Many patients with cancer encounter significant barriers to the receipt of care, according to a recent study published by Chen et al in JAMA Network Open.
Background
When attempting to access cancer care, patients often must go through several different levels of communication both before their initial appointment with a physician and throughout their cancer treatment. The first calls patients make to learn more about available cancer care services or schedule an appointment at a clinic may be critical to initiating cancer treatment.
“Racial and ethnic disparities have been observed in the outpatient visit rates for specialist care, including cancer care. However, we know very little about patients’ experiences at the critical step of attempting to access new clinic appointments for cancer care,” stressed lead study author Debbie Chen, MD, of the University of Michigan.
Study Methods and Results
In the recent study, the researchers simulated 985 patient calls by contacting 479 clinic phone numbers at 143 hospitals across 12 states. They then determined the factors that influenced cancer care accessibility, which was based on whether each caller was provided with a clinic appointment date or scheduling information. The callers used standardized scripts to inquire about a new clinic appointment for colorectal cancer, lung cancer, or thyroid cancer care in one of three languages: English, Spanish, or Mandarin.
The researchers found that only 41.5% of the simulated calls successfully accessed new patient appointments for cancer care. Even among the English-speaking calls, just 61% of them resulted in access to cancer care. Further, about 25% of the calls ended early because of workflow barriers—including calls going to a voicemail that didn’t provide adequate information or callers being on hold for over 30 minutes.
The researchers revealed that despite the poor rate of successful calls among English-speaking callers, access to new patient appointments for cancer care was worse among non-English speaking patients. The simulated Spanish- and Mandarin-speaking callers accessed cancer care in only 36% and 19% of the calls, respectively. Nearly 50% of the calls made in Spanish or Mandarin ended because of language barriers. For instance, some of the simulated callers were hung up on in response to asking: “Speak Spanish?” or “Speak Chinese?” or disconnected when the automated message didn’t provide language-specific instructions but required input to continue. Even after getting connected with interpreter services, some of the callers were unable to receive further assistance.
Conclusions
“Our study highlights existing barriers that patients may encounter when attempting to access a new clinic appointment for cancer care and illustrates how this access point functions as a gatekeeper to cancer care services, with many patient populations—including patients with limited English proficiency—unable to even get in the door to see a physician for their cancer care” Dr. Chen underscored. “Thus, interventions focused on mitigating these barriers are necessary to increase access to cancer care for all patients,” she concluded.
Disclosure: The research in this study was supported by the University of Michigan Rogel Cancer Center, the National Institute of Diabetes and Digestive and Kidney Diseases, and the National Cancer Institute. For full disclosures of the study authors, visit jamanetwork.com.
