Racial Disparities in Patient-Reported Measures of Physician Cultural Competency Among Cancer Survivors in the United States

Abstract

This survey study assesses the role that physician cultural competency plays in racial disparities in cancer incidence and outcomes.

Figure.. Rates and Multivariable Adjusted Odds Ratios^a of Patient-Reported Measures^b of Physician Cultural Competency^c

The data were stratified by patient race/ethnicity among 2244 adult cancer survivors included in the 2017 National Health Institute Survey (NHIS). The non–Hispanic white group served as the referent. A, For the belief that physicians sharing or understanding culture was very/somewhat important, the adjusted odds ratio (AOR) for nonwhite minority cancer survivors was 1.92 (95% CI, 1.46-2.52; P < .001). B, For access to culturally competent physicians, the AOR for nonwhite minority cancer survivors was 0.42 (95% CI, 0.26-0.66; P < .001). For always/most of the time receiving respectful treatment, the AOR was 0.93 (95% CI, 0.47-1.83; P = .83). For receiving easily understandable health information the AOR was 1.15 (95% CI, 0.70-1.90; P = .57), and for being asked about opinions or beliefs regarding care, 1.03 (95% CI, 0.78-1.36; P = 0.85). The error bars represent 95% CIs. ^aIn addition to race/ethnicity, the models were also adjusted for age (continuous), sex (male vs female [referent]), sexual orientation, (heterosexual/“straight, that is, not lesbian or gay” [referent] vs lesbian, gay, bisexual, or “something else” vs unknown [including responses of “I don’t know”]), citizenship status (US citizen [referent] vs non US citizen vs unknown), country of birth, (US born in 50 states [referent] vs all other birthplaces vs unknown), language spoken during NHIS interview, (English only [referent] vs any non-English), family income-to-poverty ratio (<1.00 vs 1.00-1.99 vs 2.00-3.99 [referent] vs ≥4.00), primary source of insurance, (private [referent] vs Medicare vs military based vs Medicaid vs uninsured [including Indian Health Services and Single-Service plans] vs unknown), highest education level attained, (less than high school vs high school diploma/GED vs some college vs college degree or greater [referent]), marital status (married/living with partner [referent] vs separated/widowed vs unknown), US geographic region, (Northeast [referent] vs Midwest vs South vs West), self-reported health status, (excellent vs very good vs good [referent] vs fair vs poor vs unknown), and place of usual care when sick (doctor’s office/health center/outpatient clinic/health maintenance organization/urgent care/walk-in clinic [referent] vs emergency department/other/unknown). There were no respondents with unknown variables of age or sex. Analyses were adjusted for 2 respondents with unknown race/ethnicity category. ^bSurvey question 1 (excluding 13 nonresponders): “Some people think it is important for their providers to understand or share their race or ethnicity or gender or religion or beliefs or native language. How important is it to you that your health care providers understand or are similar to you in any of these ways?” Respondents selected from 4 possible answers: “very important,” “somewhat important,” “slightly important,” or “not important at all.” Answers were binarily categorized a priori as “very important”/“somewhat important” vs “slightly important”/“not important at all.” Survey question 2 (excluding 24 nonresponders and 1263 participants not asked this question by the NHIS given response of “not important at all” in question 1): “How often were you able to see health care providers who were similar to you in any of these ways?” For questions 2 to 5, respondents selected from 4 possible answers: “always,” “most of the time,” “some of the time,” or “none of the time.” Answers were binarily categorized as “always”/“most of the time” (ie, frequently) vs “some of the time”/“none of the time.” Survey question 3 (excluding 4 nonresponders): “How often were you treated with respect by your health care providers?” Survey question 4 (excluding 4 nonresponders): “How often did your health care providers tell or give you information about your health and health care that was easy to understand?” Survey question 5 (excluding 14 nonresponders): “How often did your health care providers ask for your opinions or beliefs about your medical care or treatment? For example, what kind of tests, procedures, or medications you prefer.” ^cThe NHIS defined culture as “any race or ethnicity or gender or religion or beliefs or native language.”