Tag Archive for: structural racism

Eliminating Disparities in Breast Cancer | Tips for Navigating Inequities

Eliminating Disparities in Breast Cancer: Tips for Navigating Inequities from Patient Empowerment Network on Vimeo

How can breast cancer patients and healthcare providers advocate for underrepresented  patients? Expert Dr. Demetria Smith-Graziani discusses how some providers are working to reduce care disparities and shares patient advice to help ensure optimal care.

Demetria Smith-Graziani, MD, MPH is an Assistant Professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. Learn more about Dr. Smith-Graziani.


“…get your list of questions together about your concerns about your diagnosis and your treatment, and if you are feeling like you’re not heard, look for other doctors to talk to to get a second opinion.”

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Lisa Hatfield:

What are some of the actions being taken to combat or eliminate disparities in breast cancer? How can those in marginalized communities best advocate for themselves?

Dr. Demetria Smith-Graziani:

That’s a great question, and I want to start by saying that the true burden should be on healthcare providers of those within the healthcare system to reduce and eliminate disparities in breast cancer, because patients already have enough to deal with and are receiving discrimination and structural racism from society at large and within the healthcare system. So for providers, it’s important for us to really take a good hard look at our practices with patients, think about the way that we are relating to patients, are we making any assumptions about treatments our patients may or may not want, or may or may not be a candidate for. Are we making those assumptions based on something not related to factual data, like their breast cancer itself or other health problems they have, are we making those assumptions based on their insurance status, based on where they live, based on other social factors like race.

It’s important for us to really reflect on that and think about how we can be more equitable in the way that we deliver our care. It’s also important for us to advocate for our patients to make sure that they are receiving the treatment that they need, and sometimes that means advocating to their insurance company, advocating to our health system, our health care employers advocating to the government to make sure that our patients are all receiving high-quality care no matter where they are, and no matter who they are, now, knowing that we live in this unjust society, what can patients do to navigate these disparities and these inequities.

I think it’s important for patients to be as informed as possible to make sure that they are getting all of their questions answered by their doctor, and if you don’t feel like your questions are getting answered, if you don’t feel like your concerns are being appropriately addressed or acknowledged, please make sure that you get a second or a third opinion and talk to another doctor to see if they can answer your questions.

No oncologist is going to be upset with you getting more information from another oncologist about your treatment options, and it’s important for you to pick the doctor that you are comfortable with, that you have a good relationship with and that you feel like you can speak to honestly, and that will give you honest answers, so my activation tip for patients is to get your list of questions together about your concerns about your diagnosis and your treatment, and if you are feeling like you’re not heard, look for other doctors to talk to to get a second opinion. 

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What Is the Importance of Culturally Competent Care?

What Is the Importance of Culturally Competent Care? from Patient Empowerment Network on Vimeo.

Culturally competent care is another way to work toward health equity. Dr. Nicole Rochester and Aswita Tan-McGrory discuss barriers to providing culturally competent care and ways to address the issues.

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How Does Stress Correlate to Our Physical Ailments?


Dr. Nicole Rochester:

We know that due to structural racism, due to inequities, not everybody has access to fresh fruits and vegetables, healthy foods, not everyone has access to green spaces, nice parks where they can go outside and have safety and exercise, and that’s something that we’re being made increasingly aware of is how these social determinants of health impact healthcare. So I want to move and start to talk about the importance of culturally competent care, or I like to call it cultural humility, I don’t know that we can really ever be competent in someone else’s culture. But I want to talk about how those come together, this idea of being respectful and sensitive and aware of an individual’s culture and how that connects to some of the health inequities that we experience. So, Aswita, I know this is an area of expertise for you, so I’d love for you to chime in.

Aswita Tan-McGrory, MBA, MSPH:

Yeah, I mean, I would love it if every physician or nurse or PA started the conversation, what has been the biggest challenge for you in the last six months? If you ask that question, I mean, well the patient will be like, “Oh my God.” And not around just medical issues, they all align, right? If you don’t have housing, you’re going to have medical stress, like Broderick said. I’m just calm listening to you, so I’m going to guess that you have is really positive vibe that’s probably missing for many of us because we aren’t practicing the things that you encourage. And so I would just say that it’s really difficult in the system like I said, we set up, and we mentioned 15 minutes, doctors don’t feel like they have time to ask that question, but you’re doing it in other ways, we implement social determinants of health screening. Well, that’s really that question, right? But you formalize it because it’s not happening, so now it becomes like a screening question. And I will just say that we’re very narrow-minded in our view. I think I have seen a change in the very beginning when we started the work in our center in 2006, a lot of pushback was around thinking about what happens in the patient outside of our walls. It said,  “Well, I didn’t go to medical school to solve the problem of housing, I didn’t go to medical school to figure out how to get somebody on benefits.” And I think the healthcare system realized it doesn’t matter what you do in the hospital, it will be undone when they get home to a situation where they can’t maintain it, they can’t provide that support, they don’t…

They’re stressed out, they have mental health issues, so I think they’re finally getting there. But I think just acknowledging that the person in front of you has different experiences based on language, education, gender, ability, sexual orientation…I don’t think that’s a bad thing. I think you just need to own it, we’re working on it. So I do it better than others, but I don’t know any healthcare system, honestly, that’s nailed this to the way that we probably should, so…I’m with you, Broderick. We don’t do this very well, and most of my job includes dismantling these systems that we built to benefit the people in power and leave everybody else behind, and so that’s been really the focus in our work.