Feature

Minority patients value, but are less likely to see, oncologists who understand their culture

Brandon A. Mahal, MD
Brandon A. Mahal

The existence of racial disparities in oncology and in health care overall has been well-established. Studies have shown that minorities with cancer are underrepresented in clinical trials, have worse survival outcomes and are less likely to be offered genetic testing than their non-Hispanic white counterparts.

For these and other reasons, many nonwhite minority cancer survivors believe their physicians should either share or understand their culture, according to results of a study conducted at Dana-Farber Cancer Institute and UT Southwestern Medical Center.

The study, which used data from a national survey that included 2,244 adult cancer survivors, showed 49.6% of nonwhite minorities consider it somewhat or very important to be treated by physicians who understand their culture, compared with 31.2% of non-Hispanic whites. However, nonwhite minorities were less likely to see culturally competent providers than non-Hispanic whites (65.3% vs. 79.9%).

“What we’ve seen, in studies across cancer types, is that nonwhite minority patients are less likely to receive correct treatment regimens, and there are several reasons for this,” Brandon A. Mahal, MD, radiation oncologist at Dana-Farber and senior co-author of the study, said in an interview with Healio. “One of the biggest barriers on the patient end of things is a mistrust of the medical system. That is one of the biggest benefits of being able to see providers that understand their culture.”

Mahal spoke with Healio about the lack of diversity among oncology providers, the need for thorough cultural competency training and the goal of a more racially balanced oncology workforce.

Question: Why is diversity lacking in the oncology workforce?

Answer: There are several reasons, starting before medical training. There’s a leaky pipeline all the way down to elementary school.

Individuals in minority populations face many barriers to medical school or other health-professional schools. One major barrier is the hidden costs. Just interviewing for medical school can cost tens of thousands of dollars that aren’t built into college loans. In medical school, there are hidden costs associated with standardized test preparation and interviewing for residency programs. All of that adds up to between $50,000 and $100,000 in additional costs outside of tuition that aren’t covered.

Even within medicine, oncology is one of the least diverse specialties, often because the additional clinical and research training required can be prohibitive for trainees from poor backgrounds.

Q: How can the current oncology workforce become more culturally competent?

A: One approach to improving the delivery of culturally competent care is to diversify the workforce, but, in the meantime, we can provide cultural competency training. The problem is that a lot of cultural competency trainings are internet modules that people click through. We know that minority patients with cancer do so much worse than other patients and are less likely to access services and trials, and I think it’s important that we move some of these cultural competencies into real-world settings. We need to have hands-on modules at hire, and yearly recertification. The best way to do that is to involve patients, community leaders and advocates from different communities and cultures in building that trust and outreach. More institutions are starting to form outreach and engagement offices, where there’s a concerted effort to reach out to minority communities and improve cultural competency within the institution — but more can and needs to be done.

Q : How do you interpret the finding that although minority patients are less likely to see culturally competent physicians, they are relatively happy with their care?

A: Overall, minority patients feel that they receive respect and understandable health information. They report that physicians frequently ask them questions about their beliefs regarding care. Despite this, there is still some gap in patients feeling understood. It’s something more than respect and information; it’s about understanding where someone is coming from and what barriers they might be up against. It’s about what patients may be thinking about as they make decisions about certain treatments or clinical trials.

Q: Do you foresee significant improvements in cultural competency in the coming years?

A: Yes. A lot of folks have been doing this kind of work for a number of years, but in the past several years — especially the past 2 to 3 years — these kinds of studies and initiatives have been emphasized at the very highest levels. Now it’s bumping up to a leadership level, and even at national and international conferences, these topics are taking the main stage. There is increased funding for research, so with all that help and the attention it’s getting now, I believe that over the next decade we’re going to make a lot of changes toward improving cultural competence within the current workforce and diversifying the workforce of the future. – by Jennifer Byrne

Reference:

Butler SS, et al. JAMA Oncol. 2019;doi:10.1001/jamaoncol.2019.4720.

For more information:

Brandon A. Mahal, MD, can be reached at 450 Brookline Ave., Boston, MA 02215 email: brandon.mahal@dfci.harvard.edu.

Disclosure: Mahal reports no relevant financial disclosures.

Brandon A. Mahal, MD
Brandon A. Mahal

The existence of racial disparities in oncology and in health care overall has been well-established. Studies have shown that minorities with cancer are underrepresented in clinical trials, have worse survival outcomes and are less likely to be offered genetic testing than their non-Hispanic white counterparts.

For these and other reasons, many nonwhite minority cancer survivors believe their physicians should either share or understand their culture, according to results of a study conducted at Dana-Farber Cancer Institute and UT Southwestern Medical Center.

The study, which used data from a national survey that included 2,244 adult cancer survivors, showed 49.6% of nonwhite minorities consider it somewhat or very important to be treated by physicians who understand their culture, compared with 31.2% of non-Hispanic whites. However, nonwhite minorities were less likely to see culturally competent providers than non-Hispanic whites (65.3% vs. 79.9%).

“What we’ve seen, in studies across cancer types, is that nonwhite minority patients are less likely to receive correct treatment regimens, and there are several reasons for this,” Brandon A. Mahal, MD, radiation oncologist at Dana-Farber and senior co-author of the study, said in an interview with Healio. “One of the biggest barriers on the patient end of things is a mistrust of the medical system. That is one of the biggest benefits of being able to see providers that understand their culture.”

Mahal spoke with Healio about the lack of diversity among oncology providers, the need for thorough cultural competency training and the goal of a more racially balanced oncology workforce.

Question: Why is diversity lacking in the oncology workforce?

Answer: There are several reasons, starting before medical training. There’s a leaky pipeline all the way down to elementary school.

Individuals in minority populations face many barriers to medical school or other health-professional schools. One major barrier is the hidden costs. Just interviewing for medical school can cost tens of thousands of dollars that aren’t built into college loans. In medical school, there are hidden costs associated with standardized test preparation and interviewing for residency programs. All of that adds up to between $50,000 and $100,000 in additional costs outside of tuition that aren’t covered.

Even within medicine, oncology is one of the least diverse specialties, often because the additional clinical and research training required can be prohibitive for trainees from poor backgrounds.

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Q: How can the current oncology workforce become more culturally competent?

A: One approach to improving the delivery of culturally competent care is to diversify the workforce, but, in the meantime, we can provide cultural competency training. The problem is that a lot of cultural competency trainings are internet modules that people click through. We know that minority patients with cancer do so much worse than other patients and are less likely to access services and trials, and I think it’s important that we move some of these cultural competencies into real-world settings. We need to have hands-on modules at hire, and yearly recertification. The best way to do that is to involve patients, community leaders and advocates from different communities and cultures in building that trust and outreach. More institutions are starting to form outreach and engagement offices, where there’s a concerted effort to reach out to minority communities and improve cultural competency within the institution — but more can and needs to be done.

Q : How do you interpret the finding that although minority patients are less likely to see culturally competent physicians, they are relatively happy with their care?

A: Overall, minority patients feel that they receive respect and understandable health information. They report that physicians frequently ask them questions about their beliefs regarding care. Despite this, there is still some gap in patients feeling understood. It’s something more than respect and information; it’s about understanding where someone is coming from and what barriers they might be up against. It’s about what patients may be thinking about as they make decisions about certain treatments or clinical trials.

Q: Do you foresee significant improvements in cultural competency in the coming years?

A: Yes. A lot of folks have been doing this kind of work for a number of years, but in the past several years — especially the past 2 to 3 years — these kinds of studies and initiatives have been emphasized at the very highest levels. Now it’s bumping up to a leadership level, and even at national and international conferences, these topics are taking the main stage. There is increased funding for research, so with all that help and the attention it’s getting now, I believe that over the next decade we’re going to make a lot of changes toward improving cultural competence within the current workforce and diversifying the workforce of the future. – by Jennifer Byrne

PAGE BREAK

Reference:

Butler SS, et al. JAMA Oncol. 2019;doi:10.1001/jamaoncol.2019.4720.

For more information:

Brandon A. Mahal, MD, can be reached at 450 Brookline Ave., Boston, MA 02215 email: brandon.mahal@dfci.harvard.edu.

Disclosure: Mahal reports no relevant financial disclosures.