Racial/ethnic group differences in treatment decision-making and treatment received among older breast carcinoma patients.
BACKGROUND
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Maly
Rose C
RC
Department of Family Medicine, David Geffen School of Medicine, University of California at Los Angeles, 90095, USA. Rmaly@mednet.ucla.edu
Umezawa
Yoshiko
Y
Ratliff
Carl T
CT
Leake
Barbara
B
D001741:Black or African American; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000208:ethnology* / Q000628:therapy*; D002277:Carcinoma / Q000208:ethnology* / Q000628:therapy*; D003430:Cross-Sectional Studies; D003466:Cultural Characteristics; D003657:Decision Making; D005192:Family Health; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006630:Hispanic or Latino; D006801:Humans; D015141:Los Angeles; D008875:Middle Aged; D010347:Patient Care Planning; D010353:Patient Education as Topic; D044465:White People