title: Racial/Ethnic Differences in Patients' Selection of Surgeons and Hospitals for Breast Cancer Surgery.
abstract: OBJECTIVE
  Racial differences in breast cancer treatment may result in part from differences in the surgeons and hospitals from whom patients receive their care. However, little is known about differences in patients' selection of surgeons and hospitals.
  
  
  OBJECTIVE
  To examine racial/ethnic differences in how women selected their surgeons and hospitals for breast cancer surgery.
  
  
  METHODS
  We surveyed 500 women (222 non-Hispanic white, 142 non-Hispanic black, 89 English-speaking Hispanic, and 47 Spanish-speaking Hispanic) from northern California cancer registries with stage 0 to III breast cancer diagnosed during 2010 through 2011. We used multivariable logistic regression to assess the reasons for surgeon and hospital selection by race/ethnicity, adjusting for other patient characteristics. We also assessed the association between reasons for physician selection and patients' ratings of their surgeon and hospital.
  
  
  METHODS
  Reasons for surgeon and hospital selection and ratings of surgeon and hospital.
  
  
  RESULTS
  The 500 participants represented a response rate of 47.8% and a participation rate of 69%. The most frequently reported reason for surgeon selection was referral by another physician (78%); the most frequently reported reason for hospital selection was because it was a part of a patient's health plan (58%). After adjustment, 79% to 87% of black and Spanish-speaking Hispanic women reported selecting their surgeon based on a physician's referral vs 76% of white women (P = .007). Black and Hispanic patients were less likely than white patients to report selecting their surgeon based on reputation (adjusted rates, 18% and 22% of black and Hispanic women, respectively, vs 32% of white women; P = .02). Black and Hispanic women were also less likely than white women to select their hospital based on reputation (adjusted rates, 7% and 15% vs 23%, respectively; P = .003). Women who selected their surgeon based on reputation more often rated the care from their surgeon as excellent (adjusted odds ratio, 2.21; 95% CI, 1.24-3.93); those reporting their surgeon was one of the only surgeons available through the health plan less often reported excellent quality of surgical care (adjusted odds ratio, 0.56; 95% CI, 0.34-0.91).
  
  
  CONCLUSIONS
  Compared with white patients with breast cancer, minority patients were less actively involved in physician and hospital selection, relying more on physician referral and health plans rather than on reputation. Interventions to promote involvement in surgeon and hospital selection may have potential for addressing disparities related to lower-quality care from surgeons and hospitals.
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Freedman
authors.affiliation: Harvard Medical School, Department of Health Care Policy, Boston, Massachusetts.
authors.forename: Elena M
authors.initials: EM
authors.lastname: Kouri
authors.affiliation: Cancer Registry of Greater California, Public Health Institute, Sacramento.
authors.forename: Dee W
authors.initials: DW
authors.lastname: West
authors.affiliation: Harvard Medical School, Department of Health Care Policy, Boston, Massachusetts4Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
mesh_terms: D001741:Black or African American / Q000523:psychology*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics / Q000208:ethnology / Q000523:psychology / Q000601:surgery*; D002140:California / Q000453:epidemiology; D016009:Chi-Square Distribution; D002755:Choice Behavior; D002983:Clinical Competence; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D054625:Healthcare Disparities / Q000208:ethnology; D006630:Hispanic or Latino / Q000523:psychology*; D006761:Hospitals / Q000592:standards; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D057240:Patient Preference / Q000208:ethnology*; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation; D066231:Surgeons / Q000191:economics / Q000592:standards; D011795:Surveys and Questionnaires; D044465:White People / Q000523:psychology*