Abstract A92: Patients' experiences with breast cancer care: Do sociocultural factors attenuate racial disparities in ratings of quality?
Authors: Sheppard Vanessa B. , Mendoza Alejandra Hurtado de , Song Minna , Makambi Kepher 
Published: October 2015

Background: Several studies have reported disparities in access to quality cancer care in women from racial/ethnic groups compared to non-Hispanic whites. Few reports examine the factors associated with breast cancer patients' ratings of quality care. The goal of this study is to (1) assess racial disparities in patients' ratings of quality care and (2) identify factors that may attenuate these disparities.

Methods: We surveyed and abstracted medical records for 359 breast cancer patients (59% black; 41% white) in Washington, DC and Detroit, MI. Ratings of quality of cancer care were assessed for four domains (general satisfaction, technical quality, interpersonal manner, and financial aspects).

Results: Black women were more likely to report lower ratings on three dimensions including technical (black m=3.99; white m=4.27; p&lt;.001), interpersonal (black m=4.17; white m=4.36; p&lt;.01), and financial (black m=3.82; white m=4.01; p&lt; .05).

General satisfaction ratings: In bivariate analysis, women with higher ratings were those who made surgery decisions with the physician, reported fewer barriers to use health care services (appointment, physical, and emotional barriers) perceived lower discrimination, lower medical mistrust, had high health self-efficacy (maintaining a positive attitude, seeking information, and participating in care), and had high trust in their providers and oncologist (all p&lt;.05). In multivariate analysis, only trust in the oncologist (B=.085, SE=.04, p=.033), trust in providers (B=.069,SE=.02, p=.00), and appointment barrier (B=-.32, SE=.15, p=.04) remained significant.

Technical care ratings: In bivariate analysis, women with higher ratings were those who made decisions about treatment with the physician, were in racially concordant patient-provider relationship, had lower perceived discrimination, lower medical mistrust, higher trust in the providers and in the oncologist, and did not endorse limited office hours or emotional barriers. Additionally, self-efficacy (the three subscales) was associated with higher ratings (all p&lt;.05). In multivariate analysis, medical mistrust (B=-0.20, SE=.007, p=.003) and trust in provider remained significant (B=.083, SE=.011, p=.000).

Interpersonal care ratings: Factors associated with higher ratings in bivariate analysis included: oncologist race concordance, high trust in oncologist and in the provider, high self-efficacy (participating in care). Participants who reported more barriers (limited office hours and health insurance in particular), those with lower perceived discrimination, lower medical mistrust, and lower ratings of communalism had higher ratings of interpersonal care (all p&lt;.05). Only trust in provider (B=.05, SE= .012, p=.000) and total number of barriers (B= -.057, SE=.019, p=.003) remained significant in multivariate analysis.

Financial aspects of care ratings: In bivariate analysis, number of barriers (appointment, health insurance, money, physical, and emotion in particular), religiosity, perceived discrimination, self-efficacy (positive attitude and participating in care), medical mistrust, trust in providers and in oncologist were significantly related to ratings of financial aspects of care (all p&lt;.05). In multivariate analysis, perceived discrimination (B=-.067, SE=.028, p=.019), trust in provider (B=.053, SE=.013, p=.000), insurance (B=-.491, SE=.162, p=.003) and money barrier (B=-.672, SE=.129, p=.000), and religiosity (B=.017, SE=.007, p=.024) remained significant.

Conclusion: Black women reported lower ratings of quality for most domains. Both sociocultural (e.g. communalism) and healthcare process factors (e.g. trust) appear to diminish the impact of race. This study adds to the limited knowledge about black and white women's cancer care experiences and suggests potential intervention targets that may help reduce disparities.

Citation Format: Vanessa B. Sheppard, Alejandra Hurtado de Mendoza, Minna Song, Kepher Makambi. Patients' experiences with breast cancer care: Do sociocultural factors attenuate racial disparities in ratings of quality? [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A92.