Oncologists spend less time discussing goals of care with minority patients

Oncologists spend significantly less time discussing goals of cancer care with minority patients vs. nonminority patients, according to a study presented at the Palliative and Supportive Care in Oncology Symposium.

“During visits in which [patients with advanced cancer] were receiving results of their first scan after initiating chemotherapy, oncologists spent 3 minutes less with their minority patients when compared [with] nonminority patients, even after controlling for patients’ insurance, education status, and whether or not there was progression on scans,” Cardinale B. Smith, MD, PhD, associate professor of medicine and director of quality for cancer services at Mount Sinai Health System’s division of hematology/medical oncology and Brookdale Department of Geriatrics and Palliative Medicine, told HemOnc Today. “Given that minority patients with cancer tend to have overall poorer outcomes and reported quality of life, this difference in time spent during a visit is an important component that may be contributing to disparate outcomes.”

Smith and colleagues recruited 22 solid tumor oncologists and their patients with newly diagnosed, advanced cancer and a prognosis of less than 2 years. The trial tested a coaching model of communication skills training, and patients were interviewed after post-imaging visits.

Researchers defined goals-of-care discussions as patient-reported conversations with their oncologists about preferences for cancer treatment and what was important to them in terms of quality of life. Nonparametric tests were used to make comparisons, and mixed-effects models were used for risk adjustment.

The researchers audiotaped 142 post-imaging visits and documented the median encounter time. Of these visits, 38% were with white non-Hispanic patients, 32% were with black non-Hispanic patients and 19% were with Hispanic patients.

Median encounter times among the four study sites ranged from 10 minutes to 18 minutes (P = .009).

Patients whose disease had progressed had encounters lasting 18 minutes vs. 13 minutes for patients whose disease had not progressed (P = .007).

Oncologists spent a median face-to-face time of 12 minutes with minority patients during a goals-of-care discussion vs. 17 minutes with nonminority patients (P = .002).

Time spent with minority patients was less than with nonminority patients (15 minutes vs. 18 minutes, P = .02) after controlling for grouping of patients within hospitals and progression of disease.

“Future work is needed to evaluate what happens during these encounters that may be contributing to this,” Smith said. – by Jennifer Byrne

Reference:

Smith CB, et al. Presented at: Palliative and Supportive Care in Oncology Symposium; Nov. 16-17, 2018; San Diego.

Disclosure: Smith reports honoraria from Teva Pharmaceuticals. Please see the abstract for all other authors’ relevant financial disclosures.