Quality of Breast Cancer Care: Perception Versus Practice

Purpose Because insurers use performance and quality metrics to inform reimbursement, identifying remediable causes of poor-quality cancer care is imperative. We undertook this descriptive cohort study to assess key predictors of women's perceived quality of their breast cancer care and actual guideline-concordant quality of care received. Patients and Methods We surveyed inner-city women with newly diagnosed and surgically treated early-stage breast cancer requiring adjuvant treatment who were enrolled onto a randomized controlled trial (RCT) of patient assistance to reduce disparities in care. We assessed women's perceived quality of care and perceived quality of the process of getting care, such as getting referrals, test results, and treatments; we abstracted records to determine the actual quality of care. Results Of the 374 new patients with early-stage breast cancer enrolled onto the RCT, only a slight majority of women (55%) perceived their quality of care as excellent; 88% actually received good-quality, guideline-concordant care. Excellent perceived quality (P < .001) was significantly associated with patients' perception of the quality of the process of getting care (adjusted relative risk [RR], 1.78; 95% CI, 1.65 to 1.87). Also associated with perceived quality—and mediated by race—were trust in one's physician (adjusted RR, 1.43; 95% CI, 1.16 to 1.64) and perceived racism, which affected black women more than women of other races/ethnicities (black race–adjusted RR for perceived racism, 0.33 [95% CI, 0.10 to 0.87]; black race–adjusted RR for trust, 1.61 [95% CI, 0.97 to 1.90]; c = 0.82 for the model; P < .001). Actual quality of care provided did not affect perceived quality of care received. Conclusion Patients' perceived quality of care differs from their receipt of high-quality care. Mutable targets to improve perceived quality of care include the processes of getting care and trusting their physician.