Minority cancer patients less often see 'culturally competent' doctors

Although many minority cancer survivors would prefer to see doctors who share or understand their cultural background, that often doesn’t happen, a new U.S. study suggests.

A nationally representative survey that asked about physician “cultural competency” found that almost half of minorities said it was at least somewhat important for them to be treated by a doctor who understood or shared their culture.

But minority cancer survivors were 58% less likely than non-Hispanic white patients to be treated by a doctor who shared or understood their culture, according to the analysis published in JAMA Oncology.

“There’s a disparity between what minority patients prefer and what they receive,” said the study’s lead author, Santino Butler, a student at the Harvard Medical School and a research trainee at the Dana-Farber Cancer Institute in Boston. “This shows there’s a lot of room for improvement. And a lot of improvement could be made through more diversity of the healthcare workforce.” To take a closer look at patient preferences, Butler and his colleagues turned to the 2017 version of the National Health Interview Survey, which collects data on a range of health indicators for adults in the general population.

The 2017 survey included a supplemental set of queries regarding physician cultural competency, and included questions such as: “How often were you treated with respect by your providers?”

Among 2,244 adult cancer survivors who responded to the supplemental questions, 1,866 were non-Hispanic white, 376 were minorities, two had unknown race/ethnicity and 1,334 were women. The average age of these cancer survivors was 68.

Nonwhite minority cancer survivors were more likely than non-Hispanic white cancer survivors to say that it was somewhat or very important for their doctors to share or understand their culture: 177 out of 372 minorities versus 577 of 1,857 whites. Thirteen participants did not respond to the question.

Minority respondents were less likely to report that they were frequently able to see physicians who shared or understood their culture. And 12.6% of minority patients said they were never able to see a doctor who shared or understood their culture.

“In summary,” Butler and his colleagues write, “despite longstanding efforts to improve care for minority patients with cancer and cancer survivors, there remain racial/ethnic disparities in receipt of culturally competent care.” The findings should provide an impetus for evaluating policy and guidelines designed to improve training in cultural literacy for cancer specialists, known as oncologists, of all backgrounds, the authors conclude.

While it’s important to raise awareness of this issue, “I don’t believe cultural sensitivity training makes for better doctors,” said Dr. Otis Brawley, Bloomberg Distinguished Professor of Oncology and Epidemiology at Johns Hopkins University Medical School and Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

Instead, the focus should be on recruiting doctors who have empathy for all their patients, Brawley said. “I also don’t believe that black doctors need to be taking care of black patients or Native American doctors need to be taking care of Native American patients. We need doctors who have a certain amount of compassion toward other human beings no matter what their race is.” Part of what complicates evaluations of medical care is that it is not distributed equally, Brawley said. “A lot of minorities are poor or under-insured,” he explained. “And a lot are treated in a healthcare system where the doctors do not really have time to talk to their patients.”