Self-reported perceived discrimination and experiences of patients with cancer.

Abstract

165 Background: Racial discrimination is a significant social determinant of health inequities. Ethnic disparities can indirectly result in different access to care, while healthcare provider ethnic bias can influence healthcare outcomes. National statistics show that Black patients have higher death rates when compared to those of other race and ethnicities. Our study aims to evaluate and compare self-reported and perceived discrimination in day-to-day life and healthcare experiences of patients who receive care at our cancer center. Methods: Cancer patients were surveyed in person at the Cancer Center at Medstar Washington Hospital Center between July 2022 and January 2023. The Everyday Discrimination Scale (EDS) by D.R. Williams and Discrimination in Medical Setting (DMS) questionnaire by M.E. Peek were used to collect data. Results: 100 patients following up at the clinic completed the paper survey. 74% were females and 26% males, 75% Black, 17% White and 8% Other Races (including Hispanic and Asian). The responses to the EDS and DMS were collected and coded as continuous variables, summed together, reported as medians, and compared across the various groups of interest. P-values between medians were reported using Kruskal Wallis test/Wilcoxon rank-sum test. Highest median scores on the EDS were found in Other Races, with a higher score representing higher self-perceived discrimination, followed by Black, and White (p<0.001). Lowest median scores on the DMS questionnaire were found in White, lower score representing lower self-perceived discrimination, followed by Other Races and Black (p<0.001). 30% of our total study population reported feeling that their quality of care was affected due to racial discrimination, out of which 83% were Black and 16% were Other Races, not including White (p= 0.006). Comparison of median scores for both the scales was not statistically different across age, gender, and cancer type. Conclusions: The results of our study demonstrate that self-reported and self- perceived racial discrimination extends to health care, and for some includes self-reported effects on the quality of health care received. Worse responses of the Other Races on the EDS and DMS scales could be explained by the low number of participants. Overall, the negative responses may have been affected by a variety of factors like varying stage of diagnosis, care received at other health-care centers, all of which would attribute to self-reported poorer experience regardless of race. There is a growing need to address these disparities to providing culturally sensitive care and addressing the root causes of systemic racism and inequality. This study is the first step in determining the day-to-day and healthcare experiences among patients at our center. We hope to follow with a prospective survey-based analysis of implicit bias among all healthcare workers.