J Canc Educ DOI 10.1007/s13187-015-0846-8
Resident Physicians and Cancer Health Disparities: a Survey of Attitudes, Knowledge, and Practice Maria C. Mejia de Grubb 1 & Barbara Kilbourne 2 & Roger Zoorob 1 & Sandra Gonzalez 1 & William Mkanta 3 & Robert Levine 1
# American Association for Cancer Education 2015
Abstract Workforce development initiatives designed to mitigate cancer health disparities focus primarily on oncologists rather than on primary care providers (PCPs) who could be better positioned to address the issue at the preventive and community levels. The purpose of this project was to assess primary care resident physicians’ self-perceived attitudes and comfort level in addressing cancer health disparities. Resident physicians in their first- through third-year of training in family, internal, preventive/occupational medicine, and obstetrics and gynecology (OB/GYN) at three academic centers responded to a 13-question survey in the spring of 2013. Descriptive and chi-square statistics were performed to analyze responses to (1) attitudes about cross-cultural communication and understanding, (2) knowledge about sources of cancer health disparities, (3) self-reported preparedness to provide cross-cultural cancer care and skills to manage specific situations, and (4) relevance of cancer-disparity education to clinical practice. A total of 78 (70.9 %) residents responded to the survey. Twenty three (29.5 %) of the respondents felt they did not understand the socio-demographic characteristics of their patients’ communities, and 20 (25.6 %) did not feel capable of discussing current cancer-related care guidelines when the patients’ personal beliefs conflict with their own. Few of the relationships between residency program and location with
* Maria C. Mejia de Grubb [email protected] 1
Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Dr., Suite 600, Houston, TX 77098, USA
2
Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, USA
3
Master Health Administration/EMHA Program, Western Kentucky University, Bowling Green, KY, USA
outcome measures met the criteria for statistical significance. Family medicine residents were the most likely to report in that it was hard to interact with persons from other cultures. As PCPs will play a key role in addressing cancer health disparities, effective educational opportunities in cancer care by primary care residents are warranted. Keywords Residents . Cancer disparities . Cross-cultural . Education Cancer is a cause of significant morbidity and mortality in the USA and is influenced by a complex interplay of economic, social, and cultural factors. “Cancer health disparities” is a term commonly used to describe differences in the incidence, prevalence, mortality, and burden of cancer- and adverserelated conditions that are closely linked with social or economic disadvantage [1]. Despite improvements in the delivery of health care, data still shows a disproportionate burden of cancer among socioeconomically (SES) disadvantaged communities, including lower survival rates compared to their more affluent counterparts, regardless of race, ethnicity, gender, or age [1, 2]. Eliminating and preventing cancer-related health disparities in vulnerable and medically underserved populations have recently become a focus of public health efforts [3]. A well-trained professional workforce is essential to preventing, controlling, and ultimately eliminating this disease. However, most workforce development initiatives to mitigate cancer health disparities focus primarily on oncologists [4, 5], rather than on primary care providers (PCPs) who are better positioned to address preventive and community issues. Although the racial and ethnic health disparity awareness among physicians has somewhat improved in the last few years [6], there are still deficiencies in training and skill development related
J Canc Educ
to this issue. In fact, previous survey data have shown the need to increase awareness of health disparities among physicians [7, 8] supporting the Institute of Medicine’s previous recommendation for health professionals to receive training to better understand and address disparities [9]. The Accreditation Council for Graduate Medical Education (ACGME) recently released the Clinical Learning Environment Review Pathways to Excellence in which two of the health care quality pathways include expectations that trainees and faculty receive education on identifying and reducing health care disparities, and that they receive training in cultural competency relevant to the institution’s patient population. The literature is scarce, however, in regard to educational programs reporting on need assessments for health disparity training or program experiences in preparing trainees to address health disparities [10, 11]. Furthermore, to our knowledge, there are no previous reports on resident physicians’ preparedness to address cancer health disparities. Considering that primary care physicians play a key role in cancer screening and long-term care for patients with cancer, it is imperative to address resident physicians’ skill development and preparedness to provide cross-cultural and appropriate cancer care. The purpose of this project was to assess resident physicians’ self-perceived attitudes and comfort level in addressing cancer-related health disparities including (1) attitudes about cross-cultural communication and understanding, (2) knowledge about sources of cancer health disparities, (3) selfreported preparedness to provide cross-cultural cancer care and skills to manage specific situations, and (4) relevance of cancer-disparity education to clinical practice. Recognizing the essential role of primary care in improving cancer care outcomes is impending for the current state of health of our nation. A well-trained cadre of PCPs in cancer-related issues within clinical practice could help to reduce the gap in cancer disparities by providing appropriate cross-cultural care, communicating effectively with patients, and practicing evidencebased medicine.
chance of being chosen [12]. We included all residents available to participate in the educational sessions and willing to complete the survey. Participants voluntarily completed a twopart brief survey with no participant identifiers recorded. The first part was administered before the educational activity commenced, while the second part assessing the relevance of cancer-disparity issues to clinical practice was administered after the activity. For the first part of the instrument, the authors adapted questions from the literature [10] to assess residents’ attitudes, knowledge, and skills about cancer health disparities. All responses were anonymous, and no incentives were provided to the participants. Three constructs related to self-perceived attitudes and comfort level were assessed (total nine questions): (1) attitudes about cross-cultural communication and understanding, (2) knowledge about sources of cancer health disparities, and (3) self-reported preparedness to provide cross-cultural cancer care and skills to manage specific situations. We also assessed residents’ perceptions of the relevance of cancer-disparity education to clinical practice. Item analysis was performed for each question to determine the levels of comfort on two fivepoint Likert scales with these options: (1) “very easy,” “easy,” “uncertain,” “hard,” and “very hard” and (2) “never,” “rarely,” “sometimes,” “often,” and “always.” Level of agreement was measure on a five-point Likert scale with “strongly agree,” “agree,” “uncertain,” “disagree,” and “strongly disagree.” Descriptive statistics were generated to describe the participants and their responses. Our second analysis with chisquare tests sought to determine if the sample of residents differed by type of residency program and location of the residency program. The independent variables, program type and program location, were measured at a nominal level. The dependent variables ranged from five-category nominal to binary measures. For statistical testing, p values
Resident Physicians and Cancer Health Disparities: a Survey of Attitudes, Knowledge, and Practice Maria C. Mejia de Grubb 1 & Barbara Kilbourne 2 & Roger Zoorob 1 & Sandra Gonzalez 1 & William Mkanta 3 & Robert Levine 1
# American Association for Cancer Education 2015
Abstract Workforce development initiatives designed to mitigate cancer health disparities focus primarily on oncologists rather than on primary care providers (PCPs) who could be better positioned to address the issue at the preventive and community levels. The purpose of this project was to assess primary care resident physicians’ self-perceived attitudes and comfort level in addressing cancer health disparities. Resident physicians in their first- through third-year of training in family, internal, preventive/occupational medicine, and obstetrics and gynecology (OB/GYN) at three academic centers responded to a 13-question survey in the spring of 2013. Descriptive and chi-square statistics were performed to analyze responses to (1) attitudes about cross-cultural communication and understanding, (2) knowledge about sources of cancer health disparities, (3) self-reported preparedness to provide cross-cultural cancer care and skills to manage specific situations, and (4) relevance of cancer-disparity education to clinical practice. A total of 78 (70.9 %) residents responded to the survey. Twenty three (29.5 %) of the respondents felt they did not understand the socio-demographic characteristics of their patients’ communities, and 20 (25.6 %) did not feel capable of discussing current cancer-related care guidelines when the patients’ personal beliefs conflict with their own. Few of the relationships between residency program and location with
* Maria C. Mejia de Grubb [email protected] 1
Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Dr., Suite 600, Houston, TX 77098, USA
2
Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, USA
3
Master Health Administration/EMHA Program, Western Kentucky University, Bowling Green, KY, USA
outcome measures met the criteria for statistical significance. Family medicine residents were the most likely to report in that it was hard to interact with persons from other cultures. As PCPs will play a key role in addressing cancer health disparities, effective educational opportunities in cancer care by primary care residents are warranted. Keywords Residents . Cancer disparities . Cross-cultural . Education Cancer is a cause of significant morbidity and mortality in the USA and is influenced by a complex interplay of economic, social, and cultural factors. “Cancer health disparities” is a term commonly used to describe differences in the incidence, prevalence, mortality, and burden of cancer- and adverserelated conditions that are closely linked with social or economic disadvantage [1]. Despite improvements in the delivery of health care, data still shows a disproportionate burden of cancer among socioeconomically (SES) disadvantaged communities, including lower survival rates compared to their more affluent counterparts, regardless of race, ethnicity, gender, or age [1, 2]. Eliminating and preventing cancer-related health disparities in vulnerable and medically underserved populations have recently become a focus of public health efforts [3]. A well-trained professional workforce is essential to preventing, controlling, and ultimately eliminating this disease. However, most workforce development initiatives to mitigate cancer health disparities focus primarily on oncologists [4, 5], rather than on primary care providers (PCPs) who are better positioned to address preventive and community issues. Although the racial and ethnic health disparity awareness among physicians has somewhat improved in the last few years [6], there are still deficiencies in training and skill development related
J Canc Educ
to this issue. In fact, previous survey data have shown the need to increase awareness of health disparities among physicians [7, 8] supporting the Institute of Medicine’s previous recommendation for health professionals to receive training to better understand and address disparities [9]. The Accreditation Council for Graduate Medical Education (ACGME) recently released the Clinical Learning Environment Review Pathways to Excellence in which two of the health care quality pathways include expectations that trainees and faculty receive education on identifying and reducing health care disparities, and that they receive training in cultural competency relevant to the institution’s patient population. The literature is scarce, however, in regard to educational programs reporting on need assessments for health disparity training or program experiences in preparing trainees to address health disparities [10, 11]. Furthermore, to our knowledge, there are no previous reports on resident physicians’ preparedness to address cancer health disparities. Considering that primary care physicians play a key role in cancer screening and long-term care for patients with cancer, it is imperative to address resident physicians’ skill development and preparedness to provide cross-cultural and appropriate cancer care. The purpose of this project was to assess resident physicians’ self-perceived attitudes and comfort level in addressing cancer-related health disparities including (1) attitudes about cross-cultural communication and understanding, (2) knowledge about sources of cancer health disparities, (3) selfreported preparedness to provide cross-cultural cancer care and skills to manage specific situations, and (4) relevance of cancer-disparity education to clinical practice. Recognizing the essential role of primary care in improving cancer care outcomes is impending for the current state of health of our nation. A well-trained cadre of PCPs in cancer-related issues within clinical practice could help to reduce the gap in cancer disparities by providing appropriate cross-cultural care, communicating effectively with patients, and practicing evidencebased medicine.
chance of being chosen [12]. We included all residents available to participate in the educational sessions and willing to complete the survey. Participants voluntarily completed a twopart brief survey with no participant identifiers recorded. The first part was administered before the educational activity commenced, while the second part assessing the relevance of cancer-disparity issues to clinical practice was administered after the activity. For the first part of the instrument, the authors adapted questions from the literature [10] to assess residents’ attitudes, knowledge, and skills about cancer health disparities. All responses were anonymous, and no incentives were provided to the participants. Three constructs related to self-perceived attitudes and comfort level were assessed (total nine questions): (1) attitudes about cross-cultural communication and understanding, (2) knowledge about sources of cancer health disparities, and (3) self-reported preparedness to provide cross-cultural cancer care and skills to manage specific situations. We also assessed residents’ perceptions of the relevance of cancer-disparity education to clinical practice. Item analysis was performed for each question to determine the levels of comfort on two fivepoint Likert scales with these options: (1) “very easy,” “easy,” “uncertain,” “hard,” and “very hard” and (2) “never,” “rarely,” “sometimes,” “often,” and “always.” Level of agreement was measure on a five-point Likert scale with “strongly agree,” “agree,” “uncertain,” “disagree,” and “strongly disagree.” Descriptive statistics were generated to describe the participants and their responses. Our second analysis with chisquare tests sought to determine if the sample of residents differed by type of residency program and location of the residency program. The independent variables, program type and program location, were measured at a nominal level. The dependent variables ranged from five-category nominal to binary measures. For statistical testing, p values
