Ethnic variation in patients' ratings of communication: analysis of National Cancer Patient Experience Survey data

Abstract

BackgroundEthnic inequalities in cancer patient experience are known to exist; however, variation by ethnic subcategory is not well-explored. Information provision and communication, key domains of patient experience, are also likely to vary by ethnic subcategory, but there have been few detailed analyses to date. The aim of this study was to identify and quantify ethnic variation in cancer patients' experiences of information provision and communication through analysis of data by ethnic categories and subcategories. MethodsThe National Cancer Patient Experience Survey 2012–13 was sent to all adult cancer patients treated in a National Health Service (NHS) hospital from Sept 1, 2012, to Nov 31, 2012. The publically available dataset contained responses to 70 multiple-choice questions and associated demographic information for 68 737 cancer patients from 155 NHS trusts. In this secondary analysis, multivariate logistic regression was used to investigate associations between ethnicity and patients' ratings of overall care, information provision, and communication as measured by 24 questions. FindingsPatients' ratings of communication and information provision varied greatly by ethnicity. For example, non-white patients, in particular Asian patients, were less likely than white patients to receive understandable written information about treatment side-effects (adjusted odds ratio 0·60, 95% CI 0·51–0·70; p<0·0001), and Bangladeshi patients were the least likely within the Asian category to receive such information (0·37, 0·20–0·70; p=0·002). Similarly, non-white patients, in particular Asian patients, were less likely to receive understandable answers to important questions from doctors (0·49, 0·41–0·58; p<0·0001), and Bangladeshi patients were the least likely within the Asian category (0·12, 0·06–0·25; p<0·0001). InterpretationEffective communication and information provision are key aspects of the patient experience, and are very important to ensure that all patients are well informed and receive the best possible patient care. Ethnic inequalities, such as those identified here, should be addressed at both practice and policy level. Health-care professionals should be aware of the inequalities that exist and of their personal ethnic bias. Cultural and racial awareness training would help them to tailor their consultation to the cultural and linguistic needs of their patients. Future policy should be guided by ethnically diverse patient focus groups, and further work should aim to understand causes of ethnic variation in ratings of communication and information provision. FundingHW and LM-L are supported by the National Institute for Health Research Imperial College Healthcare NHS Trust Biomedical Research Centre and Imperial College Healthcare Charity.