Racial and ethnic disparities in patient-provider communication, quality-of-care ratings, and patient activation among long-term cancer survivors.
OBJECTIVE
We examined racial and ethnic disparities in patient-provider communication (PPC), perceived care quality, and patient activation among long-term cancer survivors.


METHODS
In 2005 to 2006, survivors of breast, prostate, colorectal, ovarian, and endometrial cancers completed a mailed survey on cancer follow-up care. African American, Asian/Pacific Islander (Asian), Hispanic, and non-Hispanic white (white) survivors who had seen a physician for follow-up care in the past 2 years (n = 1,196) composed the analytic sample. We conducted linear and logistic regression analyses to identify racial and ethnic differences in PPC (overall communication and medical test communication), perceived care quality, and patient activation in clinical care (self-efficacy in medical decisions and perceived control). We further examined the potential contribution of PPC to racial and ethnic differences in perceived care quality and patient activation.


RESULTS
Compared with white survivors (mean score, 85.16), Hispanic (mean score, 79.95) and Asian (mean score, 76.55) survivors reported poorer overall communication (P = .04 and P < .001, respectively), and Asian survivors (mean score, 79.97) reported poorer medical test communication (P = .001). Asian survivors were less likely to report high care quality (odds ratio, 0.47; 95% CI, 0.30 to 0.72) and reported lower self-efficacy in medical decisions (mean score, 74.71; P < .001) compared with white survivors (mean score, 84.22). No disparity was found in perceived control. PPC was positively associated with care quality (P < .001) and self-efficacy (P < .001). After adjusting for PPC and other covariates, when compared with whites, Asian disparities remained significant.


CONCLUSIONS
Asian survivors report poorer follow-up care communication and care quality. More research is needed to identify contributing factors beyond PPC, such as cultural influences and medical system factors.
Nynikka R.A. Palmer, San Francisco General Hospital, University of California, San Francisco, San Francisco; Ingrid Oakley-Girvan, Cancer Prevention Institute of California, Fremont; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Erin E. Kent, Neeraj K. Arora, Julia H. Rowland, Danielle Blanch-Hartigan, National Cancer Institute, National Institutes of Health; Noreen M. Aziz, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD; Laura P. Forsythe, Patient-Centered Outcomes Research Institute, Washington, DC; and Kathryn E. Weaver, Wake Forest School of Medicine, Winston-Salem, NC. palmern@medsfgh.ucsf.edu.
Nynikka R A
NR
Palmer
Nynikka R.A. Palmer, San Francisco General Hospital, University of California, San Francisco, San Francisco; Ingrid Oakley-Girvan, Cancer Prevention Institute of California, Fremont; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Erin E. Kent, Neeraj K. Arora, Julia H. Rowland, Danielle Blanch-Hartigan, National Cancer Institute, National Institutes of Health; Noreen M. Aziz, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD; Laura P. Forsythe, Patient-Centered Outcomes Research Institute, Washington, DC; and Kathryn E. Weaver, Wake Forest School of Medicine, Winston-Salem, NC.
Erin E
EE
Kent
Nynikka R.A. Palmer, San Francisco General Hospital, University of California, San Francisco, San Francisco; Ingrid Oakley-Girvan, Cancer Prevention Institute of California, Fremont; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Erin E. Kent, Neeraj K. Arora, Julia H. Rowland, Danielle Blanch-Hartigan, National Cancer Institute, National Institutes of Health; Noreen M. Aziz, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD; Laura P. Forsythe, Patient-Centered Outcomes Research Institute, Washington, DC; and Kathryn E. Weaver, Wake Forest School of Medicine, Winston-Salem, NC.
Laura P
LP
Forsythe
Nynikka R.A. Palmer, San Francisco General Hospital, University of California, San Francisco, San Francisco; Ingrid Oakley-Girvan, Cancer Prevention Institute of California, Fremont; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Erin E. Kent, Neeraj K. Arora, Julia H. Rowland, Danielle Blanch-Hartigan, National Cancer Institute, National Institutes of Health; Noreen M. Aziz, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD; Laura P. Forsythe, Patient-Centered Outcomes Research Institute, Washington, DC; and Kathryn E. Weaver, Wake Forest School of Medicine, Winston-Salem, NC.
Neeraj K
NK
Arora
Nynikka R.A. Palmer, San Francisco General Hospital, University of California, San Francisco, San Francisco; Ingrid Oakley-Girvan, Cancer Prevention Institute of California, Fremont; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Erin E. Kent, Neeraj K. Arora, Julia H. Rowland, Danielle Blanch-Hartigan, National Cancer Institute, National Institutes of Health; Noreen M. Aziz, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD; Laura P. Forsythe, Patient-Centered Outcomes Research Institute, Washington, DC; and Kathryn E. Weaver, Wake Forest School of Medicine, Winston-Salem, NC.
Julia H
JH
Rowland
Nynikka R.A. Palmer, San Francisco General Hospital, University of California, San Francisco, San Francisco; Ingrid Oakley-Girvan, Cancer Prevention Institute of California, Fremont; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Erin E. Kent, Neeraj K. Arora, Julia H. Rowland, Danielle Blanch-Hartigan, National Cancer Institute, National Institutes of Health; Noreen M. Aziz, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD; Laura P. Forsythe, Patient-Centered Outcomes Research Institute, Washington, DC; and Kathryn E. Weaver, Wake Forest School of Medicine, Winston-Salem, NC.
Noreen M
NM
Aziz
Nynikka R.A. Palmer, San Francisco General Hospital, University of California, San Francisco, San Francisco; Ingrid Oakley-Girvan, Cancer Prevention Institute of California, Fremont; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Erin E. Kent, Neeraj K. Arora, Julia H. Rowland, Danielle Blanch-Hartigan, National Cancer Institute, National Institutes of Health; Noreen M. Aziz, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD; Laura P. Forsythe, Patient-Centered Outcomes Research Institute, Washington, DC; and Kathryn E. Weaver, Wake Forest School of Medicine, Winston-Salem, NC.
Danielle
D
Blanch-Hartigan
Nynikka R.A. Palmer, San Francisco General Hospital, University of California, San Francisco, San Francisco; Ingrid Oakley-Girvan, Cancer Prevention Institute of California, Fremont; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Erin E. Kent, Neeraj K. Arora, Julia H. Rowland, Danielle Blanch-Hartigan, National Cancer Institute, National Institutes of Health; Noreen M. Aziz, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD; Laura P. Forsythe, Patient-Centered Outcomes Research Institute, Washington, DC; and Kathryn E. Weaver, Wake Forest School of Medicine, Winston-Salem, NC.
Ingrid
I
Oakley-Girvan
Nynikka R.A. Palmer, San Francisco General Hospital, University of California, San Francisco, San Francisco; Ingrid Oakley-Girvan, Cancer Prevention Institute of California, Fremont; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Erin E. Kent, Neeraj K. Arora, Julia H. Rowland, Danielle Blanch-Hartigan, National Cancer Institute, National Institutes of Health; Noreen M. Aziz, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD; Laura P. Forsythe, Patient-Centered Outcomes Research Institute, Washington, DC; and Kathryn E. Weaver, Wake Forest School of Medicine, Winston-Salem, NC.
Ann S
AS
Hamilton
Nynikka R.A. Palmer, San Francisco General Hospital, University of California, San Francisco, San Francisco; Ingrid Oakley-Girvan, Cancer Prevention Institute of California, Fremont; Ann S. Hamilton, Keck School of Medicine, University of Southern California, Los Angeles, CA; Erin E. Kent, Neeraj K. Arora, Julia H. Rowland, Danielle Blanch-Hartigan, National Cancer Institute, National Institutes of Health; Noreen M. Aziz, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD; Laura P. Forsythe, Patient-Centered Outcomes Research Institute, Washington, DC; and Kathryn E. Weaver, Wake Forest School of Medicine, Winston-Salem, NC.
Kathryn E
KE
Weaver
D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D003142:Communication; D005260:Female; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000208:ethnology / Q000628:therapy*; D010358:Patient Participation; D010817:Physician-Patient Relations; D011787:Quality of Health Care; D017741:Survivors; D044465:White People