Racial Discrimination in Cancer Care Setting Impacts Black Patients Long-Term

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Black patients reported associating negative emotions with experiences of racial discrimination long after the experience concluded, raising concerns about long-term health outcomes.

A discouraging trend of racial discrimination in cancer care was identified in an in-depth analysis published in the Journal of the National Cancer Institute.1 Racial disparities in health care have long been a topic of concern, with recent research shedding light on the impact of racial discrimination on Black patients with cancer.

The study, conducted from May 2019 to March 2020, aimed to explore how experiences of racial discrimination within the health care setting manifest for Black patients with cancer and contribute to disparities in cancer care.

The research employed a qualitative analysis approach, utilizing semi-structured in-depth interviews with 18 Black cancer survivors not currently on active treatment. The participants, ranging in age from 29 to 88 years, provided valuable insights into their encounters with racial discrimination in the health care system. All interviews were audio recorded, professionally transcribed, and analyzed using Dedoose software to identify major themes and subthemes.

The findings revealed most participants reported experiencing racial discrimination when seeking cancer care. The sources of discrimination were diverse, encompassing interactions with health care staff, medical assistants, front desk personnel, and health insurance administrators. Overt racial discrimination was identified, rooted in racial stereotypes and often manifested through verbal insults. Some physicians were reported using phrases like "you people," exacerbating the degradation of the patient-provider relationship.

“When instances of experiencing racial discrimination occurred, patients expressed these experiences were associated with negative emotions long after the experience concluded and impacted the ability of the health care system to demonstrate trustworthiness and limited the options available to patients to make informed decisions about care,” the investigators wrote.

“Instances of racial discrimination also resulted in patients feeling their voices were dismissed and increased the psychological burden and time toxicity with receiving care,” they continued. “The silencing of Black cancer patient voices impacted patients’ health-care utilization and had implications for their physical health.”

The study aligns with prior research indicating that exposure to racial discrimination is linked to psychological distress, negative patient experiences, lower levels of trust, satisfaction, and communication in health services. For Black patients with cancer, such exposure is associated with challenges in adhering to cancer screening guidelines and fewer physician office visits, leading to underutilization and disengagement from health care services.

Most medical interactions for Black patients occur in racially discordant settings, where the patient is Black and the physician is not, investigators noted. Such interactions are characterized by less patient-centered communication and lower levels of positive affect, potentially stemming from implicit biases present among health care providers.

Quality of care, including time spent with providers, shared decision-making, emotional support, and effective communication, emerged as a significant predictor of Black cancer survivors' self-reported health outcomes. The study underscored the impact of patient–provider relationships on health outcomes, suggesting that exposure to racial discrimination may worsen health disparities by degrading these relationships.

The study advocated for a biopsychosocial approach in future research on social determinants of health, emphasizing the importance of considering individual and health care system-level factors specific to Black patients in addressing cancer care disparities. The authors emphasized the need for partnerships with communities to expand research participation and enhance access to high-quality cancer prevention, early detection, and treatment.

Additionally, they called for accountability, urging the development of routine methods for patients to provide feedback on racial discrimination experiences and transparency to identify strategic improvements in healthcare organizations.

This article originally appeared in AJMC.

Reference
1. Garrett E, Ma C, Ochoa-Dominguez CY, et al. Black cancer patients navigating a healthcare system of racial discrimination [published online ahead of print, 2023 Oct 18]. J Natl Cancer Inst. 2023;djad208. doi:10.1093/jnci/djad208
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