Disparities Associated with Decision to Undergo Oncologic Surgery: A Prospective Mixed-Methods Analysis.

التفاصيل البيبلوغرافية
العنوان:	Disparities Associated with Decision to Undergo Oncologic Surgery: A Prospective Mixed-Methods Analysis.
المؤلفون:	Van Haren RM; University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA. vanharrm@ucmail.uc.edu., Kovacic MB; University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.; Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, Cincinnati, OH, USA.; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA., Delman AM; University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA., Pratt CG; University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA., Griffith A; University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA., Arbili L; University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA., Harvey K; University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA., Kohli E; University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA., Pai A; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA., Topalian A; University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA., Rai SN; University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA., Shah SA; University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA., Kues J; University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
المصدر:	Annals of surgical oncology [Ann Surg Oncol] 2024 Sep; Vol. 31 (9), pp. 5757-5764. Date of Electronic Publication: 2024 Jun 13.
نوع المنشور:	Journal Article
اللغة:	English
بيانات الدورية:	Publisher: Springer Country of Publication: United States NLM ID: 9420840 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1534-4681 (Electronic) Linking ISSN: 10689265 NLM ISO Abbreviation: Ann Surg Oncol Subsets: MEDLINE
أسماء مطبوعة:	Publication: 2005- : New York, NY : Springer Original Publication: New York, NY : Raven Press, c1994-
مواضيع طبية MeSH:	Physician-Patient Relations* , Healthcare Disparities* , Decision Making* , Trust*, Humans ; Prospective Studies ; Middle Aged ; Male ; Female ; Aged ; Black or African American/statistics & numerical data ; Black or African American/psychology ; Prognosis ; Gastrointestinal Neoplasms/surgery ; Lung Neoplasms/surgery ; Follow-Up Studies ; Cultural Competency ; Communication ; White People/statistics & numerical data ; Minority Groups/statistics & numerical data ; Adult
مستخلص:	Background: Underrepresented minority patients with surgical malignancies experience disparities in outcomes. The impact of provider-based factors, including communication, trust, and cultural competency, on outcomes is not well understood. This study examines modifiable provider-based barriers to care experienced by patients with surgical malignancies. Methods: A parallel, prospective, mixed-methods study enrolled patients with lung or gastrointestinal malignancies undergoing surgical consultation. Surveys assessed patients' social needs and patient-physician relationship. Semi-structured interviews ascertained patient experiences and were iteratively analyzed, identifying key themes. Results: The cohort included 24 patients (age 62 years; 63% White and 38% Black/African American). The most common cancers were lung (n = 18, 75%) and gastroesophageal (n = 3, 13%). Survey results indicated that food insecurity (n = 5, 21%), lack of reliable transportation (n = 4, 17%), and housing instability (n = 2, 8%) were common. Lack of trust in their physician (n = 3, 13%) and their physician's treatment recommendation (n = 3, 13%) were identified. Patients reported a lack of empathy (n = 3, 13%), lack of cultural competence (n = 3, 13%), and inadequate communication (n = 2, 8%) from physicians. Qualitative analysis identified five major themes regarding the decision to undergo surgery: communication, trust, health literacy, patient fears, and decision-making strategies. Five patients (21%) declined the recommended surgery and were more likely Black (100% vs. 21%), lower income (100% vs. 16%), and reported poor patient-physician relationship (40% vs. 5%; all p < 0.05). Conclusions: Factors associated with declining recommended cancer surgery were underrepresented minority race and poor patient-physician relationships. Interventions are needed to improve these barriers to care and racial disparities. (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)
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فهرسة مساهمة:	Keywords: Cancer disparities; Complex surgical malignancies; Decision-making strategies; Modifiable provider-based barriers; Patient-physician relationships
تواريخ الأحداث:	Date Created: 20240613 Date Completed: 20240808 Latest Revision: 20240815
رمز التحديث:	20240815
مُعرف محوري في PubMed:	PMC11300547
DOI:	10.1245/s10434-024-15610-4
PMID:	38869765
قاعدة البيانات:	MEDLINE

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تدمد:	1534-4681
DOI:	10.1245/s10434-024-15610-4