Sign up now to receive e-mail notification of each online issue
Inside research
Health disparities in cancer care
Examining delays and disparities in colon cancer diagnosis
Trained actors will help determine if doctors respond differently based on race and gender
A nationally recognized expert on health communication and decision-making in disease treatment, Laura A. Siminoff, Ph.D., associate director of the Cancer Prevention and Control Program at Virginia Commonwealth University Massey Cancer Center, and colleagues are gaining insight as to how social, cultural and behavioral factors affect public health.
Siminoff and her team focus on educating the public to make lifestyle and other changes to improve the standard of health, with an emphasis on cancer, chronic disease and health care disparities among various populations.
This fall, Siminoff was awarded two grants from the National Cancer Institute totaling more than $4.25 million to conduct two studies to examine delays and disparities in colon cancer diagnosis.
“African-Americans get more colon cancer and die from it more often than their white counterparts. If we can gain a better understanding of how physicians respond to patients who may have colon cancer, as well as how patients respond to their own symptoms, we may be able to develop programs and tools that will lead to earlier diagnosis, which could help to reduce mortality rates from this disease,” said Siminoff, who is chair of the VCU School of Medicine’s Department of Social and Behavioral Health.
The first study will focus on appraisal delays and disparities in timely colon cancer diagnosis. “Appraisal delay” describes patients with difficulty identifying and interpreting their symptoms, which can impede their reporting of symptoms to health care providers.
The study will examine whether appraisal delay is more prevalent in African-American cancer patients. Researchers will interview recently diagnosed patients to identify how patients interpreted their symptoms and acted on them. The study will use cognitive interviewing, the administration of standardized instruments and chart reviews to obtain data. The NCI will support the study with $1.4 million over three years.
The second study will test whether or not primary care physicians (PCPs) communicate with patients differently depending on race and gender. It uses an innovative method with trained actors to simulate four patients — an African-American man and woman and a Caucasian man and woman — who will visit 110 PCPs unannounced and present pre-diagnosis symptoms of colon cancer. The researchers will compare the communication patterns and subsequent patient management decisions made by the physicians to see if there are any patterns of diagnostic delays (inactions or incorrect actions) to make a diagnosis.
“As in real life, each patient will have a story and a set of symptoms,” Siminoff said. “We’ll be focused on how the doctors communicate with them and what they recommend as next steps for the patients. As we examine the data, we will look for any patterns that show whether patients were treated differently based on their race or gender.”
The study’s design, training, implementation and data analysis is expected to take five years.
Putting the safety net system for the uninsured under the microscope
Cathy J. Bradley, Ph.D., a health economist at Massey, is conducting research on disparities in cancer diagnoses, treatment and cost based on insurance coverage in Virginia.
Bradley’s study is the result of the Institute of Medicine’s report “Insuring America’s Health: Principles and Recommendations,” which highlighted the sub-par health care of the approximately 43 million uninsured persons in the U.S. and called for a universal health insurance program. Currently, the U.S. relies on a safety net system to treat uninsured patients, including patients with chronic, life-threatening and costly diseases like cancer.
Bradley’s project, supported by a grant from the American Cancer Society, will use patient data to analyze the performance of the safety net system in caring for individuals with cancer. The analysis is expected to help Virginia policy makers make informed decisions aimed toward covering the uninsured. The commonwealth has nearly 1 million uninsured residents with the highest percentage concentrated in Central Virginia.
“In the absence of specific knowledge on the performance of Virginia’s safety net system, policy makers may attribute differences between the uninsured and insured to mean that an expansion of the safety net, instead of comprehensive coverage, can ameliorate differences,” said Bradley.
“Our analysis will allow us to make significant strides toward expanding and refining the role that health insurance plays in cancer diagnosis and treatment and the cost resulting from the absence of health insurance,” she said.
The study’s primary goals are twofold:
- To compare inpatient cancer treatment and survival in uninsured patients to that of insured patients in safety net providers versus other types of providers
- To compare treatment and survival of uninsured and insured cancer patients within the safety net provider system
“By taking a comprehensive look at patient data, we will be able to thoroughly describe treatment experiences by health insurance status and test a number of hypotheses that will broaden understanding of the performance of the safety net,” said Bradley, whose research as a health economist has received international attention.
“The health insurance crisis in the U.S. is a critical issue and the focus of a lot of national debate,” said Gordon Ginder, M.D., director of Massey. “I have no doubt that the results of Bradley’s research will be instrumental in shaping much-needed policy decisions in Virginia and across the nation.”
The VCU Medical Center is one of the largest safety net providers in Virginia and, as part of the center, Massey is the safety net provider for many uninsured patients with cancer. Bradley will use data from administrative claims, along with data from the Virginia Health Information state discharge database and the Virginia Cancer Registry, to conduct the study.