Oncologists Overlook Older African American Men's Psychosocial Needs after a New Cancer Diagnosis

Background and Purpose: African American men (AAM) experience significant disparities in the detection, treatment, and survival of certain cancers when compared to white men. Patients facing a new cancer diagnosis may be at risk for psychological distress, and the psychosocial concerns of AAM with cancer have been understudied. The purpose of this study was to investigate the extent to which psychosocial issues were addressed during initial consultations between oncologists and older AAM cancer patients.

Methods: We analyzed 30 video-recorded oncology interactions depicting 30 older AAM and 19 oncologists at a comprehensive cancer center serving a diverse urban patient population. Video-recorded interactions captured the first consultation after an initial cancer diagnosis or new cancer recurrence (metastases in a new area of the body).  Each video was sliced into three five-minute segments representing the beginning, middle, and end of the physician’s contact with the AAM patient. A coding framework was adapted from Communication Accommodation Theory to identify and score 16 verbal behaviors for physicians (i.e. asking questions, using personal disclosure). The Medical Interaction Processing System was adapted to identify 7 nonverbal behaviors for AAM and physicians (i.e. assertiveness, eye contact); along with three global measures of the medical interaction (i.e. patient-centeredness, patient-directedness, and psychosocial focus). An operational definition and behavioral anchor was developed for each item; three coders established reliability over several weeks of training and met for consensus-checking regularly. The current analysis centered on the psychosocial focus of the overall interaction; defined as any verbal discussion pertaining to coping or adjustment, obtaining support from family, friends, religious or other communities; or addressing stress or mental health concerns. Psychosocial focus was rated on a scale ranging from 1 (not psychosocially focused) to 4 (very psychosocially focused) based on the frequency and breadth of psychosocial topics discussed during each video segment.

Results: The mean age of participants was 60.83 years; 56.6% were married, 47.5% had some college education or more and 40% had a household income under $20,000. Just 5% of oncologists were African American (n=1) or women (n=1).  Psychosocial topics were discussed by two different oncologists in 10% of interactions (n=3); the mean global rating score across all interactions for psychosocial focus was 1 (not psychosocially focused). We documented that most oncologists did not inquire about psychological coping or adjustment to a new cancer diagnosis, assess patient need for psychosocial services, or probe AAM for information about family or community support Patient-physician communication focused primarily on medical history taking, treatment planning, and symptom management.

Conclusions and Implications: Findings indicate that psychosocial needs for this sample of older AAM were not assessed or addressed during the initial consultation for a new cancer diagnosis. Oncologists may assume that psychosocial needs are outside of their purview and should be addressed by other members of the health care team. Distress screening is a newer requirement for comprehensive cancer center accreditation and future research should investigate whether older AAM are experiencing a gap in psychosocial cancer care specific to clinical communication with their oncologists.