Demographic and clinical characteristics of the cohort are listed by type of cancer in . A substantially larger proportion of surveys were completed by surrogates of deceased patients for those with lung cancer than with colorectal cancer (31.5% v 8.3%, respectively), reflecting the greater proportion of patients with lung cancer who had stage IV disease at diagnosis (41.1% v 18.5%, respectively). For each cancer, one third of black patients were from Alabama, and approximately 90% of Hispanic and Asian/Pacific Islander patients were from the two areas in California (data not shown).
Demographic and Clinical Characteristics of Study Cohort
Mean scores for physician communication, nursing care, and coordination and responsiveness of care ranged from 84 to 90 on these 100-point scales. For lung cancer, the mean scores were 85.4 (standard deviation [SD], 20.1), 89.9 (SD, 19.4), and 84.4 (SD, 19.5), respectively, and for colorectal cancer, they were 88.4 (SD, 17.6), 89.5 (SD, 18.9), and 87.9 (SD, 16.7), respectively. In unadjusted analyses, white (mean scores, 85 and 89 for lung and colorectal cancer, respectively) and black patients (means scores, 85 and 89, respectively) reported the most positive experiences with coordination and responsiveness of care, whereas Hispanic (mean scores, 81 and 84, respectively) and English-speaking Asian/Pacific Islander patients (mean scores, 79 and 87, respectively) reported somewhat worse experiences in this domain, and Chinese-speaking patients (mean scores, 67 and 73 respectively) reported much worse experiences. Similar patterns were evident in experiences with physician communication and nursing care (data not shown). Relative to white and black patients, Chinese-speaking patients reported experiences that were approximately 20 points lower for physician communication and 10 points lower for nursing care.
In adjusted analyses of both cancers, the most negative experiences in all domains of interpersonal care were reported for Chinese-speaking patients and patients in fair or poor health or who had died within 4 months of diagnosis (). Their scores were 4 to 22 points lower than white patients or those in excellent health, respectively. For both cancers, patients in Los Angeles County reported 4- to 7-point lower adjusted scores than patients in the Cancer Research Network, and patients with depression also reported scores that were significantly lower than other patients. In contrast, adjusted experiences with interpersonal care did not differ consistently by age, sex, black race, Hispanic ethnicity, education, income, marital status, or other comorbid conditions. In secondary analyses of patients' experiences with care, patients who received chemotherapy for lung cancer or colorectal cancer reported significantly better adjusted experiences with physician communication, nursing care, and coordination and responsiveness of care (all P < .001) of approximately 4 to 6 points on these 100-point scales.
Adjusted Differences in Experiences With Care by Patient Demographic and Clinical Characteristics
Excellent overall ratings of cancer care were reported for 44.4% of patients with lung cancer and 53.0% of patients with colorectal cancer (). Lower proportions of patients with lung and colorectal cancer rated their care as very good (30.7% and 29.6%, respectively), good (15.5% and 12.3%, respectively), fair (5.8% and 3.7%, respectively), or poor (3.6% and 1.6%, respectively). For both cancers, excellent ratings of care were substantially less common among surrogates of living patients, nonwhite patients, Chinese-speaking patients, patients with low incomes or less education, unmarried patients, patients in less than excellent health, patients with stage IV cancers, and patients with a history of depression.
Unadjusted Proportion of Patients Rating Care As Excellent by Demographic and Clinical Variables
After multivariate adjustment (), excellent ratings of care remained significantly less common for both cancers among black patients, English- or Chinese-speaking Asian patients, and patients in less than excellent health (all P < .05). For lung cancer, excellent adjusted ratings of care were also significantly less common among patients younger than age 55 years and patients with depression. For colorectal cancer, excellent ratings of care were significantly more common in patients younger than age 65 years, patients in North Carolina, and patients with diabetes, and such ratings were less common among English-speaking Hispanic patients, lower income patients, and patients in Los Angeles County.
Adjusted Odds Ratios for Excellent Care Ratings by Patient Demographics and Clinical Characteristics
In secondary analyses with treatment indicators added to these models, care was rated as excellent more commonly among patients with colorectal cancer who received chemotherapy (adjusted odds ratio [OR], 1.49; 95% CI, 1.20 to 1.85), but no other treatments were significantly associated with ratings of care (data not shown). In secondary adjusted analyses predicting excellent or very good ratings of care, these ratings were less common among black patients (P < .02) and Chinese-speaking Asian patients (P < .001) for both cancers and among patients with annual incomes less than $40,000 for colorectal cancer (P < .05). These ratings were also less common for both cancers for patients in less than very good health (all P < .05).
Patients' experiences in the three domains of physician communication, nursing care, and coordination and responsiveness of care were significantly correlated with ratings of the quality of care for lung cancer (Spearman rank correlation coefficients of 0.41, 0.29, and 0.49, respectively) and for colorectal cancer (Spearman rank correlation coefficients of 0.39, 0.28, and 0.42, respectively; all P < .001). After adjustment for demographic and clinical factors, a 10-point improvement (SD, 0.5 to 0.6) in patients' experiences with coordination and responsiveness of care was associated with a substantially greater likelihood of rating their cancer care as excellent overall for both lung cancer and colorectal cancer (adjusted OR, 1.83 for lung cancer and 1.63 for colorectal cancer; both P < .001). The likelihood of patients rating their cancer care as excellent was significantly but less strongly associated with 10-point improvements in experiences with physician communication (adjusted OR, 1.24 and 1.26 for lung and colorectal cancer, respectively) and nursing care (adjusted OR, 1.12 and 1.18 for lung and colorectal cancer respectively; all P ≤ .001). However, adding these three scales to the adjusted analyses of overall ratings of care accounted for only a small proportion of the significant differences by race, language, and health status (data not shown).