Explaining gaps in guideline-concordant endometrial cancer treatment among Black women: Insights from patient interviews

• In Event: Medical Sociology Section Roundtables
  In Refereed Roundtable (90 minute): Table 9. Racialized Experiences of Health and Healthcare

Abstract

Black patients with endometrial cancer are less likely to receive guideline-concordant treatment than White women, and Black women’s survival outcomes are worse. The existing literature has not yet illuminated the reasons for treatment disparities, which may stem from interpersonal, social, structural, and/or healthcare dynamics. To fill this gap and set the stage for interventions to improve receipt of guideline-concordant treatment among Black women, we have been engaged in mixed-method studies guided by the multi-level National Institute of Minority Health and Health Disparities (NIMHD) Research Framework. Here, we report the results of a qualitative study of the treatment experiences of Black patients diagnosed with endometrial cancer. Our findings suggest that receipt of non-concordant treatment cannot be understood solely as an individual-level decision or as a simple failure of access. Rather, women’s stories point to cumulative processes that unfold across the diagnostic and treatment continuum. These processes include delays or ambiguities in symptom recognition and referral, uneven communication about treatment options and opportunities for patients to engage in shared decision making, and differential trust or mistrust shaped by prior experiences with healthcare institutions. Structural factors, including insurance instability, employment precarity, transportation burdens, familial responsibilities, and geographic access to gynecologic oncology specialists, appear to interact with clinical recommendations in ways that may limit the feasibility of completing multi-modality or time-sensitive treatments. Women’s narratives suggest that treatment gaps may emerge through subtle processes: differential framing of risk, the cumulative burden of navigating fragmented systems, and the operationalization of shared decision making in social and cultural context.

Authors

• Tasleem Juana Padamsee, The Ohio State University

• Courtni Montgomery

• Eoghan Quinn Victory, The Ohio State University

• Caitlin Meade, Wake Forest School of Medicine

• Kemi M. Doll, University of Washington

• Ashley S. Felix, Wake Forest University School of Medicine