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Supportive Care / Symptom Management (Prevention of Cancer Morbidity)

Projects and Investigators

Race effects in oncologists' end-of-life communication

Program Description:

African Americans experience significantly higher incidence and mortality than Whites for many cancers. Race disparities also exist during the period of time that bridges life and death because African Americans are less likely to use hospice care and therefore more likely to endure undue suffering and pain. These disparities may be due to many factors, including lack of awareness of palliative care options and poor communication between patients and oncologists at the end of life. A transdisciplinary team of investigators at Duke University Medical Center with expertise in social psychology, patient-physician communication, oncology, and statistics and a track record in end-of-life care is postured to explore race differences that occur in conversations at the end of life and potential reasons for this disparity. The specific aims of this study are to examine whether White oncologists are more likely to use patient-centered techniques with White patients with advanced cancer than with African American patients and whether these differences translate into race differences in patients' ratings of their relationship with their oncologist and trust in their oncologist. To accomplish these aims, we plan to analyze follow-up data that will be collected as part of an ongoing NCI-funded, randomized, controlled trial (R01CA10387, Tulsky, PI) that is testing the efficacy of a communication intervention for oncologists. In the baseline phase of this trial, we recruited 28 White oncologists that had conversations audio-recorded with approximately 139 different patients with advanced cancer (27 African American, 105 White, 7 of other races). We expect that we will obtain a similar distribution of patients at the follow-up period. Coders will assess the frequency with which oncologists use patient- centered techniques. In addition, we will assess patients' level of trust in their oncologist, perceived oncologist communication, perceived empathy, and their relationship with their oncologist. We will control for important covariates in the analyses, namely gender of the patient and oncologist, length of relationship, nature of visit, length of visit, type and stage of cancer, and physician specialty. Further, we will analyze qualitative data collected from structured interviews with White and African-American patients to assess whether race differences exist in sources of trust in oncologists. We also will link the qualitative and quantitative data to obtain the most in-depth analysis of race differences in trust of physicians. Results of this study will expand the field of oncologist-patient communication by identifying sources of race disparities - information that can be used in the future to develop patient and physician interventions to reduce the disproportional pain and suffering among African-American cancer patients. The public health impact of this study is that we may prevent some suffering by African Americans at the end of life by understanding communication patterns between patients and oncologists.