African-Americans less likely to receive surgery for early lung cancer
Some lung cancer patients chose not to have surgery — even when it’s the best treatment option. African-American patients are disproportionately represented among those patients who opt out of such surgery. These findings may help explain the disproportionately high death rate from lung cancer among African-Americans.
In the June 16 issue of JAMA,(1) Cykert et al report that African-American patients were less likely to follow a recommendation for surgery than white patients. These researchers also noted that patients who opted out of surgery often said their doctor’s communication skills influenced their decision. The best treatment for early-stage lung cancer is surgery; however, Cykert et al found that one-third of white patients and nearly one half of African-American patients with early-stage disease refused to take this route.
What is it that docs are saying or not saying that’s causing these patients to choose less effective treatment? Clearly, just saying that “of those patients with stage 1a and stage 2 lung cancer, 70% of those who receive surgery will survive out to 5 years” is not enough. We have to learn how to explain to working-class, rural, and minority populations what our physician mumbo-jumbo means. We have to learn to communicate with peoples other than ourselves — people from different cultural backgrounds and from different social classes. We have to learn to be culturally proficient. We have people and organizations willing to help clinicians develop cultural competency. Let’s use them.
However, the problem is more than our cultural incompetence. I believe that physicians’ implicit biases against racial and ethnic minorities, working-class people of any racial or ethnic category, and rural folk in general play a role in the the health system’s failure to adequately communicate with these populations. As I noted in a blog post almost a year ago, “Are white physicians racist? The vast majority of them are not. Do white physicians hold unconscious biases against African Americans and Latinos? The overwhelming majority of them do. When less than 6% of physicians are African American or Latino, this fact has a big impact. Unconscious racial stereotyping and bias contributes to the health inequities suffered by African-American and Latino populations.” Physicians (and others) hold such implicit biases not only against people of color, but those in the working class and rural populations, as well. REF PROJ IMPLICIT
Although the majority of racial and ethnic health inequities result from structural problems with the health care delivery system such as lack of health care insurance, clinicians’ implicit racial biases and lack of cultural competence also play a role. Equal access to care does not ensure equal treatment unless we reduce or eliminate implicit bias and train culturally proficient clinicians.
1. Cykert S, Dilworth-Anderson P, Monroe MH, et al. “Factors Associated with Decisions to Undergo Surgery Among Patients with Newly Diagnosed Early-Stage Lung Cancer.” JAMA 2010;303:2368-76.