Advertisement

Exploring Racial Differences in Patient Centeredness of Care (PCC) During Breast Cancer (BC) Chemotherapy Clinical Visits

  • Tinnikkar Angel Robertson-Jones
  • Madison M. Tissue
  • Mary Connolly
  • Sarah Frazier Gallups
  • Catherine M. Bender
  • Margaret Quinn RosenzweigEmail author
Article

Abstract

Objectives

The communication patterns between clinician and patient, described as the patient centeredness of care (PCC), may be a critically important etiology of breast cancer (BC) racial disparity. The purpose of this prospective, comparative pilot study was to qualitatively explore and code for PCC during the clinical visit of women undergoing BC chemotherapy and compare by race.

Methods

Age-matched Black and White women were recruited. Audio recordings of clinical visits conducted prior to any cycle (except first) chemotherapy infusion were obtained and transcribed. Transcripts were blindly reviewed by three independent coders assigning PCC scores, ranging from 1 to 5, with lower scores indicating better PCC. Consensus was reached among reviewers via discussion.

Results

Dyads consisted of five Black (mean age 47) and five White (mean age 45) women undergoing BC chemotherapy. Twenty-four recordings were analyzed, 13 White and 11 Black. For all 22 PCC items, the mean scores were worse for Black women with significant differences (compared by chi-square analysis) noted for 6/22 items (27%).

Conclusions

Qualitatively exploring clinician and patient communication patterns during the chemotherapy clinical visits informs the understanding of racial differences for symptom assessment, reporting, and management. These pilot findings inform future research exploring racial disparity in cancer treatment dose intensity.

Keywords

Racial disparity Breast cancer chemotherapy Patient-centered communication Symptom management 

Notes

Funding

This study was funded by The University of Pittsburgh School of Nursing [HUB 04.30148.00304].

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Siegel RL, Miller KD, Fedewa SA, Ahnen DJ, Meester RGS, Barzi A, et al. Colorectal cancer statistics, 2017. CA Cancer J Clin. 2017;67:177–93.CrossRefGoogle Scholar
  2. 2.
    Gordon HS, Street RL, Sharf BF, Souchek J. Racial differences in doctors’ information giving and patients’ participation. Cancer. 2006;107:1313–20.CrossRefGoogle Scholar
  3. 3.
    Yee MK, Sereika SM, Bender CM, Brufsky AM, Connolly MC, Rosenzweig MQ. Symptom incidence, distress, cancer-related distress, and adherence to chemotherapy among African American women with breast cancer. Cancer. 2017;123:2061–9.CrossRefGoogle Scholar
  4. 4.
    Von AD. Health-related quality of life of African American breast cancer survivors compared to healthy African American women. Cancer N. 2012;35:99337–46.Google Scholar
  5. 5.
    Eversley R, Estrin D, Dibble S, Wardlaw L, Pedrosa M, Favila-Penney W. Post-treatment symptoms among ethnic minority breast cancer survivors. Oncol Nurs Forum. 2005;32:250–6.CrossRefGoogle Scholar
  6. 6.
    Rosenzweig MQ, Wiehagen T, Brufsky A, et al. The unique perspective of illness among women with metastatic breast cancer according to race and income. J Hosp Palliat Nurs. 2009;11:39–40.CrossRefGoogle Scholar
  7. 7.
    Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003;139:907–15.CrossRefGoogle Scholar
  8. 8.
    Thornton RLJ, Powe NR, Roter D, et al. Patient-physician social concordance, medical visit communication and patients’ perceptions of health care quality. Patient Educ Couns. 2011;85:e201–8.CrossRefGoogle Scholar
  9. 9.
    Street RL, Mazor KM. Clinician–patient communication measures: drilling down into assumptions, approaches, and analyses. Patient Educ Couns. 2017;100:1612–8.CrossRefGoogle Scholar
  10. 10.
    Smith AK, Davis RB, Krakauer EL. Differences in the quality of the patient-physician relationship among terminally ill African-American and White patients: impact on advance car planning and treatment preferences. J Gen Intern Med. 2007;22:1579–82.CrossRefGoogle Scholar
  11. 11.
    Sheppard VB, Isaacs C, Luta G, Willey SC, Boisvert M, Harper FWK, et al. Narrowing racial gaps in BC chemotherapy initiation: the role of the subject– provider relationship. Breast Cancer Res Treat. 2013;139:207–16.CrossRefGoogle Scholar
  12. 12.
    Paskett ED, Alfano CM, Davidson MA, Andersen BL, Naughton MJ, Sherman A, et al. Breast cancer survivors’ health-related quality of life: racial differences and comparisons with noncancer controls. Cancer. 2008;113:3222–30.CrossRefGoogle Scholar
  13. 13.
    Cooper LA, Roter DL, Carson KA, Beach MC, Sabin JA, Greenwald AG, et al. The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. Am J Public Health. 2012;102:979–87.CrossRefGoogle Scholar
  14. 14.
    Stein T, Frankel RM, Krupat E. Enhancing communication skills in a large healthcare organization: a longitudinal case study. Patient Educ Couns. 2005;58:4–12.CrossRefGoogle Scholar
  15. 15.
    Krupat E, Frankel R, Stein T, Irish J. The Four Habits Coding Scheme: validation of an instrument to assess clinicians’ communication behavior. Patient Educ Couns. 2006;62:38–45.CrossRefGoogle Scholar
  16. 16.
    Clayton MF, Latimer S, Dunn TW, Haas L. Assessing patient-centered communication in a family practice setting: how do we measure it, and whose opinion matters? Patient Educ Couns. 2011;84:294–302.CrossRefGoogle Scholar
  17. 17.
    Jensen BF, Gulbrandsen P, Benth JS, et al. Interrater reliability for the Four Habits Coding Scheme as part of a randomized controlled trial. Patient Educ Couns. 2010;80:405–9.CrossRefGoogle Scholar
  18. 18.
    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81.CrossRefGoogle Scholar
  19. 19.
    IBM SPSS statistics for Windows, version 21.0. Armonk, NY: IBM Corp, IBM Corp., 2012.Google Scholar
  20. 20.
    Liu Y, Malin JL, Diamant AL, Thind A, Maly RC. Adherence to adjuvant hormone therapy in low-income women with breast cancer: the role of provider-patient communication. Breast Cancer Res Treat. 2013;137:829–36.CrossRefGoogle Scholar
  21. 21.
    Lin J, Sklar GE, Sen oh VM, et al. Factors affecting therapeutic compliance: a review from the patient’s perspective. Ther Clin Risk Manag. 2008;4:269–86.CrossRefGoogle Scholar
  22. 22.
    Epstein RM, Franks P, Fiscella K, Shields CG, Meldrum SC, Kravitz RL, et al. Measuring patient-centered communication in patient–physician consultations: theoretical and practical issues. Soc Sci Med. 2005;61:1516–28.CrossRefGoogle Scholar
  23. 23.
    Jenkins C, Lapelle N, Zapka JG, Kurent JE. End-of-life care and African Americans: voices from the community. J Palliat Med. 2005;8:585–92.CrossRefGoogle Scholar
  24. 24.
    Maly RC, Stein JA, Umezawa Y, Leake B, Anglin MD. Racial/ethnic differences in breast cancer outcomes among older patients: effects of physician communication and patient empowerment. Health Psychol. 2008;27:728–36.CrossRefGoogle Scholar
  25. 25.
    Kagawa-Singer M, Dadia AV, Yu MC, Surbone A. Cancer, culture, and health disparities: time to chart a new course? CA Cancer J Clin. 2010;60:12–39.CrossRefGoogle Scholar
  26. 26.
    Davidhizar R, Giger JN. A review of the literature on care of clients in pain who are culturally diverse. Int Nurs Rev. 2004;51:47–55.CrossRefGoogle Scholar
  27. 27.
    Agency for Healthcare Research and Quality. 2015 National healthcare quality and disparities report and 5th anniversary update on the national quality strategy. Rockville, MD: Agency for Healthcare Research and Quality; 2016.Google Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2018

Authors and Affiliations

  1. 1.Hampton University School of NursingHamptonUSA
  2. 2.University of Pittsburgh School of NursingPittsburghUSA
  3. 3.Acute and Tertiary Care DepartmentUniversity of Pittsburgh School of NursingPittsburghUSA

Personalised recommendations