Concordance of identity, which refers to similarities in race, religion, personal believes, values and gender, etc. between patients and clinicians is generally associated with increased patient satisfaction, participation, trust and intention to adhere to the recommended treatment. [1][2]

Studies have shown that the relationship between the clinician and the patient is strengthened when patients see themselves as similar to their physicians in personal beliefs, values, and communication. [1][2] As a result, cancer survivors often prefer clinicians who understand or share their culture, race or religion as their healthcare provider. However, the mechanisms through which concordance of identity leads to better outcomes, and a patients’ perceptions of similarity to their physicians has long been unknown. In addition, the extent to which identity discordance is a barrier to care also remains unclear. [1]

In a new study, researchers at the Johns Hopkins Kimmel Cancer Center, in collaboration with Dell Medical School, University of Minnesota, and the Vanderbilt University Medical Center, assessed the prevalence of delayed or forgone care due to patient-clinician identity discordance among cancer survivors and the general population and evaluated factors associated with this barrier among survivors.

The researchers used a national data sample from the National Institutes of Health’s All of Us Research Program, housed at the Vanderbilt University Medical Center.

The study results revealed that a small but statistically significant proportion of patients with cancer, especially younger and lower-income minorities, disproportionately reported delaying care because of patient/clinician racial, gender and cultural differences.

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The study, led by student doctor and first author Vishal Patel from Dell Medical School at the University of Texas at Austin and senior author S. M. Qasim Hussaini, MD, Chief Medical Oncology Fellow at the Johns Hopkins Kimmel Cancer Center, was published on March 30, 2023 in the journal JAMA Oncology.[3]

Diversity, Equity, and Inclusion
Hussaini, along with program leadership, led recent efforts focused on Diversity, Equity, and Inclusion within the hematology-oncology fellowship program at Johns Hopkins with a dedicated program focused on curricular development, recruitment and retention, minority engagement, and health systems research.

Otis Webb Brawley, MD, is Associate Director, Community Outreach and Engagement Sidney Kimmel Comprehensive Cancer Center
Professor of Oncology.

The current work addresses the American Society of Clinical Oncology’s recently announced strategic action plans to improve workforce diversity and clinician preparedness, Hussaini said.

The findings, he noted, directly inform policies to increase uptake of educational priorities and workforce diversification within oncology.

“Our article provides important evidence that a lack of physician diversity may be contributing to disparities in care delivery for patients with cancer and can be harmful to patients,” Patel said.

“This represents the kind of important research that needs to be done if we are to get optimal care to all Americans.  The greatest reason for racial health disparities in cancer outcomes is racial disparities in receipt of quality care,” concluded Otis W. Brawley, MD, Bloomberg Distinguished Professor of Oncology and Epidemiology

[1] Street RL Jr, O’Malley KJ, Cooper LA, Haidet P. Understanding concordance in patient-physician relationships: personal and ethnic dimensions of shared identity. Ann Fam Med. 2008 May-Jun;6(3):198-205. doi: 10.1370/afm.821. PMID: 18474881; PMCID: PMC2384992.
[2] Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003 Dec 2;139(11):907-15. doi: 10.7326/0003-4819-139-11-200312020-00009. PMID: 14644893.
[3] Patel VR, Gupta A, Blaes AH, Winkfield KM, Haynes AB, Hussaini SMQ. Prevalence of Delayed or Forgone Care Due to Patient-Clinician Identity Discordance Among US Cancer Survivors. JAMA Oncol. 2023 Mar 30:e230242. doi: 10.1001/jamaoncol.2023.0242. Epub ahead of print. PMID: 36995727; PMCID: PMC10064278.

Featured image by CDC. on Unsplash. Used with permission.

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