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Background: Delays in breast cancer diagnosis and treatment lead to worse survival and quality of life. Racial disparities in care timeliness have been reported, but few studies have examined access at multiple points along the care continuum (diagnosis, treatment initiation, treatment duration, and genomic testing)., Methods and Findings: The Carolina Breast Cancer Study (CBCS) Phase 3 is a population-based, case-only cohort (n = 2,998, 50% black) of patients with invasive breast cancer diagnoses (2008 to 2013). We used latent class analysis (LCA) to group participants based on patterns of factors within 3 separate domains: socioeconomic status ("SES"), "care barriers," and "care use." These classes were evaluated in association with delayed diagnosis (approximated with stages III-IV at diagnosis), delayed treatment initiation (more than 30 days between diagnosis and first treatment), prolonged treatment duration (time between first and last treatment-by treatment modality), and receipt of OncotypeDx genomic testing (evaluated among patients with early stage, ER+ (estrogen receptor-positive), HER2- (human epidermal growth factor receptor 2-negative) disease). Associations were evaluated using adjusted linear-risk regression to estimate relative frequency differences (RFDs) with 95% confidence intervals (CIs). Delayed diagnosis models were adjusted for age; delayed and prolonged treatment models were adjusted for age and tumor size, stage, and grade at diagnosis; and OncotypeDx models were adjusted for age and tumor size and grade. Overall, 18% of CBCS participants had late stage/delayed diagnosis, 35% had delayed treatment initiation, 48% had prolonged treatment duration, and 62% were not OncotypeDx tested. Black women had higher prevalence for each outcome. We identified 3 latent classes for SES ("high SES," "moderate SES," and "low SES"), 2 classes for care barriers ("few barriers," "more barriers"), and 5 classes for care use ("short travel/high preventive care," "short travel/low preventive care," "medium travel," "variable travel," and "long travel") in which travel is defined by estimated road driving time. Low SES and more barriers to care were associated with greater frequency of delayed diagnosis (RFDadj = 5.5%, 95% CI [2.4, 8.5]; RFDadj = 6.7%, 95% CI [2.8,10.7], respectively) and prolonged treatment (RFDadj = 9.7%, 95% CI [4.8 to 14.6]; RFDadj = 7.3%, 95% CI [2.4 to 12.2], respectively). Variable travel (short travel to diagnosis but long travel to surgery) was associated with delayed treatment in the entire study population (RFDadj = 10.7%, 95% CI [2.7 to 18.8]) compared to the short travel, high use referent group. Long travel to both diagnosis and surgery was associated with delayed treatment only among black women. The main limitations of this work were inability to make inferences about causal effects of individual variables that formed the latent classes, reliance on self-reported socioeconomic and healthcare history information, and generalizability outside of North Carolina, United States of America., Conclusions: Black patients face more frequent delays throughout the care continuum, likely stemming from different types of access barriers at key junctures. Improving breast cancer care access will require intervention on multiple aspects of SES and healthcare access., Competing Interests: M.L.R. received consulting fees from Concert Genetics and National Committee for Quality Assurance, unrelated to the submitted work., (Copyright: © 2024 Dunn et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Understanding how patients and physicians discuss screening barriers may illuminate reasons for non-adherence to recommended colorectal cancer (CRC) screening. The goal of the present study was to describe patients' reporting of and physicians' responses to CRC screening barriers and examine their associations with patients' CRC screening behaviors. Audio-recorded primary care consultations (N = 413) with patients due for CRC screening were used to identify CRC screening-related barrier talk and physician responses. Presence of barrier talk was associated with less patient adherence to CRC screening (OR = 0.568, p = 0.007). Neither CRC screening talk (n = 413) nor physician responses (n = 151) were associated with patients' CRC screening. Among the consultations in which barrier talk occurred (n = 151), patients most often reported test-related (28.9%) and psychological (26.1%) barriers. Barriers were most often reported in the context of CRC screening discussions (45.7%) or in direct response to a physician's question about CRC screening (48.6%). Results indicated that patients rarely raised CRC screening barriers unprompted and that presence of barrier talk was predictive of CRC screening behavior. These findings may help improve future clinical practice by highlighting that patients may benefit from physicians initiating and facilitating discussions of CRC screening barriers and directly helping patients overcome known barriers to CRC screening.

382 Background: The use of telehealth visits in cancer care can improve accessibility, timeliness, and convenience for patients. However, disparities in its use persist with few studies having evaluated both patient- and community-level factors in relation to telehealth visit use in cancer care. Methods: We assembled a cohort of adults with an upcoming healthcare visit related to their cancer treatment at two academic medical centers (one in central NC and one in southeast MI) and their community affiliates. Black adults and those with a scheduled telehealth visit were oversampled during recruitment. Pre-visit surveys administered by telephone (N=773, RR=15%) collected information on sociodemographic characteristics, use of telehealth visits, healthcare access concerns, and patient symptoms/visit goals. We linked participant residential address to community-level measures, including broadband access. The two patient-reported outcomes of interest were 1) whether a choice in visit type (virtual or in-person) was offered and 2) scheduled visit type among those offered a choice. Associations of each outcome with sociodemographic characteristics and barriers (individual- and census tract-level) were assessed through estimation of unadjusted and adjusted prevalence differences (PDs). Results: 773 adults (RR=15%) were included in the cohort, mostly from the central NC site (N=621, RR=23%). After excluding non-recall for being offered a choice, the analytic sample (N=725) was 46% aged <65 years, 42% Black, and 67% women. Black participants were less likely than non-Black participants to be offered a choice (15% vs 23%, PD= -8.7 (-14.4, -3.0), and if offered a choice, less likely to accept a telehealth visit: 20% vs 67%, PD= -47.0 (-62.0, -32.0). Similarly, women were less likely to be offered a choice (16% vs 27%, PD= -10.9 (-17.4, -4.4)) and accept a telehealth visit 42% vs 63%, PD= -20.8 (-36.8, -4.7). Those who expressed technology-related worries were less likely to schedule a telehealth visit, such as those who were worried about internet access: 33% vs 57%, PDadj= -11.9 (-32.9, 9.2). Participants who indicated their insurance did not cover telehealth visits were less likely to be offered a choice (10% vs 24%, PDad = -9.4 (-23.1, 4.4). Lower community technology access (e.g. broadband ownership) and higher area-level poverty were associated with both outcomes, although these estimates were attenuated after adjustment. Conclusions: Not being offered a choice in visit type and/or not accepting a telehealth visit were associated with individual- and community-level barriers as well as demographic characteristics which may reflect additional unmeasured structural inequities (namely racism and sexism). Interventions to improve access to telehealth visits in cancer care should consider patient- and community-level barriers to care. [ABSTRACT FROM AUTHOR]

The article discusses about the potential benefits of incorporating virtual visits in oncology care, the challenges faced and how virtual oncology programs can be designed to enhance equity. Topics of discussion includes the benefits includes increased patient access and convenience especially among rural patients or those with mobility, access, or financial challenges while access to technology remains a barrier to virtual visit adoption.

Since publication of Unequal Treatment by the Institute of Medicine in 2003, there has been a growing recognition of the role of provider implicit racial bias in patient care. Provider implicit racial bias has been consistently negatively associated with both care satisfaction and provider trust among racial/ethnic minority patients. This suggests provider implicit racial bias likely manifests through their communication behaviors, which in turn may offer a means of addressing racial disparities in healthcare and ultimately in health. However, identifying provider communication behaviors that mediate the links between provider implicit racial bias and patient outcomes is challenging. In this paper, we argue that identifying these provider communication behaviors requires (1) taking into account findings from social psychology research of implicit racial bias and (2) incorporating the perspectives of racial/ethnic minority patients into patient-provider communication research. We discuss the utility of mixed methods research designs as a framework for resolving this complex scientific question. Research that draws on social psychology research of implicit racial bias and incorporates the racial/ethnic minority patient perspectives can inform the development of communication skills training programs for students and residents in various healthcare fields. Such programs are one element of a broader effort to reduce racial/ethnic disparities in healthcare. [ABSTRACT FROM AUTHOR]

This study investigated racial differences in patient-physician communication around mental health versus biomedical issues. Data were collected from audiorecorded periodic health examinations of adults with mental health needs in the Detroit area (2007-2009). Patients and their primary care physicians conversed for twice as long, and physicians demonstrated greater empathy during mental health topics than during biomedical topics. This increase varied by patient and physician race. Patient race predicted physician empathy, but physician race predicted talk time. Interventions to improve mental health communication could be matched to specific populations based on the separate contributions of patient and physician race. [ABSTRACT FROM AUTHOR]