Psychological Safety in the Medical Care of Black Breast and Ovarian Cancer Patients and Families.

Background: Psychological safety is critical to early and continued engagement with healthcare providers, yet no studies have explored this concept in relationship to cancer care. Black/African American ("Black") individuals experience disparities in breast and ovarian cancer beyond what can be explained biologically.

Aims: We explored factors influencing psychological safety among Black breast and ovarian cancer patients and their family members.

Methods: Socioeconomically diverse patients with a personal diagnosis or family history of breast and/or ovarian cancer were invited to complete a semi-structured qualitative interview on their cancer and healthcare experiences between September 2020 and April 2021. Informed by principles of grounded theory, interview transcripts were qualitatively analyzed for thematic content related to psychological safety.

Results: Black breast and ovarian cancer patients and their family members described personal and community experiences and structural components of the healthcare system that suggested they may receive differential cancer care due to their race, placing them on guard. This posture was mediated by several self-identified factors that added to or detracted from their comfort, including provider racial and gender concordance in healthcare, personalized care, and effective communication. The priorities and perceptions of care in participants receiving care in safety net clinics were more focused on what was feasible given resource limitations rather than what was ideally desired.

Conclusions: Implementation of strategies to promote psychological safety with Black cancer patients may foster improved patient experiences, as well as encourage early screening, patient engagement, and treatment continuation.