White women with breast cancer were more likely than black or Hispanic women to be actively involved in the choice of surgeon or hospital for their care, with minorities in the survey relying more on doctor-directed or health plan-dictated choices.
The questionnaire-based study, published online by JAMA Oncology, heard from 500 women with breast cancer. It investigated racial and ethnic differences between women selecting their surgeons and hospitals for breast cancer care.
All of the California-based women's surgeon selections were most frequently (78%) the result of a physician's referral decision, and health insurance plans dictated most decisions (58%) about the hospital of choice.
The study identified respondents by race/ethnicity, surveying 222 white, 142 black and 136 Hispanic women, and further categorized the Hispanic women by whether they spoke mainly English (89 women) or Spanish (47).
The authors present the following as their key findings:
- Black and Hispanic women were more likely than white women to select the statement, "I was referred to the surgeon by another doctor" for their breast cancer care
- Black and Hispanic patients were less likely than white patients to say they had followed reputation for their choice of surgeon or hospital
- Women who selected their surgeon based on reputation more often rated the care from their surgeon as excellent.
In background information for the study, the authors cite "well-described" evidence of disparities of care received by minority groups of patients. For breast cancer specifically, they cite this example:
"Black women are more likely than white women to undergo breast surgery at hospitals with lower rates of radiation use following breast conservation."
The researchers say that while disparities based on hospital and physician factors are well-described, "data are limited" on how women from different ethnic groups select their physician and hospital for cancer treatment. Concluding their findings on these questions, the authors say:
"Compared with white patients with breast cancer, minority patients were less actively involved in physician and hospital selection, relying more on physician referral and health plans rather than on reputation."
The following is how the survey numbers compared on the question of surgeon selection:
- 18% of black and 22% of Hispanic patients reported choices based on reputation
- 32% of white women reported selecting surgeons in this way.
A similar disparity of choice was found on selection of hospital. Black and Hispanic women were less likely than white women to select theirs based on reputation.
Of white women, 23% chose hospital by reputation, compared with 7% for black women with breast cancer and 15% for Hispanic.
In the study overall, the authors noted a high proportion of women being insured by Kaiser Permanente, "which could explain why a large number of women reported their health plan influenced their selection."
The authors discuss their conclusions: "Most women relied on referrals from their physicians for selecting surgeons, particularly black women and Spanish-speaking Hispanic women.
"In addition, minority patients were less likely to report reputation as an important component of their decisions about surgeons and hospitals and were more likely to select a hospital because it was part of their health plan.
"These findings suggest less-active involvement of minority patients with regard to selecting physicians and hospitals for their care."
In another publication from the same group of journals this week, in JAMA Surgery, doctors showed race and social bias in computer-based social psychology tests.
The "unconscious prejudices" did not, however, seem to influence provision of care - they failed to show through in the study's analysis of clinical decision-making.