Perceived discrimination, trust in physicians, and prolonged symptom duration before ovarian cancer diagnosis in the African American Cancer Epidemiology Study

Megan A. Mullins, Lauren C. Peres, Anthony J. Alberg, Elisa V. Bandera, Jill S. Barnholtz-Sloan, Melissa L. Bondy, Ellen Funkhouser, Patricia G. Moorman, Edward S. Peters, Paul Terry, Ann G. Schwartz, Andrew B. Lawson, Joellen M. Schildkraut, Michele L. Cote

Research output: Contribution to journalArticle

Abstract

Background: Discrimination and trust are known barriers to accessing health care. Despite well-documented racial disparities in the ovarian cancer care continuum, the role of these barriers has not been examined. This study evaluated the association of everyday discrimination and trust in physicians with a prolonged interval between symptom onset and ovarian cancer diagnosis (hereafter referred to as prolonged symptom duration). Methods: Subjects included cases enrolled in the African American Cancer Epidemiology Study, a multisite case-control study of epithelial ovarian cancer among black women. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for associations of everyday discrimination and trust in physicians with a prolonged symptom duration (1 or more symptoms lasting longer than the median symptom-specific duration), and it controlled for access-to-care covariates and potential confounders. Results: Among the 486 cases in this analysis, 302 women had prolonged symptom duration. In the fully adjusted model, a 1-unit increase in the frequency of everyday discrimination increased the odds of prolonged symptom duration 74% (OR, 1.74; 95% CI, 1.22-2.49), but trust in physicians was not associated with prolonged symptom duration (OR, 0.86; 95% CI, 0.66-1.11). Conclusions: Perceived everyday discrimination was associated with prolonged symptom duration, whereas more commonly evaluated determinants of access to care and trust in physicians were not. These results suggest that more research on the effects of interpersonal barriers affecting ovarian cancer care is warranted.

Original languageEnglish (US)
JournalCancer
DOIs
StateAccepted/In press - Jan 1 2019

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African Americans
Ovarian Neoplasms
Epidemiology
Physicians
Odds Ratio
Confidence Intervals
Neoplasms
Continuity of Patient Care
Case-Control Studies
Logistic Models
Delivery of Health Care
Research

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Mullins, M. A., Peres, L. C., Alberg, A. J., Bandera, E. V., Barnholtz-Sloan, J. S., Bondy, M. L., ... Cote, M. L. (Accepted/In press). Perceived discrimination, trust in physicians, and prolonged symptom duration before ovarian cancer diagnosis in the African American Cancer Epidemiology Study. Cancer. https://doi.org/10.1002/cncr.32451

Perceived discrimination, trust in physicians, and prolonged symptom duration before ovarian cancer diagnosis in the African American Cancer Epidemiology Study. / Mullins, Megan A.; Peres, Lauren C.; Alberg, Anthony J.; Bandera, Elisa V.; Barnholtz-Sloan, Jill S.; Bondy, Melissa L.; Funkhouser, Ellen; Moorman, Patricia G.; Peters, Edward S.; Terry, Paul; Schwartz, Ann G.; Lawson, Andrew B.; Schildkraut, Joellen M.; Cote, Michele L.

In: Cancer, 01.01.2019.

Research output: Contribution to journalArticle

Mullins, MA, Peres, LC, Alberg, AJ, Bandera, EV, Barnholtz-Sloan, JS, Bondy, ML, Funkhouser, E, Moorman, PG, Peters, ES, Terry, P, Schwartz, AG, Lawson, AB, Schildkraut, JM & Cote, ML 2019, 'Perceived discrimination, trust in physicians, and prolonged symptom duration before ovarian cancer diagnosis in the African American Cancer Epidemiology Study', Cancer. https://doi.org/10.1002/cncr.32451
Mullins, Megan A. ; Peres, Lauren C. ; Alberg, Anthony J. ; Bandera, Elisa V. ; Barnholtz-Sloan, Jill S. ; Bondy, Melissa L. ; Funkhouser, Ellen ; Moorman, Patricia G. ; Peters, Edward S. ; Terry, Paul ; Schwartz, Ann G. ; Lawson, Andrew B. ; Schildkraut, Joellen M. ; Cote, Michele L. / Perceived discrimination, trust in physicians, and prolonged symptom duration before ovarian cancer diagnosis in the African American Cancer Epidemiology Study. In: Cancer. 2019.
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abstract = "Background: Discrimination and trust are known barriers to accessing health care. Despite well-documented racial disparities in the ovarian cancer care continuum, the role of these barriers has not been examined. This study evaluated the association of everyday discrimination and trust in physicians with a prolonged interval between symptom onset and ovarian cancer diagnosis (hereafter referred to as prolonged symptom duration). Methods: Subjects included cases enrolled in the African American Cancer Epidemiology Study, a multisite case-control study of epithelial ovarian cancer among black women. Logistic regression was used to calculate odds ratios (ORs) and 95{\%} confidence intervals (CIs) for associations of everyday discrimination and trust in physicians with a prolonged symptom duration (1 or more symptoms lasting longer than the median symptom-specific duration), and it controlled for access-to-care covariates and potential confounders. Results: Among the 486 cases in this analysis, 302 women had prolonged symptom duration. In the fully adjusted model, a 1-unit increase in the frequency of everyday discrimination increased the odds of prolonged symptom duration 74{\%} (OR, 1.74; 95{\%} CI, 1.22-2.49), but trust in physicians was not associated with prolonged symptom duration (OR, 0.86; 95{\%} CI, 0.66-1.11). Conclusions: Perceived everyday discrimination was associated with prolonged symptom duration, whereas more commonly evaluated determinants of access to care and trust in physicians were not. These results suggest that more research on the effects of interpersonal barriers affecting ovarian cancer care is warranted.",
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AU - Mullins, Megan A.

AU - Peres, Lauren C.

AU - Alberg, Anthony J.

AU - Bandera, Elisa V.

AU - Barnholtz-Sloan, Jill S.

AU - Bondy, Melissa L.

AU - Funkhouser, Ellen

AU - Moorman, Patricia G.

AU - Peters, Edward S.

AU - Terry, Paul

AU - Schwartz, Ann G.

AU - Lawson, Andrew B.

AU - Schildkraut, Joellen M.

AU - Cote, Michele L.

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N2 - Background: Discrimination and trust are known barriers to accessing health care. Despite well-documented racial disparities in the ovarian cancer care continuum, the role of these barriers has not been examined. This study evaluated the association of everyday discrimination and trust in physicians with a prolonged interval between symptom onset and ovarian cancer diagnosis (hereafter referred to as prolonged symptom duration). Methods: Subjects included cases enrolled in the African American Cancer Epidemiology Study, a multisite case-control study of epithelial ovarian cancer among black women. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for associations of everyday discrimination and trust in physicians with a prolonged symptom duration (1 or more symptoms lasting longer than the median symptom-specific duration), and it controlled for access-to-care covariates and potential confounders. Results: Among the 486 cases in this analysis, 302 women had prolonged symptom duration. In the fully adjusted model, a 1-unit increase in the frequency of everyday discrimination increased the odds of prolonged symptom duration 74% (OR, 1.74; 95% CI, 1.22-2.49), but trust in physicians was not associated with prolonged symptom duration (OR, 0.86; 95% CI, 0.66-1.11). Conclusions: Perceived everyday discrimination was associated with prolonged symptom duration, whereas more commonly evaluated determinants of access to care and trust in physicians were not. These results suggest that more research on the effects of interpersonal barriers affecting ovarian cancer care is warranted.

AB - Background: Discrimination and trust are known barriers to accessing health care. Despite well-documented racial disparities in the ovarian cancer care continuum, the role of these barriers has not been examined. This study evaluated the association of everyday discrimination and trust in physicians with a prolonged interval between symptom onset and ovarian cancer diagnosis (hereafter referred to as prolonged symptom duration). Methods: Subjects included cases enrolled in the African American Cancer Epidemiology Study, a multisite case-control study of epithelial ovarian cancer among black women. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for associations of everyday discrimination and trust in physicians with a prolonged symptom duration (1 or more symptoms lasting longer than the median symptom-specific duration), and it controlled for access-to-care covariates and potential confounders. Results: Among the 486 cases in this analysis, 302 women had prolonged symptom duration. In the fully adjusted model, a 1-unit increase in the frequency of everyday discrimination increased the odds of prolonged symptom duration 74% (OR, 1.74; 95% CI, 1.22-2.49), but trust in physicians was not associated with prolonged symptom duration (OR, 0.86; 95% CI, 0.66-1.11). Conclusions: Perceived everyday discrimination was associated with prolonged symptom duration, whereas more commonly evaluated determinants of access to care and trust in physicians were not. These results suggest that more research on the effects of interpersonal barriers affecting ovarian cancer care is warranted.

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