How Lack of Access to Prostate Care Determines Outcomes of Underserved Populations

When it comes to medical care, many factors can determine the types of treatment and medications that are available to patients. Often times, populations with less access to adequate care, particularly with regards to specialized treatment for diseases like prostate cancer, may experience poorer outcomes.

"We tend to think of it [access] as varying by different racial groups," says Samuel Washington, MD, second year clinical urologic oncology fellow in the UC San Francisco Department of Urology. "But across all racial lines those who are underserved have different outcomes compared to those who have better access to care. It's about learning how those similarities are affecting broad populations and, in general, how we can optimize outcomes for the underserved."

Though the problem of access is easily recognized, the methods for solving it are complex and less understood. Throughout his residency and fellowship training, Dr. Washington regularly encounters patients who may belong to underserved populations and are hesitant to be their own advocates. "In my own personal experience, [I've dealt] with patients who are concerned that their level of care is not the quality others would receive at different hospitals, or they're afraid to talk to doctors. I know that doctors and urologists try to provide the best care possible, but it's a two-way street. Both of us [patients and doctors] need to work together as a team rather than patients on one side of the line and doctors on the other, working independent from one another."

Yet, the majority of the work that needs to be done to further expand access across all populations rests in the hands of not only individuals, but the health care system. "Everyone tends to focus on what the patient can do to optimize outcomes, but I think we need to change our focus to how we can optimize the system in order to make things better for the patients." As Dr. Washington explains, making a change on the personal level for doctors could be "making sure that I provide the same care across the board, based on guidelines, and provide what I think are best practices." For hospitals and other medical institutions such as UCSF, it's working to change policies, practices, and techniques to better serve broader populations.

One such example is by finding ways to provide access to geographic areas where access to better care is historically limited. "Geography matters – when we're talking about access to care in rural or urban areas and specialized care such as the ability to see a urologist… Even within the Bay Area, [care] may vary dramatically depending on which neighborhood you're in… In our field, we' re working on different ways to provide access to urologic care in different geographic regions – whether it be telemedicine, or increasing efforts to get urologists out to areas that do not have urologists locally."

Overall, says Dr. Washington, a critical step for improving outcomes of prostate cancer treatment and other diseases for underserved populations is through the approach of each practitioner, where individualized care is paramount. "When we're interacting with patients, [we should] tailor care to the patient's specific situation rather than relying on assumptions or schema that we often learn in medical schools. A more personalized approach to providing care for patients from the urologist and provider standpoint would help [improve outcomes] across the board."