C. Zhao2, P. Dowzicky1,2, L. Colbert-Mack1, S. Roberts1,2, R. R. Kelz1,2 1Hospital Of The University Of Pennsylvania,Department Of Surgery,Philadelphia, PA, USA 2Hospital Of The University Of Pennsylvania,Center For Surgery And Health Economics,Philadelphia, PA, USA
Introduction: A recent summit on surgical disparities established the importance of the patient-provider relationship as a target to address surgical disparities. However, there is no consensus on whether patient-provider race, gender, and language concordance provides benefits to surgical patients. In this systematic review, we report the association between patient-provider concordance and patient preferences and outcomes in Surgery.
Methods: We performed a systematic review of the literature with defined search terms using Medline and PubMed to identify studies related to patient-provider concordance in surgical patients. We included studies published in English in the United States between 1998 and July, 2018. The number of studies associated with each outcome is reported below. Using the Oxford Centre for Evidence-Based Medicine guidelines, four members of a multi-disciplinary team assigned a level of evidence (1Best – 5Worst) to each study.
Results: Out of 253 titles screened, sixteen studies met inclusion criteria. Six discussed race-concordance, eleven discussed gender-concordance, and three discussed language-concordance. (Some examined multiple concordance types.) The studies included 12,614 patients (Mean 788; Range 18-4,157). The studies were performed in several specialties: surgical oncology (n=6) including two in plastic surgery, obstetrics and gynecology (n=3), cardiothoracic surgery (n=2), and other (n=5). Outcomes examined included patient preferences (n=6), patient adherence to physician recommendations (n=3), quality of care (n=5), effectiveness of communication (n=2) and decision-making regarding the patients’ willingness to undergo an elective operation (n=1). Five studies were rated as having level 4 evidence, with the remaining 11 studies rated as having level 3 evidence. In two out of six relevant studies, patients preferred providers with a similar background. Patients infrequently expressed a preference for provider concordance (n=2/6). Race, gender, and language-concordance had no effect on adherence to provider recommendations (n=3/3). No effect of race concordance on the quality of care was seen (n=2/3). Gender concordance was associated with improved quality of care (n=2/3). There were mixed effects of concordance on the effectiveness of communication (n=2). Patients treated by gender concordant physicians were more likely to undergo elective breast reconstruction (n=1).
Conclusions: Overall the number of studies examining patient-provider concordance and patient outcomes was small and the level of evidence modest. Most patients prioritize culturally, technically, and clinically competent providers over race, gender, and language concordance. Interventions to ameliorate surgical disparities should focus on giving physicians the training to provide an accommodating demeanor when working with vulnerable patients.