Exploring racial differences in patient centeredness of care (PCC) during breast cancer (BC) chemotherapy clinic visits.

Abstract

49 Background: Racial disparity in breast cancer survival may be attributed to racial differences in BC treatment dose intensity (dose received/dose prescribed within specific time frame). Poor dose intensity is associated with symptom distress among Black women. Chemotherapy associated symptoms and distress are traditionally assessed by the clinician and reported by the patient during the clinical visit. Poor communication patterns between clinician and patient that do not reflect care that is patient centered may be an important etiology of poor symptom reporting and management influencing BC racial treatment disparity. The purpose of this prospective, comparative pilot study was to qualitatively explore and code for the PCC during the chemotherapy clinical visit of women undergoing BC chemotherapy and compare by race. Methods: Dyads consisting of age-matched Black and White women were recruited. Audio recordings of clinical visits conducted prior to any chemotherapy cycle (except first) infusion were obtained and transcribed. The transcripts were reviewed blindly by two independent coders assigning scores using the Four Habits Coding Scheme, a measure of PCC which includes 23 items coded on five-point scale; lower scores indicate better PCC. Mean scores were tabulated from both coders’ scores and then compared by racial groups using t-test. Results: Matched dyads consisting of 6 Black and 5 White patients undergoing breast cancer chemotherapy were recruited from 1/15/2014 to 12/4/2014 at a 90% recruitment rate. Attrition of one black patient left groups of 5 White (mean age 45) and 5 Black (mean age 47) patients. A total of 15 recordings were analyzed for White and 14 for Black participants. All of the 23 PCC scores were better for White vs. Black women. Black women had worse scores (p < .05) for 6/22 or (27%) of the PCC scores. Conclusions: Qualitatively exploring the PCC during the chemotherapy clinical visits may elucidate reasons for racial disparity in symptom assessment, reporting, management and subsequent distress. These preliminary findings inform future research exploring racial disparity in symptom communication as an etiology of disparity in cancer treatment intensity.