Influence of socioeconomic factors on patient-reported provider communication among patients with cancer.

Abstract

12091 Background: Patient-provider communication is central to patient’s understanding and overall experience, particularly in multi-disciplinary cancer care. Socioeconomic disadvantages may amplify downstream consequences of poor communication by eroding trust and exacerbating structural and access-related barriers. Using nationally representative survey data, we examined the association between socioeconomic factors and patient-reported communication experiences among adult cancer survivors. Methods: We analyzed pooled 2011-2023 data from the US Medical Expenditure Panel Survey (MEPS) to identify adults (≥18 years) with a history of cancer. Patient-provider communication was assessed by how often providers (1) treated patients with respect, (2) listened carefully, (3) explained things in a way they understood, and (4) spent enough time. Survey-weighted estimates compared communication scores across income and insurance groups. Multivariable ordinal logistic regression (MVA) models including survey year, race/ethnicity, education, region, sex, marital status and age estimated adjusted odds ratios (aORs) for the association of income level and insurance with patient-provider communication. Results: Among 9,535 cancer survivors, those in the lowest income quintile (family income < federal poverty line (FPL)) reported the lowest rates of effective provider communication across all domains (57% listened, 53% time, 61% respect, and 57% explained). Survivors who reported being uninsured similarly reported the lowest rates of provider communication (50% listened, 43% time, 49% respect, and 51% explained). In adjusted analyses, lowest-income survivors were less likely than the highest income quintile survivors ( > 4×FPL) to report being listened to (aOR 0.76, 95% CI 0.63–0.91), respected (aOR 0.76, 95% CI 0.63–0.93), or receiving clear explanations (aOR 0.75, 95% CI 0.63–0.91). Compared with privately insured patients, uninsured survivors were less likely to report clear explanations (aOR 0.57, 95% CI 0.39–0.85), or feeling listened to (aOR 0.56, 95% CI 0.38–0.82). Both uninsured and Medicaid-insured survivors were less likely to report adequate time (uninsured: aOR 0.54, 95% CI 0.36–0.82; Medicaid: aOR 0.89, 95% CI 0.79–0.99), or feeling respected (uninsured: aOR 0.51, 95% CI 0.35–0.73; Medicaid: aOR 0.86, 95% CI 0.76–0.98). Conclusions: Lower income and lack of insurance were associated with worse communication among US cancer survivors. Given substantial financial, logistical, and personal burdens of cancer care, these communication gaps may weaken trust and undermine patients’ ability to understand and engage with recommended treatments. Targeted provider interventions aimed at improving clinician communication and care coordination will be essential to advancing equitable cancer care and rebuilding trust in an increasingly fractured healthcare system.