Patients' Perceptions of Quality of Care for Colorectal Cancer by Race, Ethnicity, and Language

• Published in: Journal of clinical oncology Vol. 23; no. 27; pp. 6576 - 6586
• Main Authors: Ayanian, John Z, Zaslavsky, Alan M, Guadagnoli, Edward, Fuchs, Charles S, Yost, Kathleen J, Creech, Cynthia M, Cress, Rosemary D, O'Connor, Lilia C, West, Dee W, Wright, William E
• Format: Journal Article
• Language: English
• Published: Baltimore, MD American Society of Clinical Oncology 20-09-2005; Lippincott Williams & Wilkins
• Subjects: Adult; Aged; Attitude to Health - ethnology; Biological and medical sciences; California; Cohort Studies; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - ethnology; Colorectal Neoplasms - mortality; Colorectal Neoplasms - therapy; Combined Modality Therapy; Communication Barriers; Cultural Diversity; Ethnic Groups - statistics & numerical data; Female; Gastroenterology. Liver. Pancreas. Abdomen; Health Care Surveys; Health Services Accessibility - standards; Health Services Accessibility - trends; Humans; Language; Male; Medical sciences; Middle Aged; Patient Compliance; Patient Satisfaction - statistics & numerical data; Probability; Quality of Health Care; Socioeconomic Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surveys and Questionnaires; Survival Analysis; Treatment Outcome; Tumors; California; Human; Rectal disease; Colorectal cancer; Malignant tumor; Ethnic group; Care; Colonic disease; Cancerology; Quality; Race; Digestive diseases; Intestinal disease; Perception
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2005.06.102

To identify opportunities for improving care, we evaluated patients' perceptions of the quality of their cancer care by race, ethnicity, and language.
We surveyed a population-based cohort of 1,067 patients with colorectal cancer in northern California approximately 9 months after diagnosis. Adjusting for clinical and demographic factors, mean problem scores were analyzed on a 100-point scale for six domains of care.
Mean problem scores were highest for health information (47.8), followed by treatment information (32.3), psychosocial care (31.7), coordination of care (21.3), confidence in providers (13.1), and access to cancer care (12.7). In adjusted comparisons with white patients, African American patients reported more problems with coordination of care (difference, 9.8; P < .001), psychosocial care (difference, 7.2; P = .03), access to care (difference, 6.6; P = .03), and health information (difference, 12.5; P < .001). Asian/Pacific Islander patients reported more problems than did white patients with coordination of care (difference, 13.2; P < .001), access to care (difference, 15.5; P < .001), and health information (difference, 12.6; P = .004). Hispanic patients tended to report more problems with coordination of care (difference, 4.4; P = .06), access to care (difference, 5.8; P = .08), and treatment information (difference, 7.0; P = .06). Non-English-speaking white patients reported more problems than other white patients with coordination of care (difference, 21.9; P < .001), psychosocial care (difference, 16.1; P = .009), access to care (difference, 19.8; P = .003), and treatment information (difference, 17.8; P = .002). Non-English-speaking Hispanic patients reported more problems than other Hispanic patients with confidence in providers (difference, 16.9; P = .01).
Efforts to improve patients' experiences with cancer care should address disparities by race, ethnicity, and language, particularly in coordination of care, access to care, and the provision of relevant information.