Patient-reported unfair treatment within the health care system.

Abstract

115 Background: Patients with cancer who perceive discrimination and unfair treatment from the health care system are at risk for lower health-related quality of life. This study seeks to better understand the characteristics of under-resourced patients who report unfair treatment from the health care system and providers. Methods: This cross-sectional analysis used data from a nationwide survey distributed in December 2020 by Patient Advocate Foundation (PAF), a US non-profit organization providing case management and financial aid to individuals with chronic illness. The survey was fielded via email to those who received PAF services from July 2019-April 2020. Inclusion criteria included a valid e-mail address, aged ≥ 19, and either current or previous cancer treatment. Respondents reported unfair treatment in connection to their health care. Age, sex, race/ethnicity, and annual household income were abstracted from the PAF database. The validated Group-Based Medical Mistrust Scale was used to assess respondents’ level of mistrust in medical providers as it relates to their ethnic group. Scores range from 12-60 and were categorized based on tertiles as high mistrust (scores ≥ 29), neutral (21-28), and low mistrust (≤ 20). Frequencies and percentages were calculated for categorical variables. Results: There were a total of 429 survey respondents with cancer. Most respondents were female (73%) and aged 56-75 (57%); 31% were Black, Indigenous, or Persons of Color (BIPOC). The most common cancer types were hematologic (33%) and breast (33%). Overall, 20% (n = 86) of respondents reported having received unfair treatment. Of those reporting unfair treatment, 56% reported receipt from their doctor, nurse, or health care provider, 51% insurance company, 38% the health care system, and 14% pharmacist. When asked why they felt unfairly treated, the most common responses were related to insurance status (51%), disease or condition (45%), and income (35%). Notably, unfair treatment due to race/ethnicity (6%), sex (9%), and sexual orientation/gender expression (3%) were uncommon. When compared to those who reported objective treatment, respondents reporting unfair treatment were more often unemployed/other (28% vs 11%), privately insured (38% vs 27%), having income < $23,000 (40% vs 25%), having 3+ comorbidities (40% vs 23%) and reporting more mistrust in medical providers (53% vs 27%). There did not appear to be a difference in reporting of unfair treatment by race/ethnicity. Of BIPOC respondents, 51% reported high mistrust in medical providers. Conclusions: This under-resourced population of respondents with cancer reported unfair treatment related to their finances, insurance, and disease status. Our data suggest health care-associated discrimination may occur based on socioeconomic resources. This work identifies a novel equity consideration warranting further evaluation.