Originally published as JCO Early Release 10.1200/JCO.2005.06.102 on August 22 2005

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Patients' Perceptions of Quality of Care for Colorectal Cancer by Race, Ethnicity, and Language

From the Division of General Medicine and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Department of Health Care Policy, Harvard Medical School; Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Center on Outcomes, Research and Education Evanston Northwestern Healthcare Research Institute, Evanston, IL; Cancer Surveillance Program, Sacramento; Public Health Institute, Berkeley; Northern California Cancer Center, Union City; and Cancer Surveillance Section, California Department of Health Services, Sacramento, CA

Address reprint requests to John Z. Ayanian, MD, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115; e-mail: ayanian{at}hcp.med.harvard.edu

PURPOSE: To identify opportunities for improving care, we evaluated patients' perceptions of the quality of their cancer care by race, ethnicity, and language.

PATIENTS AND METHODS: We surveyed a population-based cohort of 1,067 patients with colorectal cancer in northern California approximately 9 months after diagnosis. Adjusting for clinical and demographic factors, mean problem scores were analyzed on a 100-point scale for six domains of care.

RESULTS: Mean problem scores were highest for health information (47.8), followed by treatment information (32.3), psychosocial care (31.7), coordination of care (21.3), confidence in providers (13.1), and access to cancer care (12.7). In adjusted comparisons with white patients, African American patients reported more problems with coordination of care (difference, 9.8; P < .001), psychosocial care (difference, 7.2; P = .03), access to care (difference, 6.6; P = .03), and health information (difference, 12.5; P < .001). Asian/Pacific Islander patients reported more problems than did white patients with coordination of care (difference, 13.2; P < .001), access to care (difference, 15.5; P < .001), and health information (difference, 12.6; P = .004). Hispanic patients tended to report more problems with coordination of care (difference, 4.4; P = .06), access to care (difference, 5.8; P = .08), and treatment information (difference, 7.0; P = .06). Non–English-speaking white patients reported more problems than other white patients with coordination of care (difference, 21.9; P < .001), psychosocial care (difference, 16.1; P = .009), access to care (difference, 19.8; P = .003), and treatment information (difference, 17.8; P = .002). Non–English-speaking Hispanic patients reported more problems than other Hispanic patients with confidence in providers (difference, 16.9; P = .01).

CONCLUSION: Efforts to improve patients' experiences with cancer care should address disparities by race, ethnicity, and language, particularly in coordination of care, access to care, and the provision of relevant information.

Supported by Grants No. R01 HS09869 and U01 CA93324 from the Agency for Healthcare Research and Quality and the National Cancer Institute.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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