Patient-reported communication and satisfaction in breast cancer: Does doctor-patient identity concordance matter?

Abstract

11071 Background: Effective communication is a key element in patient engagement, adherence, and satisfaction. Prior research has shown that doctor-patient race and/or gender concordance may improve both health outcomes and patient satisfaction, however the effects of identity concordance in oncology and specifically within breast cancer are less studied. Methods: Between 7/2023-8/2023, cancer survivors were recruited from Breastcancer.org and consented to participate in an anonymous online survey in English or Spanish. Eligibility included: US resident, age ≥18, and diagnosed within the past 10 years. Survey assessed patient-reported aspects of communication as well as patient-identified provider race/ethnicity and gender. Chi-square and Fisher’s exact tests tested associations between patient and/or provider identity and patient-reported satisfaction with communication. Results: Of 997 who completed the survey, 759 reported provider race/ethnicity and gender and were included in this analysis. Patients were median age 63 (range, 32-97), mostly White race (91%) and non-Hispanic (99%); almost all were women (98%). Patients were a median of 3.3 years (1.4-10) post diagnosis. Overall, 60% had concordant gender with their provider. 64% had concordant race; White patients had higher racial concordance 68% (n=470/690) than Black (14%, n=5/35) or Asian/Pacific Islander patients (50%, n=9/18) (p<0.0001). 0% of Hispanic patients (n=0/11) had ethnic concordance with their provider. Patients reported high levels (94-97% “usually” or “always”) of being treated with courtesy/respect, with no significant differences by identity concordance (either racial, ethnic, or gender concordance). Similarly, they reported their doctors listened carefully (89-98% usually/always) and explained things in a way they could understand (89-98% usually/always), with no differences by concordance. Most patients reported no one talked to them about possible clinical trial options (75% White, 51% Black, 56% Asian patients, p=0.003 comparison), but there were no differences by concordance. There were no significant differences by patient-reported race for questions regarding courtesy/respect, listening, explanations, or discussing clinical trials. Similarly, there were no significant differences by patient-reported provider race or gender. Conclusions: In this study of breast cancer survivors, patient-provider identity concordance did not have effects on patient-reported communication. There were no identified differences in communication by race, ethnicity, or gender of patient or provider, although overall satisfaction was very high with limited sample diversity which may stymie capacity for identifying differences. Very few Black and zero Hispanic patients had racial or ethnic concordance with their provider, reflecting known gaps in the oncology workforce.