Survey suggests people with disabilities may feel disrespected by health care providers

Embargoed for release until 5:00 p.m. ET on Monday 3 March 2025   

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.         
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1. Survey suggests people with disabilities may feel disrespected by health care providers

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01964 

URL goes live when the embargo lifts            

An analysis of data from a cross-sectional household survey found that people with disabilities were more likely than those without disabilities to report negative experiences with their health care provider’s “cultural responsiveness,” or the way the provider treated them and engaged them in their care. The findings complement recent evidence of physicians’ harmful perceptions of people with disabilities and underscore the need for future research on how adverse health care experiences affect health outcomes for such patients. The study is published in Annals of Internal Medicine. 

Dr. Mihir Kakara and other researchers from the Penn Medicine Center for Health Equity Advancement studied data from 22,864 adults who participated in the 2017 National Health Interview Survey (NHIS) to compare the perceptions of culturally responsive care among people with and without disabilities and stratified by disability type. Participants had seen a health care provider in the prior year and were asked questions to capture their perceptions of their health care provider’s “cultural competence.” The researchers analyzed responses to 3 of the 4-point Likert scale questions that they dichotomized (“always/most of the time” as positive and “some/none of the time” as negative) to capture patient perceptions of whether health care providers treated them with respect, solicited their opinions and beliefs, and provided easy-to-understand information. Disability status was defined as having a limitation in any activity. 

Overall, people with disabilities reported not receiving culturally responsive care. People with all types of disabilities said they were less likely to receive easily understood information, especially those with vision, hearing or cognitive disabilities. People with nearly all disability types reported feeling like they weren’t treated with respect and participants with psychological, vision, and hearing disabilities were less likely to perceive receiving culturally responsive care across all three questions. According to the authors, the findings also highlighted a need to broaden the concept of culturally responsive care to include disabilities that are not immediately visible. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Jaya Aysola, MD, DTMH, MPH please email Frank Otto at Frank.Otto@pennmedicine.upenn.edu.

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2. Molecular imaging an accurate alternative to adrenal vein sampling for diagnosing unilateral aldosterone-producing adrenal tumors

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-00761

URL goes live when the embargo lifts           

A prospective within-patient comparison was conducted to determine whether the accuracy of postdexamethasone [¹¹C]metomidate ([¹¹C]MTO) positron emission tomography–computed tomography, a molecular imaging diagnostic test for unilateral aldosterone-producing adrenal adenomas (APAs), is superior or noninferior to the accuracy of adrenal vein sampling (AVS) in predicting outcomes from unilateral adrenalectomy. The study found that molecular imaging is an accurate and non-invasive alternative to AVS. The results are published in Annals of Internal Medicine.  

AVS has historically been the primary way of diagnosing unilateral PA, but it is invasive, difficult to perform, and has limited availability. As such, researchers from Queen Mary University of London sought to determine whether a molecular imaging diagnostic test ([¹¹C]MTO) for unilateral PA is comparable to the accuracy of AVS and whether [¹¹C]MTO is interchangeable with its longer-half-life analogue, para-chloro-2-[¹⁸F] fluoroethyletomidate ([¹⁸F]CETO).  They studied data for 169 patients aged 18 and older with primary aldosteronsim (PA) desiring surgery if unilateral PA was diagnosed between December 2016 and December 2022. The order of AVS or molecular imaging was determined by minimization. AVS was performed by one of three established radiologists and all molecular imaging scans were analyzed by a single radiologist who was blinded to the AVS result. AVS lateralization indices of less than three, three to four and greater than four were considered to indicate low, intermediate, and high probability, respectively, of unilateral PA. There were three requirements to determine high probability of unilateral PA from molecular imaging: 1) a focal adrenal nodule with characteristics of a benign adrenocortical adenoma, 2) uptake of [¹¹C]MTO into this nodule, and 3) a ratio of tumor maximum standardized uptake values (SUVmax) to contralateral gland SUVmax of more than 1.25. A multidisciplinary team reviewed and scored AVS and molecular imaging results. 31 participants underwent both [¹¹C]MTO and [¹⁸F]CETO to determine if they are interchangeable procedures. The primary end point was the accuracy of [¹¹C]MTO and AVS at predicting biochemical and clinical outcomes six months after surgery in patients considered to have a high probability of unilateral PA. 

The researchers found [¹¹C]MTO graded 89 of 169 (52.7%) participants as having high probability of unilateral PA compared with 78 of 169 (46.2%) participants graded as having high probability via AVS. 93 of these participants reached the primary outcome time duration of six months after surgery, and 92.3% of these participants achieved complete or partial biochemical success. They also found there was a high degree of agreement in the prediction of unilateral PA between [¹¹C]MTO and [¹⁸F]CETO. The results suggest that [¹¹C]MTO is noninferior to AVS in diagnosing unilateral PA, providing clinicians a potential non-invasive, operator independent alternative to AVS.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Morris J. Brown, MD, please email Faustine Akwa at f.akwa@qmul.ac.uk.

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Also new in this issue:

There Is No Substitute for Primary Care Physicians: A Response to the Association of American Medical College’s Workforce Model

Christin Giordano McAuliffe, MD

Ideas and Opinions

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03806