Cancer
Perceptions of the health care system as mediators in the association between experiences of discrimination, communication from providers, and gaps in mammography. Hannah Cohen-Cline* Hannah Cohen-Cline Megan Holtorf Monique Gill
Background: Breast cancer is a leading cause of cancer death among women, and early detection is critical for positive outcomes. However, there are well documented disparities in the completion of regular preventive mammography, and understanding what drives gaps in mammography remains a critical area of focus. Negative healthcare experiences contribute to decreased utilization of health services, influence perceptions of the system, and damage relationships between patients and providers, but there is limited knowledge of how they interact with each other to shape use of screening mammography.
Objective: This study aimed to assess if perceptions of the healthcare system mediate the relationships between patient-centered communication and healthcare discrimination and gaps in mammography.
Methods: We fielded a survey about healthcare experiences, healthcare perceptions, and mammogram history to 20,000 female Providence Health System patients aged 50-74 in Oregon and Washington, of whom 7,473 (37.3%) responded. We constructed structural equation models to assess the direct effects of patient-centered communication and healthcare discrimination on mammogram completion, as well as the extent to which each effect was mediated by healthcare perceptions.
Results: Approximately 89% of respondents were current on mammography. Women who reported patient-centered communication were significantly more likely to be current (RR = 1.16; p<0.001), while those who experienced healthcare discrimination were less likely to be current (RR = 0.94; p<0.001). Both effects were partially mediated by perceptions of the healthcare system (28% mediated for patient-centered communication; 19% mediated for healthcare discrimination).
Conclusion: Patient-centered communication, discrimination, and perceptions are key contributors to disparities in mammography, and healthcare systems must take action to ensure that solutions improve access to and quality of care for all.