Provider perception of racial healthcare disparities among women with gynecologic malignancies

Objectives: To identify patterns in provider perception of healthcare disparities among black patients with gynecologic malignancies. Methods: An anonymous survey was distributed among the US physician members of the Society of Gynecologic Oncology. Participants were queried about demographics and their perceptions of healthcare disparities among patients with gynecologic malignancies. Responses to the outcome questions were collected on a continuous scale from 0-100, where 0 represented ‘strongly disagree’ and 100 represented ‘strongly agree’. For the analysis, we dichotomized the continuous response to a binary outcome where the collected response >50 is 1, and 0 otherwise. All survey responses, demographic and outcome questions, were analyzed descriptively using frequency (percent). The outcome questions were also summarized by whether the participant self-identified as white/non-White. Chi-square and Fisher's exact tests were performed to test independence. Results: A total of 229 responses to the survey were analyzed. Of the respondents, 74% identified as White/Caucasian, 10% identified as Black/African American, 2.2% identified as Hispanic or Latino, 8.7% identified as Asian, 0.4% identified as American Indian or Alaskan native, and 3.9% identified as mixed race. A total of 31% of respondents were male and 69% female. Irrespective of their own identified race, respondents felt strongly that Black women with gynecologic malignancies have worse outcomes than White women, with 94% of respondents with a score >50. However, respondents remained more neutral when queried about their own black patients’ outcomes, with only 48% of respondents answering with a score >50. This did not vary when comparing white to non-white respondents (p=0.9). When queried about the 2 most significant contributors to poor outcomes among Black patients, 70% of respondents cited socioeconomic status. Other cited contributors included systemic racism (58%), distrust of the medical field (49%), unconscious bias/prejudice (47%), education/health literacy (45%), and intrinsic biological differences (31%). A total of 86% agreed that they could contribute to addressing healthcare disparities (87% responding >50 for white respondents vs 84% responding >50 for non-white respondents; p=0.8). Non-white respondents were more likely than white respondents to disagree that their institutions have measures to address healthcare disparities in black women (73% responding <50 vs 47%, respectively; p=0.002). The most commonly cited metric addressing disparities at respondents’ respective institutions was cancer care navigation, cited by 67% of respondents, followed closely by financial navigation at 64%. These measures were more often identified by white/Caucasian respondents vs non-white (cancer care navigation 72% vs 48%, financial navigation 68% vs 45%). A total of 35% of respondents cited disease prevention and enhanced screening programs as a measure to address disparities in black patients at their institutions. Community outreach was cited as a measure by 59% of the respondents; however, this was cited more by white/Caucasian respondents than non-white respondents (63% vs 41%). Conclusions: Though most respondents agreed that Black patients have worse oncologic outcomes, most did not perceive these issues within their own patients. There remains room for improvement in the identification of healthcare disparities within our own patients and implementation of well-studied measures used to address these gaps in outcomes. To identify patterns in provider perception of healthcare disparities among black patients with gynecologic malignancies. An anonymous survey was distributed among the US physician members of the Society of Gynecologic Oncology. Participants were queried about demographics and their perceptions of healthcare disparities among patients with gynecologic malignancies. Responses to the outcome questions were collected on a continuous scale from 0-100, where 0 represented ‘strongly disagree’ and 100 represented ‘strongly agree’. For the analysis, we dichotomized the continuous response to a binary outcome where the collected response >50 is 1, and 0 otherwise. All survey responses, demographic and outcome questions, were analyzed descriptively using frequency (percent). The outcome questions were also summarized by whether the participant self-identified as white/non-White. Chi-square and Fisher's exact tests were performed to test independence. A total of 229 responses to the survey were analyzed. Of the respondents, 74% identified as White/Caucasian, 10% identified as Black/African American, 2.2% identified as Hispanic or Latino, 8.7% identified as Asian, 0.4% identified as American Indian or Alaskan native, and 3.9% identified as mixed race. A total of 31% of respondents were male and 69% female. Irrespective of their own identified race, respondents felt strongly that Black women with gynecologic malignancies have worse outcomes than White women, with 94% of respondents with a score >50. However, respondents remained more neutral when queried about their own black patients’ outcomes, with only 48% of respondents answering with a score >50. This did not vary when comparing white to non-white respondents (p=0.9). When queried about the 2 most significant contributors to poor outcomes among Black patients, 70% of respondents cited socioeconomic status. Other cited contributors included systemic racism (58%), distrust of the medical field (49%), unconscious bias/prejudice (47%), education/health literacy (45%), and intrinsic biological differences (31%). A total of 86% agreed that they could contribute to addressing healthcare disparities (87% responding >50 for white respondents vs 84% responding >50 for non-white respondents; p=0.8). Non-white respondents were more likely than white respondents to disagree that their institutions have measures to address healthcare disparities in black women (73% responding <50 vs 47%, respectively; p=0.002). The most commonly cited metric addressing disparities at respondents’ respective institutions was cancer care navigation, cited by 67% of respondents, followed closely by financial navigation at 64%. These measures were more often identified by white/Caucasian respondents vs non-white (cancer care navigation 72% vs 48%, financial navigation 68% vs 45%). A total of 35% of respondents cited disease prevention and enhanced screening programs as a measure to address disparities in black patients at their institutions. Community outreach was cited as a measure by 59% of the respondents; however, this was cited more by white/Caucasian respondents than non-white respondents (63% vs 41%). Though most respondents agreed that Black patients have worse oncologic outcomes, most did not perceive these issues within their own patients. There remains room for improvement in the identification of healthcare disparities within our own patients and implementation of well-studied measures used to address these gaps in outcomes.