"A lot of the times, patients really don't know what questions to ask:" Communication perspectives of Black patients with advanced lung cancer

Abstract

Objectives: Patients with advanced (stage III-IV) lung cancer carry a significant symptom burden, and Black (i.e., the broad African diaspora) patients generally experience worse symptom management relative to White patients. Clinician-patient communication is one understudied factor that can contribute to symptom management inequities. However, Black patients' experiences discussing symptoms with their oncology clinicians are understudied. This secondary analysis sought to explore Black patients' experiences with symptom management communication, and identify areas of improvement.

Methods: We conducted semi-structured interviews with Black patients with advanced lung cancer (n = 26; 62% women; Age M = 65.0; M = 16.6 months post-diagnosis) in two thoracic oncology clinics in the Mid-Atlantic. Interviews were recorded, transcribed, and analyzed via inductive coding to identify themes relevant to clinician-patient communication.

Results: Participants expressed both positive and negative communication experiences throughout their cancer journey, including situations where their racial identity impacted comfort with communication. Positive (e.g., timely responses) and negative (e.g., confusion about side effects) experiences with care shaped communication dynamics. Communication barriers included disclosure hesitancy, not knowing what questions to ask, and feeling unheard. Participants highlighted that patient behaviors (self-advocacy), clinician behaviors (honest and transparency), and the presence of support people helped promote communication. Suggested strategies for improvement included facilitating communication through informational resources and clinician training to provide culturally competent communication in cancer care.

Conclusions: Communication plays a key role in symptom management for Black patients with advanced lung cancer, and is influenced by both patient and clinician factors, as well as the larger historical context of racism in medicine. Future work should further examine multilevel drivers of communication for intervention.

Practice implications: To enhance symptom communication with Black patients with advanced lung cancer, there is a need for clinician training focused on cultural humility and awareness, and for patient informational resources.

Keywords: Black patients with cancer; Communication; Health equity; Lung cancer.