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. 2024 Jun 14;24(1):733.
doi: 10.1186/s12913-024-11174-x.

Inequalities in patients' experiences with cancer care: the role of economic and health literacy determinants

Vladimir Jolidon  1 , Manuela Eicher  2   3 , Isabelle Peytremann-Bridevaux  1 , Chantal Arditi  4
Affiliations

Inequalities in patients' experiences with cancer care: the role of economic and health literacy determinants

Vladimir Jolidon et al. BMC Health Serv Res. .

Abstract

Background: Patients with fewer socioeconomic and health literacy resources are disadvantaged in their access and use of healthcare, which may give rise to worse experiences with care and thus inequalities in patient experiences. However, only a limited number of studies have examined how socioeconomic and health literacy factors shape inequalities in patients' experiences with cancer care.

Objective: To examine whether patients' experiences with cancer care differ according to their economic status and health literacy.

Methods: Secondary analysis of data on 2789 adult patients diagnosed with cancer from the Swiss Cancer Patient Experiences-2 (SCAPE-2) study, a cross-sectional survey conducted in eight hospitals across Switzerland from September 2021 to February 2022. Regression analysis was applied to examine the independent effect of patients' economic status and health literacy on various outcomes of experiences with cancer care, covering eight different dimensions of patient-centred care, controlling for confounding factors.

Results: Adjusted regression analysis showed that patients with lower economic status reported significantly worse experiences with cancer care in 12 out of 29 specific care experiences, especially in the dimensions of 'respect for patients' preferences' and 'physical comfort' where all items of experiences were associated with economic status. Additionally, lower health literacy was associated with worse patient experiences in 23 specific care experiences. All items in the dimensions of 'respect for patients' preferences', 'physical comfort' and 'emotional support' were associated with health literacy.

Discussion: This study revealed significant inequalities in experiences with cancer care shaped by the economic status and health literacy of patients across different dimensions of patient-centred care. It is essential to address the needs of more disadvantaged patients who face obstacles in their access and use of the healthcare system, not only to mitigate inequalities in cancer care but also to avoid inequalities in health outcomes.

Keywords: Access; Cancer; Communication; Continuity; Coordination; Emotions; Health literacy; Information; Needs; Patient experience; Patient satisfaction; Patient survey; Quality of care; Socioeconomic status.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Effect of economic status on patients’ experiences with cancer care, odds ratio and 95% confidence intervals, unadjusted (M1) and adjusted models (M2). Note: M1 only included the independent variable ‘economic status’ and hospital fixed effects, and M2 added sex, age, self-rated health, and health literacy as control variables
Fig. 2
Fig. 2
Effect of health literacy on patients’ experiences with cancer care, odds ratio and 95% confidence intervals, unadjusted (M1) and adjusted models (M2). Note: M1 only included the independent variable ‘health literacy’ and hospital fixed effects, and M2 added sex, age, self-rated health, and economic status as control variables
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