Article
Racial/ethnic differences in breast cancer outcomes among older patients: effects of physician communication and patient empowerment.
Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, California 90024, USA.
Health Psychology (impact factor:
3.87).
12/2008;
27(6):728-36.
DOI:10.1037/0278-6133.27.6.728
pp.728-36
Source: PubMed
-
Article: Racial/ethnic group differences in treatment decision-making and treatment received among older breast carcinoma patients.
[show abstract] [hide abstract]
ABSTRACT: Health care disparities have been identified in the treatment of older and racial/ethnic minority breast carcinoma patients. The purpose of the current study was to examine racial/ethnic group differences in the treatment decision-making process of older breast carcinoma patients and the differential impact on treatment received. A cross-sectional survey was conducted of a population-based, consecutive sample identified by the Los Angeles Cancer Surveillance Program comprised of Latina (n = 99), African-American (n = 66), and white (n = 92) women age > or = 55 years (total n = 257) and who were between 3-9 months after their primary breast carcinoma diagnosis. Approximately 49% of less acculturated Latinas and 18% of more acculturated Latinas indicated that their family members determined the final treatment decision, compared with less than 4% of African-Americans and whites (P < 0.001). This disparity remained in multiple logistic regression analysis, controlling for potential confounders, including sociodemographic, physician-patient communication, social support, and health variables. Compared with African-American and white women, Latina women were more likely to identify a family member as the final treatment decision-maker (adjusted odds ratio [AOR] of 7.97; 95% confidence interval [95% CI], 2.43-26.20, for less acculturated Latinas; and AOR of 4.48; 95% CI, 1.09-18.45, for more acculturated Latinas). A multiple logistic regression model, controlling for sociodemographic and health characteristics, indicated that patients were less likely to receive breast-conserving surgery (BCS) when the family made the final treatment decision (AOR of 0.39; 95% CI, 0.18-0.85). Family appears to play a powerful role in treatment decision-making among older Latina breast carcinoma patients, regardless of the level of acculturation. This family influence appears to contribute to racial/ethnic group differences in treatment received. Physicians should acknowledge and educate patients' family members as potential key participants in medical decision-making, rather than merely as translators and providers of social support.Cancer 02/2006; 106(4):957-65. · 4.77 Impact Factor -
Article: Effect of a decision aid on knowledge and treatment decision making for breast cancer surgery: a randomized trial.
[show abstract] [hide abstract]
ABSTRACT: The long-term results of randomized trials have demonstrated equivalent survival rates for mastectomy and breast-conserving therapy for the treatment of early stage breast cancer. Consequently, the choice of treatment should be based on a patient's preferences. To evaluate the impact of a decision aid regarding the different surgical treatment options on patient decision making. A cluster randomized trial for which general surgeons in the communities of central-west, and eastern Ontario, Canada, were randomly assigned to use the decision aid or not in the surgical consultation. Patients received the decision aid or not based on the surgeon seen. Twenty surgeons participated in the study. Of the 208 eligible women with newly diagnosed clinical stage I or II breast cancer seen by study surgeons, 201 agreed to be evaluated: 94 were assigned to the decision board and 107 to usual practice. Patients were recruited from November 1999 to April 2002. The decision board is a decision aid designed to help physicians inform their patients about different treatment options and to enable patients to express a preference for treatment. Patient knowledge about the surgical treatment of breast cancer; decisional conflict; satisfaction with decision making; and the treatment decision following the consultation. Patients in the decision board group had higher knowledge scores about their treatment options (66.9 vs 58.7; P<.001), had less decisional conflict (1.40 vs 1.62, P =.02), and were more satisfied with decision making (4.50 vs 4.32, P =.05) following the consultation. Patients who used the decision board were more likely to choose BCT (94% vs 76%, P =.03). The decision board was helpful in improving communication and enabling women to make a choice regarding treatment. Such instruments should be considered by surgeons when communicating the different surgical options to women with breast cancer.JAMA The Journal of the American Medical Association 07/2004; 292(4):435-41. · 30.03 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed.
The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual
current impact factor.
Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence
agreement may be applicable.
Keywords
1 month posttreatment
9 months
breast cancer
breast cancer knowledge
breast cancer treatment
latent variable model
Los Angeles Cancer Surveillance Program
minority women
older women
older women's health-related quality
participatory decision
patient cognitive empowerment
patient efficacy
Physician communication
Physician communication style
physician interactions
primary breast cancer diagnosis
QoL measures
surgical treatment
tested model
