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Minority cancer survivors are less likely than their white counterparts to have frequent access to doctors who understand or share their culture, according to a new national study published in the journal JAMA Oncology — even as they are more likely to value such cultural competence.
Researchers analyzed 2,244 adult cancer survivors’ responses to the National Health Interview Survey, which added a set of cultural-competency questions in 2017. Non-white minority patients (65%) were less likely than non-Hispanic white patients (80%) to say they were frequently able to visit doctors who understood or shared their culture. In fact, almost 13% of non-white patients (compared to 4% of white patients) reported never being able to visit such physicians.
Meanwhile, minority patients were more likely than white patients to place importance on their doctors understanding or sharing their culture (50% versus 31%).
“Despite longstanding efforts to improve care for minority patients with cancer and cancer survivors, there remain racial/ethnic disparities in receipt of culturally competent care,” the study’s authors wrote.
Though they experienced differences in access to care, both patient groups were likely to report being asked about their beliefs or opinions relating to care, receiving respectful treatment, and being given easily comprehensible health information.
The researchers propose a few possible explanations for the observed gaps in access to care. One piece of the puzzle might be the oncology workforce’s diversity, or lack thereof, they say: Just 2.3% of practicing oncologists identify as black or African American, while 5.8% identify as Hispanic, according to the American Society of Clinical Oncology.
“Our findings could also be explained by insufficient training in cultural competency — irrespective of physician background — geographic variations in physician availability, insurance plan coverage networks, and potential preferences of physician characteristics other than cultural competency that some patients may value more,” the study’s authors added.
The research’s limitations included potential response bias from patients, a lack of racial or ethnic data on physicians, and a lack of information on a patient’s primary doctor being an oncologist or a physician.
Disparities with respect to race, ethnicity, socioeconomic status and geographical location also exist in cancer diagnoses and deaths. These differences are associated with risk factors including access to health care, socioeconomic factors, diet, biological factors, and physical and chemical exposures, according to the National Cancer Institute.
“Members of minority racial/ethnic groups in the United States are more likely to be poor and medically underserved (that is, to have little or no access to effective health care) than whites, and limited access to quality health care is a major contributor to disparities,” the government’s cancer agency says.
“For example, regardless of their racial/ethnic background, the poor and medically underserved are less likely to have recommended cancer screening tests than those who are medically well served. They are also more likely to be diagnosed with late-stage cancer that might have been treated more effectively if diagnosed earlier.”
The present study’s authors suggest that racial cancer disparities could be partly related to doctors’ lack of cultural competence.
While some experts stress that a patient’s experience matters more than their clinician’s identity, there can be benefits to finding a doctor with cultural overlap. One 2018 experimental study distributed by the National Bureau of Economic Research, for example, suggested that having a black doctor could reduce black men’s cardiovascular mortality.
Patient bias against health-care providers is quite common, as is provider bias against patients: Nearly a third of Muslims say they’ve perceived being discriminated against in a health-care setting, according to a 2015 study in the Journal of Muslim Mental Health. Thirty-two percent of African-American respondents to a 2017 NPR/Robert Wood Johnson Foundation/Harvard T.H. Chan School of Public Health poll felt they had been “personally discriminated against” on the basis of race during a health-clinic or doctor visit, while 20% of Latinos reported the same.
To ward off implicit bias by physicians and other health-care professionals, experts advise that patients educate themselves on treatment options; ensure that their doctor understands their beliefs and asks questions; bring a trusted person as an advocate; and choose a provider and facility that will make them the most comfortable, whenever possible.
