SAN DIEGO—Oncologists spent less face time discussing care goals with newly diagnosed minority patients with solid tumors than they did with non-minorities, a study by investigators at Icahn School of Medicine at Mount Sinai's Tisch Cancer Institute has found. The findings were presented at the 2018 Palliative and Supportive Care in Oncology Symposium sponsored by ASCO (Abstract 19). On average, the oncologists in the study spent 5 minutes less with minorities regardless of whether or not their cancer had progressed, according to the report.
During an oral abstract session, lead author Cardinale B. Smith, MD, PhD, Associate Oncology Professor at Icahn School of Medicine at Mount Sinai in New York City, noted that research has shown that minorities tend to receive what she called “substandard” care, especially discussion with an oncologist about treatment, prognosis, and goals of care (GoC). This often results in worse quality of life and higher mortality rates than for non-minorities.
“There is a paucity of data on the quality of communication among minority patients with advanced cancer,” Smith said in explaining why the researchers conducted the study.
“Disparities in timing have not been studied in patients with cancer previously,” she told Oncology Times. “Evaluating factors that contribute to this disparity is critically important to ensure minority patients receive high-quality cancer care.”
Smith, who is also Director of Quality for Cancer Services at Mount Sinai Health System, added that the researchers hope to look more closely at possible reasons for the care gap. “We plan to evaluate the role implicit bias may play in these disparities outcomes.”
The researchers examined the amount of time that a randomized sample of 22 oncologists from four sites spent with newly diagnosed minority and non-minority cancer patients during GoC discussions. The sample included doctors at community, academic, municipal, and rural hospitals.
They audiotaped 142 post-imaging GoC visits and recorded median discussion time. GoC discussions were based on patients reporting that their oncologist discussed preferences for cancer treatment and helped to clarify things most important to them given their illness. Among the patients, 38 percent were non-Hispanic Whites, 32 percent were non-Hispanic Blacks, and 19 percent were Hispanic.
Smith noted that the researchers discovered the median face time oncologists spent during an encounter was 12 minutes for minority patients compared to 17 minutes for non-minorities, although encounter times varied between the sites and ranged from 10 minutes to 18 minutes. For visits after progression, the median duration of a visit was 18 minutes versus 13 minutes if there was no progression.
After controlling for differences in the number of patients treated at each of four hospitals and disease progression, the amount of time spent with minority patients was 3 minutes shorter than discussions with non-minority patients.
Joshua Adam Jones, MD, Assistant Professor of Clinical Radiation Oncology at the University of Pennsylvania's Perelman Center for Advanced Medicine in Philadelphia, told Oncology Times that there are a number of factors that might influence how much time oncologists spend discussing treatment goals with advanced cancer patients regardless of race.
“Even in this study, different hospitals recorded different average times of conversations about goals of care, and this could be related to different clinical workflows as well as different patient and family characteristics and expectations of the conversations,” he noted. “As such, it will be important to continue to look more broadly at patient populations with different socioeconomic/demographic/geographic backgrounds to understand the cultural differences that impact the way we optimize our communication strategies for patients and families.”
He emphasized that there is no standard approach to communication for patients with advanced cancer. “We, as an oncology community, need to continue to explore how we best understand the needs of each patient/family to provide the best communication for that individual.”
One of the challenges with conducting a study like this one is understanding the content of the conversations between patients and oncologists, Adams continued.
“The current study describes length of time of the conversation but does not describe the actual content, nor does it describe patient and family satisfaction with a conversation. As such, the study raises many important questions about why there are disparities in length of conversation, but it does not further our understanding of the quality of those conversations.”
He said it will be very important in the future to continue to explore not only how long the discussions are, but what is covered, patient and family understanding of the information provided, patient and family values elicited, changes to treatment plan (if any) as a result of the discussion, and patient/family satisfaction with the discussions.
“Only by better understanding what happens during conversations about goals of care and the impact of those conversations on patients and families of all backgrounds can we continue to improve our communication with and care for all patients.”
Kurt Samson is a contributing writer.