SAN DIEGO – Oncologists spent on average 3 minutes less with minority patients than with nonminority patients at a critical transition visit to talk about a scan result related to advanced cancer, a study investigator reported.
The gap was most pronounced for visits where a negative scan result was communicated, said investigator Cardinale B. Smith, MD, PhD, director of Quality for Cancer Services, Mount Sinai Health System, New York.
Future work is needed to look at the content of these conversations to determine to what extent physician- or patient-specific factors may have contributed to this difference, according to Dr. Smith.
“This will be critically important to ensure that we provide high-quality care to our minority patients,” Dr. Smith said at the 2018 Palliative and Supportive Care in Oncology Symposium.
The study included 22 oncologists from four hospitals randomized to either a usual-care group or an intervention group that included several interventions designed to improve communication techniques related to goals-of-care conversations
Sixty-nine percent of the physicians were white, while 23% were Asian, 8% were Hispanic, and 5% were black, Dr. Smith said.
Postimaging encounters were audio recorded for 142 patients, more than half of whom were minorities; 32% were black and 26% were Hispanic, according to the investigator, while 38% were white and 4% were Asian.
Overall, time spent with minorities at the scan results visit was 11.5 minutes versus 16.5 minutes for nonminorities (P = .0007), Dr. Smith reported.
When the scan was positive, there was actually no significant difference in time spent on minority versus nonminority visits, (16 versus 18 minutes; P = .59), a finding that Dr. Smith said was “encouraging” in an interview. However, there was a marked difference in length of time spent on minority versus nonminority visits when the scans showed no progression (10 versus 15 minutes; P = .0003).
“There’s something about regular, routine visits, which are still just as important as [positive] scan visits, in which there is a difference in the time spent,” Dr. Smith said in an interview. “We’re really interested in doing a more in-depth analysis of those conversations to see what’s contributing to those differences.”
After adjusting for patient insurance, education, income progression, status, and hospital, investigators found that oncologists spent 13.5 minutes (interquartile range, 12-16) with minority patients versus 16.5 minutes (IQR, 16-19) for nonminority patients (P less than .0001).
In terms of the communications intervention, investigators found no difference in time spent with minorities versus nonminorities among the intervention or control physicians. However, the intervention was aimed at improving the rate of goals of care conversations rather than improving communication based on race or ethnicity, Dr. Smith said.
By contrast, the finding of decreased time spent in communication encounters with minority patients merits further study to see how much of the disparity is mediated by differences in patients versus oncologists, she added.
In literature on communication disparities in other care settings outside of oncology, care conversations with minorities tend to be more closed ended, as opposed to open ended – so instead of asking if a patient is doing well, a physician might start out with a declarative statement that the patient’s findings are positive, she said.
On the other hand, some literature suggests that minority patients may not question the physician as much as nonminorities, or may not spend as much time asking directed questions during the visit. “That may also contribute to decreased time spent during those encounters,” Dr. Smith added.
The research was supported by the Patient Centered Outcomes Research Institute. Dr. Smith reported honoraria and a consulting or advisory role with Teva.
SOURCE: Smith CB et al. PallOnc 2018, .