 Ilalo St, Rm 323, Honolulu, HI, 96813, USA.
| | - Ken Sumida
- University of Hawaii Cancer Center, Honolulu, HI, USA,John A. Burns School of Medicine, Honolulu, HI, USA
| | - Jeffrey Berenberg
- University of Hawaii Cancer Center, Honolulu, HI, USA,John A. Burns School of Medicine, Honolulu, HI, USA,Tripler Army Medical Center, Honolulu, HI, USA
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Badreldin N, DiTosto JD, Grobman WA, Yee LM. Association Between Patient-Prescriber Racial and Ethnic Concordance and Postpartum Pain and Opioid Prescribing. Health Equity 2022; 6:198-205. [PMID: 35402767 PMCID: PMC8985536 DOI: 10.1089/heq.2021.0130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 11/12/2022] Open
Abstract
Objective: To evaluate whether patient-prescriber racial and ethnic concordance is associated with postpartum opioid prescribing patterns and patient-reported pain scores. Methods This is a retrospective cohort study of patients who delivered at a tertiary care center between December 1, 2015 and November 30, 2016. Self-identified non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, or Asian patients were included. Patient-prescriber pairs were categorized as racially and ethnically concordant if they shared the same racial and ethnic identity; the prescriber was defined as the obstetrical provider who was responsible for the postpartum discharge of the patient. Multivariable regression models controlling for demographic and clinical confounders were used to assess the relationship of patient-prescriber racial and ethnic concordance with receipt of an opioid prescription and patient-reported pain score at discharge. Results Of 10,242 patients included in this analysis, 62.3% identified as NHW, 19.1% Hispanic, 9.7% NHB, and 8.9% Asian. About half (52.8%) of patients were discharged by a racially and ethnically concordant prescriber. Patient-prescriber racial and ethnic concordance was not associated with receipt of an opioid prescription (adjusted odds ratio [aOR] 0.82, confidence interval [95% CI] 0.67–1.00) or reporting a pain score ≥5 (aOR 0.90, 95% CI 0.69–1.16). However, NHB and Hispanic patients were less likely to receive an opioid prescription (aOR 0.73, 95% CI 0.56–0.95; aOR 0.73, 95% CI 0.57–0.92, respectively) and significantly more likely to report a pain score ≥5 (aOR 2.13, 95% CI 1.51–3.00; aOR 1.48 95% CI 1.08–2.01, respectively) than NHW patients, even when accounting for concordance. Conclusion Disparities in postpartum opioid prescribing and pain perception are not ameliorated by patient-prescriber racial and ethnic concordance.
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Affiliation(s)
- Nevert Badreldin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University School of Medicine, Chicago, Illinois, USA
| | - Julia D. DiTosto
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University School of Medicine, Chicago, Illinois, USA
| | - William A. Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University School of Medicine, Chicago, Illinois, USA
| | - Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University School of Medicine, Chicago, Illinois, USA
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Nwokolo OO, Coombs AAT, Eltzschig HK, Butterworth JF. Diversity and Inclusion in Anesthesiology. Anesth Analg 2022; 134:1166-1174. [PMID: 35130194 DOI: 10.1213/ane.0000000000005941] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In today's world, departments of anesthesiology and professional organizations are rightfully expected to have racial, ethnic, and gender diversity. Diversity and inclusiveness are considered important contributors to an effective and collaborative work environment by promoting excellence in patient care, education, and research. This has been re-emphasized in the racial reckoning in the summer of 2020, and the ongoing health care disparities manifested by the global coronavirus disease 2019 (COVID-19) pandemic. Moreover, the negative consequences of a lack of diversity and inclusion in health care have been shown to impact recruitment, retention, and the economic well-being of academic departments. In the present article, we review the current state of diversity in anesthesiology departments and professional organizations in the United States. We discuss strategies and important approaches to further enhance diversity to promote an inclusive perioperative work environment.
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Affiliation(s)
- Omonele O Nwokolo
- From the Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Alice A T Coombs
- Department of Anesthesiology, Virginia Commonwealth University School of Medicine, West Hospital, Richmond, Virginia
| | - Holger K Eltzschig
- From the Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - John F Butterworth
- Department of Anesthesiology, Virginia Commonwealth University School of Medicine, West Hospital, Richmond, Virginia
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41
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Mattes MD, Deville C. A Survey to Assess and Delineate Approaches to Medical Student Outreach to Promote Diversity at Academic Radiation Oncology Programs. Int J Radiat Oncol Biol Phys 2022; 112:1083-1089. [PMID: 35017009 DOI: 10.1016/j.ijrobp.2021.12.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/02/2021] [Accepted: 12/24/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE/OBJECTIVE(S) To assess how academic radiation oncology departments engage medical students who are either female and/or from racial and ethnic demographic groups that are underrepresented in medicine (URiM). MATERIALS/METHODS An electronic survey was sent to all 83 radiation oncology residency program directors (or if applicable medical student directors) whose department is affiliated with an on-site medical school. Questions assessed whether any faculty in the participants' department offer exposure in radiation oncology specifically to medical and premedical student groups whose members are typically female or URiM, or promote the American Society for Radiation Oncology (ASTRO) Minority Summer Fellowship (MSF) Award. Barriers to these types of involvement were also assessed. RESULTS A representative from 54/83 programs responded (response rate 65%). Faculty from 83% of departments had given a presentation to an oncology or radiation oncology medical student interest group. However, faculty from only 18% of departments had given a presentation to a Student National Medical Association chapter, 9% to a Latino Medical Student Association chapter, and 11% to an American Medical Women's Association chapter. Faculty from 15% of departments actively promote the MSF to the general student body, and 24% promote it to any minority students who express interest in radiation oncology. Faculty from 22% of departments had given a presentation to a premedical student group, 10% to an undergraduate student group focused on minority or female students, and 20% to a pipeline program for high school (or younger) female or URiM students. Lack of awareness of the existence of such programs, or not being invited, were the most common barriers to participation. CONCLUSIONS Most academic radiation oncology departments do not offer educational outreach specifically targeting women or minority students or promote the MSF. Further efforts are needed to break from the status quo and attract a more diverse workforce.
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Affiliation(s)
- Malcolm D Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
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Chilakala A, Camacho-Rivera M, Frye V. Experiences of race- and gender-based discrimination among Black female physicians. J Natl Med Assoc 2022; 114:104-113. [DOI: 10.1016/j.jnma.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/24/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
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Lor M, Badenoch N, Yang MJ. Technical Meets Traditional: Language, Culture, and the Challenges Faced by Hmong Medical Interpreters. J Transcult Nurs 2022; 33:96-104. [PMID: 34404302 PMCID: PMC10711740 DOI: 10.1177/10436596211039553] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Ineffective intercultural communication can occur due to inaccurate medical interpreting for limited English proficiency (LEP) patients. Research shows that Hmong patients experience poorer quality interpreter services than other LEP populations. This study's purpose is to understand Hmong medical interpreters' perceptions of the factors that affect their ability to make accurate medical interpretations during clinical encounters. METHOD A qualitative study was conducted with Hmong-speaking medical interpreters. The interviews were semistructured, audio recorded, and analyzed using conventional content analysis. RESULTS 13 interpreters aged 29 to 49 years participated in the study. Three factors affected the interpreters' ability to make accurate medical interpretations for Hmong-speaking patients: (a) matched gender between the interpreter and patient, (b) culturally taboo topics in communicating about reproductive body parts and sexual health/activity, and (c) culture and generational language differences between interpreters and Hmong patients. DISCUSSION Clinical encounters that match patient-interpreter ages, gender, and/or local culture may reduce communication barriers.
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Affiliation(s)
- Maichou Lor
- University of Wisconsin–Madison, Madison, WI, USA
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Wallis CJD, Jerath A, Coburn N, Klaassen Z, Luckenbaugh AN, Magee DE, Hird AE, Armstrong K, Ravi B, Esnaola NF, Guzman JCA, Bass B, Detsky AS, Satkunasivam R. Association of Surgeon-Patient Sex Concordance With Postoperative Outcomes. JAMA Surg 2021; 157:146-156. [PMID: 34878511 DOI: 10.1001/jamasurg.2021.6339] [Citation(s) in RCA: 127] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Surgeon sex is associated with differential postoperative outcomes, though the mechanism remains unclear. Sex concordance of surgeons and patients may represent a potential mechanism, given prior associations with physician-patient relationships. Objective To examine the association between surgeon-patient sex discordance and postoperative outcomes. Design, Setting, and Participants In this population-based, retrospective cohort study, adult patients 18 years and older undergoing one of 21 common elective or emergent surgical procedures in Ontario, Canada, from 2007 to 2019 were analyzed. Data were analyzed from November 2020 to March 2021. Exposures Surgeon-patient sex concordance (male surgeon with male patient, female surgeon with female patient) or discordance (male surgeon with female patient, female surgeon with male patient), operationalized as a binary (discordant vs concordant) and 4-level categorical variable. Main Outcomes and Measures Adverse postoperative outcome, defined as death, readmission, or complication within 30-day following surgery. Secondary outcomes assessed each of these metrics individually. Generalized estimating equations with clustering at the level of the surgical procedure were used to account for differences between procedures, and subgroup analyses were performed according to procedure, patient, surgeon, and hospital characteristics. Results Among 1 320 108 patients treated by 2937 surgeons, 602 560 patients were sex concordant with their surgeon (male surgeon with male patient, 509 634; female surgeon with female patient, 92 926) while 717 548 were sex discordant (male surgeon with female patient, 667 279; female surgeon with male patient, 50 269). A total of 189 390 patients (14.9%) experienced 1 or more adverse postoperative outcomes. Sex discordance between surgeon and patient was associated with a significant increased likelihood of composite adverse postoperative outcomes (adjusted odds ratio [aOR], 1.07; 95% CI, 1.04-1.09), as well as death (aOR, 1.07; 95% CI, 1.02-1.13), and complications (aOR, 1.09; 95% CI, 1.07-1.11) but not readmission (aOR, 1.02; 95% CI, 0.98-1.07). While associations were consistent across most subgroups, patient sex significantly modified this association, with worse outcomes for female patients treated by male surgeons (compared with female patients treated by female surgeons: aOR, 1.15; 95% CI, 1.10-1.20) but not male patients treated by female surgeons (compared with male patients treated by male surgeons: aOR, 0.99; 95% CI, 0.95-1.03) (P for interaction = .004). Conclusions and Relevance In this study, sex discordance between surgeons and patients negatively affected outcomes following common procedures. Subgroup analyses demonstrate that this is driven by worse outcomes among female patients treated by male surgeons. Further work should seek to understand the underlying mechanism.
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Affiliation(s)
- Christopher J D Wallis
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.,Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Angela Jerath
- Department of Anesthesia, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Natalie Coburn
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Zachary Klaassen
- Division of Urology, Medical College of Georgia, Augusta University, Augusta
| | - Amy N Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Diana E Magee
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Amanda E Hird
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen Armstrong
- Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Bheeshma Ravi
- Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.,Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nestor F Esnaola
- Division of Surgical Oncology and Gastrointestinal Surgery, Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Jonathan C A Guzman
- Department of Urology, Houston Methodist Hospital, Houston, Texas.,Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas
| | - Barbara Bass
- School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Allan S Detsky
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
| | - Raj Satkunasivam
- Department of Urology, Houston Methodist Hospital, Houston, Texas.,Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas.,Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station
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Bullock JL, O'Brien MT, Minhas PK, Fernandez A, Lupton KL, Hauer KE. No One Size Fits All: A Qualitative Study of Clerkship Medical Students' Perceptions of Ideal Supervisor Responses to Microaggressions. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S71-S80. [PMID: 34348373 DOI: 10.1097/acm.0000000000004288] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE This study explores medical students' perspectives on the key features of ideal supervisor responses to microaggressions targeting clerkship medical students. METHOD This single-institution, qualitative focus group study, based in an interpretivist paradigm, explored clerkship medical students' perceptions in the United States, 2020. During semistructured focus groups, participants discussed 4 microaggression scenarios. The authors employed the framework method of thematic analysis to identify considerations and characteristics of ideal supervisor responses and explored differences in ideal response across microaggression types. RESULTS Thirty-nine students participated in 7 focus groups, lasting 80 to 92 minutes per group. Overall, students felt that supervisors' responsibility began before a microaggression occurred, through anticipatory discussions ("pre-brief") with all students to identify preferences. Students felt that effective bystander responses should acknowledge student preferences, patient context, interpersonal dynamics in the room, and the microaggression itself. Microassaults necessitated an immediate response. After a microaggression, students preferred a brief one-on-one check-in with the supervisor to discuss the most supportive next steps including whether further group discussion would be helpful. CONCLUSIONS Students described that an ideal supervisor bystander response incorporates both student preferences and the microaggression context, which are best revealed through advanced discussion. The authors created the Bystander Microaggression Intervention Guide as a visual representation of the preferred bystander microaggression response based on students' discussions. Effective interventions promote educational safety and shift power dynamics to empower the student target.
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Affiliation(s)
- Justin L Bullock
- J.L. Bullock is a second-year resident, internal medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Meghan T O'Brien
- M.T. O'Brien is assistant professor, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Prabhjot K Minhas
- P.K. Minhas is a second-year medical student, University of California, San Francisco School of Medicine, San Francisco, California
| | - Alicia Fernandez
- A. Fernandez is associate dean for population health and health equity and professor, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Katherine L Lupton
- K.L. Lupton is associate professor, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Karen E Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards and professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
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Prasad T, Buta E, Cleary PD. Is Patient-Physician Gender Concordance Related to the Quality of Patient Care Experiences? J Gen Intern Med 2021; 36:3058-3063. [PMID: 33469761 PMCID: PMC8481522 DOI: 10.1007/s11606-020-06411-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/07/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is great interest in identifying factors that are related to positive patient experiences such as physician communication style. Documented gender-specific physician communication and patient behavior differences raise the question of whether gender concordant relationships (i.e., both the provider and patient share the same gender) might affect patient experiences. OBJECTIVE Assess whether patient experiences are more positive in gender concordant primary care relationships. DESIGN Statewide telephone surveys. Linear mixed regression models to estimate the association of CAHPS scores with patient gender and gender concordance. SUBJECTS Two probability samples of primary care Medicaid patients in Connecticut in 2017 (5/17-7/17) and 2019 (7/19-10/19). MAIN MEASURES Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey augmented with questions about aspects of care most salient to PCMH-designated organizations and two questions to assess access to mental health services. KEY RESULTS There were no significant effects of gender concordance and differences in experiences by patient gender were modest. CONCLUSIONS This study did not support the suggestion that patient and physician gender and gender concordance have an important effect on patient experiences.
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Affiliation(s)
| | - Eugenia Buta
- Yale Center for Analytical Studies, Yale School of Public Health, PO Box 208034, New Haven, CT, 06520-8034, USA
| | - Paul D Cleary
- Anna M.R. Lauder Professor of Public Health, Department of Health Policy and Management, Yale School of Public Health, PO Box 208034, New Haven, CT, 06520-8034, USA.
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Wu X, Jiang YN, Zhang YL, Chen J, Mao YY, Zhang L, Zhou DB, Cao XX, Li J. Impact of Physicians' Personalities and Behavioral Traits on Treatment-Related Decision-making for Elderly Acute Myeloid Leukemia. J Gen Intern Med 2021; 36:3023-3030. [PMID: 33511569 PMCID: PMC8481415 DOI: 10.1007/s11606-020-06467-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Elderly patients with acute myeloid leukemia (AML) can be treated with intensive therapy, low-intensity therapy, or best supportive care. Medical decision-making might be affected by physicians' occupational and non-occupational factors. OBJECTIVE To explore the impact of physicians' personalities and behavioral traits on treatment-related decision-making for elderly AML patients. DESIGN A nationwide cross-sectional survey. PARTICIPANTS Hematologists in mainland China (N = 529; response rate 64.5%). MAIN MEASURES The medical decision-making for elderly AML patients was evaluated using 6 clinical vignettes. Hematologists' attitudes toward risk and uncertainty, Big Five personality traits, and decision-making styles were assessed using binary lottery choices and well-recognized self-report inventories. KEY RESULTS The resulting binary regression model in predicting treatment intensity contained professional title group (OR = 0.012, 95% CI 0.001 to 0.136, P < 0.001), conscientiousness (OR = 0.336, 95% CI 0.121 to 0.932, P = 0.036), extraversion (OR = 0.403, 95% CI 0.166 to 0.974, P = 0.044), conscientiousness by title group (OR = 2.009, 95% CI 1.100 to 3.667, P = 0.023), and extraversion by title group (OR = 1.627, 95% CI 0.965 to 2.743, P = 0.068) as predictors of therapy intensity preference. Junior physicians with a higher level of extraversion (mean difference = 0.27; 95% CI 0.07 to 0.45; P = 0.009) or conscientiousness (mean difference = 0.19; 95% CI 0.01 to 0.36; P = 0.028) tended to prescribe more intensive therapy. Meanwhile, no significant correlation was found between physicians' personalities or behavioral traits and treatment-related decision-making in senior physicians. CONCLUSIONS Physicians' personalities contribute to treatment-related decision-making for elderly AML patients, depending on the professional titles. More extravert or conscientious attending physicians tended to prescribe more intensive therapy. Meanwhile, the decisions made by chief and associate chief physicians were not impacted by their personal traits. Junior physicians should be aware of such potential influence when making medical decisions.
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Affiliation(s)
- Xia Wu
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Yi-Nan Jiang
- Department of Psychology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Yue-Lun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Jia Chen
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Yue-Ying Mao
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Lu Zhang
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Dao-Bin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xin-Xin Cao
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
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48
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Cudjoe J, Nkimbeng M, Turkson-Ocran RA, Commodore-Mensah Y, Han HR. Understanding the Pap Testing Behaviors of African Immigrant Women in Developed Countries: A Systematic Review. J Immigr Minor Health 2021; 23:840-856. [PMID: 33165711 PMCID: PMC8747177 DOI: 10.1007/s10903-020-01119-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND African immigrant (AI) women remain burdened by cervical cancer, but the prevalence and correlates of Pap testing remains unclear in this population. OBJECTIVE To review studies on the prevalence and determinants of Pap testing among AI women living in developed countries. METHODS PubMed, CINAHL, Embase, and Scopus were searched for relevant articles that included African-born immigrant participants; were published in English; addressed the prevalence of Pap testing; conducted in a developed country; and identified correlates of Pap testing behavior. The Andersen Behavioral Model guided synthesis of the key findings. RESULTS Sixteen studies met the inclusion criteria. The prevalence of Pap testing ranged from 4.6% to 73.0%. Having a female provider and access to primary care facilitated Pap testing. Barriers to Pap testing included low income, male healthcare providers, and no history of gynecological exam. CONCLUSIONS Healthcare providers and social determinants-particularly income and healthcare access, play an important role in improving Pap testing among AI women. Larger qualitative and mixed methods studies are needed to explore other important determinants of Pap testing such as disease knowledge, self-efficacy, health literacy to reduce the burden of cervical cancer among AI women.
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Affiliation(s)
- Joycelyn Cudjoe
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, 21205, USA.
- Inova Health System, 8110 Gatehouse Road, Falls Church, VA, 22042, USA.
| | - Manka Nkimbeng
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
- University of Minnesota School of Public Health, 420 Delaware St SE, Minneapolis, MN, 55444, USA
| | - Ruth-Alma Turkson-Ocran
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Yvonne Commodore-Mensah
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
- Center for Cardiovascular and Chronic Care, The Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Hae-Ra Han
- School of Nursing, The Johns Hopkins University, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
- Center for Cardiovascular and Chronic Care, The Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
- Center for Community Innovation and Scholarship, The Johns Hopkins School of Nursing, 855 N Wolfe Street, Baltimore, MD, 21205, USA
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49
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Orji AF, Yamashita T. Racial disparities in routine health checkup and adherence to cancer screening guidelines among women in the United States of America. Cancer Causes Control 2021; 32:1247-1256. [PMID: 34216336 DOI: 10.1007/s10552-021-01475-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 06/28/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Routine health checkup and cancer screening rates among women are suboptimal, partially due to the health care disparities by race/ethnicity in the USA. This study examined the previously understudied associations between routine health checkup, cervical cancer screening, and breast cancer screening by race/ethnicity using the national representative sample of women. METHODS Data were obtained from three cycles (2017, 2018, and 2019) of the Health Information National Trends Survey (HINTS) (n = 12,227). Survey-weighted logistic regressions were evaluated to assess associations between routine health checkup and cervical and breast cancer screening compliance with the established guidelines with the age criteria and frequency of screening by race/ethnicity (Black, White, Hispanic, and Other). RESULTS This study included 6,941 women in the cervical cancer screening and 8,005 women for breast cancer screening, considering the age criteria. Women who had received routine health checkups were more likely to meet the cervical cancer screening guideline (Odds ratio 3.24, p < 0.05) and breast cancer screening guideline (OR 5.86, p < 0.05) compared to women who did not receive routine health checkups. While routine health checkups were associated with both types of cancer screenings in most racial/ethnic groups, analyses stratified by race/ethnicity suggest that Hispanic women and Other women did not benefit from routine health checkup in relation to cervical and breast cancer screening, respectively. CONCLUSION Promotion of routine health checkups could promote cancer screening among women across racial/ethnic groups, although specific racial/ethnic groups may require additional support.
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Affiliation(s)
- Amarachukwu F Orji
- Department of Global and Community Health, College of Health and Humanities, George Mason University, Fairfax, VA, USA
| | - Takashi Yamashita
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD, 21250, USA.
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50
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Haas JS, Vogeli C, Yu L, Atlas SJ, Skinner CS, Harris KA, Feldman S, Tiro JA. Patient, provider, and clinic factors associated with the use of cervical cancer screening. Prev Med Rep 2021; 23:101468. [PMID: 34258177 PMCID: PMC8254123 DOI: 10.1016/j.pmedr.2021.101468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/13/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022] Open
Abstract
Cervical cancer screening delivery remains suboptimal. Understanding the multiple influences on use of screening is important to designing interventions. We describe the influence of patient, primary care provider (PCP), and clinic characteristics on whether a woman is up-to-date with cervical screening as of December 2016. PCPs (n = 194) and their female screen-eligible patients age 21–65 years (n = 32,115) were included in this cross-sectional analysis of patients from two primary care networks linked to a contemporaneous PCP survey. Principal independent variables for patients included: age, race, insurance, continuity of care; for PCP included: overall satisfaction with the practice of medicine, gender, hours worked per week, financial support for achieving clinical targets; and for clinic included: routine receipt of data on preventive care performance and language translation resources. Overall, 66.6% of women were up-to-date. Women were less likely to be up-to-date with cervical cancer screening if they were younger and were more likely to be screened if they were Black, Hispanic or Asian vs. White. Women with greater continuity of primary care or with a female PCP were more likely to be up-to-date (1.52; 1.33–1.75); those who received care in a clinic that was less prepared to manage language translation were less likely to be up-to-date (0.78; 0.65–0.95). Patient, provider, and clinic factors all influence use of cervical cancer screening. Systems interventions like improving continuity of care, promoting translation services, or enhanced efforts to track screening among patients of male PCPs may improve delivery.
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Affiliation(s)
- Jennifer S Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Mongan Institute, Massachusetts General Hospital, Boston, MA, United States
| | - Christine Vogeli
- Mongan Institute, Massachusetts General Hospital, Boston, MA, United States
| | - Liyang Yu
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Steven J Atlas
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Mongan Institute, Massachusetts General Hospital, Boston, MA, United States
| | - Celette Sugg Skinner
- Department of Population & Data Sciences and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Kimberly A Harris
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sarah Feldman
- Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Jasmin A Tiro
- Department of Population & Data Sciences and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
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