Abstract C87: Provider characteristics and timely receipt of cancer screening: The role of communication and race/sex concordance between patients and providers
Authors: Vichare Anushree M. 
Published: March 2017

Background: Early detection through screening is an important predictor of cancer prognosis and can significantly improve quality of life, lower mortality and reduce treatment costs. Despite improved access, screening remains sub-optimal. Healthcare providers play a crucial role in promoting positive health behaviors by establishing trust through effective patient-provider interactions and communication. It is known that optimal alignment of race/ethnicity and sex between patients and providers as well as satisfaction with interaction with providers may encourage compliance with treatment. It remains unclear if concordance and patient's perceptions of quality of provider's communication influences utilization and adherence to cancer screening. This study's objectives are two-fold:1) To examine if race/ethnicity and sex concordance is associated with compliance for breast, cervical and colorectal cancer screening (CRC) and 2) To estimate the association between patients rating of their provider's communication and receipt of timely screening.

Methods: Analyses data are adult respondents with a usual source of care (USC) identified from 2008-2013 Medical Expenditure Panel Survey. Sample sizes varied by services based on U.S. Preventive Services Task Force screening recommendations for breast, cervical and CRC. Concordance was categorized as no concordance, race only, sex only or dual concordance using respondents' report of their own and their providers' race/ethnicity and sex. Perceptions of provider's communication were measured on four dimensions; how often USC 1) asked about prescription medications and treatments from other doctors, 2) showed respect for medical, traditional and alternative treatments that the person wants, 3) involved in making decisions between treatments, 4) presented and explained all options. Separate multivariate logistic regressions were conducted for each cancer screening to examine association with concordance and each communication behavior individually.

Results: Women with female providers were more likely to report adherence to mammography [Odds Ratio (OR) = 1.8, 95% confidence interval (CI): 1.3, 2.4; p&lt;0.001] and PAP tests [OR = 1.5, 95% CI: 1.3, 2.0; p=0.006]. Neither sex nor dual concordance was associated with CRC screening. Race concordance alone was not statistically associated with any cancer screening. Women who perceived USC to involve in decision making or asked about treatments from other doctors were more likely to report timely mammograms [OR = 1.2, 95% CI: 1.0, 1.4; p=0.04 and OR = 1.5, 95% CI: 1.2,1.7; p&lt;0.001 respectively] and cervical cancer screening [OR = 1.2, 95% CI: 1.03, 1.4; p=0.02 and OR = 1.3, 95% CI: 1.09,1.6; p=0.005 respectively]. However, only one communication behavior of being asked about treatments was associated with timely CRC screening [OR = 1.2, 95% CI: 1.02, 1.3; p=0.02]. Subgroup analysis indicated that positive perceptions of communication were associated with higher likelihood of reporting all cancer screening among racial and ethnic minorities.

Conclusions: Association between sex concordance with breast and cervical cancer screening suggests that either female providers are more likely to recommend them because of better attunement to female preventive needs or patients are more comfortable receiving them from female providers. Results on communication patterns indicate that both measures that were significant, were related to providers' soliciting response from patients which may encourage patient activation and facilitate receipt of cancer screening especially among racial and ethnic minorities. Thus, greater patient involvement and encouraging dialogue with patients can be an important platform for promotion of disease prevention. Healthcare providers play a crucial role in mitigating disparities in cancer screening and should consider interpersonal communication with their patients as an effective instrument to promote timely screening.

Note: This abstract was not presented at the conference.

Citation Format: Anushree M. Vichare. Provider characteristics and timely receipt of cancer screening: The role of communication and race/sex concordance between patients and providers. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C87.