Racial disparities are a huge problem in American healthcare, with decades of research demonstrating that Black Americans are less likely to receive quality healthcare than their White peers.
The results are as predictable as they are unacceptable: Black Americans are almost twice as likely to have no health insurance as White Americans. They’re more likely than other ethnicities to suffer from asthma as children, and from hypertension as adults. And healthcare providers are less likely to be located in Black neighborhoods.
Closing this rift in healthcare equity won’t be an easy task, as lacking healthcare access and worse outcomes for Black Americans are tied to a variety of social factors Researchers are finding that systemized care with an emphasis on personal interactions shows promise in bridging the gap in outcomes between White and Black patients.
A pair of studies led by Dr. Samuel Cykert of the University of North Carolina School of Medicine and followed on previous studies that documented racial disparities during cancer treatment owing to implicit biases among care providers, poor clinical communication, and other factors.
“A Black and a White patient of the same age could require the same surgery, have the same comorbidities, have the same income and insurance, yet White patients were more likely to receive the surgery and get their cancer treated,” Cykert said in a statement.
Cykert’s previous studies did not reach conclusions about why Black patients were less likely to complete treatment regimens. But we know from other research that oncologists who score higher on implicit bias tests spend less time talking with Black patients about their diagnosis and treatment options, and that those patients had less confidence in their treatment plans.
This sort of racially-induced gap in patient communication - and down the road, in care – is what Cykert and his team aimed to address in a pair of studies between 2012 and 2017 – one following lung cancer patients, and the other primarily following patients with breast cancer. In both cases, Cykert and his team noted a gap in the likelihood that Black patients and their White counterparts would complete treatment plans after being diagnosed.
The two studies implemented new practices, developed in partnership with the Greensboro Health Disparities Collaborative ,that aimed to increase transparency and emphasize patient-centered communication plans for all patients.
For starters, clinical teams were given real-time warnings that triggered a follow-up communication when a patient missed an appointment. They were also provided with regular reports about which patients had completed treatment, and which had dropped out at some point. Finally, teams were joined by a nurse navigator who worked to build trust with patients, iron out miscommunications, and help them overcome barriers accessing care.
Over the course of 5 years, personalized interventions helped to close the divide in treatment completion rates between Black and White patients. What’s more, they improved completion rates for patients as a whole. Prior to the breast cancer-focused study , 87% of White patients were completing their treatment programs, compared to 80% of Black patients. After implementing the researchers’ personalized advocacy techniques, those numbers rose to 89% of White patients and 88% of Black patients, all but eliminating the racial disparity in treatment completion.
The lung cancer study showed even more promising results. At the five cancer centers involved, 87% of White patients completed their cancer treatments compared to 78% of Black patients. After five years, both numbers improved significantly, with 95% of White patients and 96% of Black patients completing their treatment regimens.
While research alone can’t fix racial inequities in healthcare, these studies show that the problems aren’t intractable. What’s more, they suggest that closing gaps in how physicians communicate treatment options to Black and White patients and prioritizing personalized advocacy can go a long way toward eliminating differences in healthcare along racial lines and improving healthcare for everyone.
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