title: Latina patient perspectives about informed treatment decision making for breast cancer.
abstract: OBJECTIVE
  To evaluate Latina breast cancer patient perspectives regarding informed decision making related to surgical treatment decision making for breast cancer.
  
  
  METHODS
  2030 women with non-metastatic breast cancer diagnosed from 8/05 to 5/06 and reported to the Los Angeles metropolitan SEER registries were mailed a survey shortly after surgical treatment. Latina and African-American women were over-sampled. We conducted regression of four decision outcome to evaluate associations between race/ethnicity, demographic and clinical factors, and mechanistic variables (i.e., health literacy) and decision outcomes.
  
  
  RESULTS
  Our analytic sample was 877 women: 24.5% Latina-Spanish speaking (Latina-SP), 20.5% Latina-English speaking, 24% African-American and 26.6% Caucasian. Approximately 28% of women in each ethnic group reported a surgeon-based, 36% a shared, and 36% a patient-based surgery decision. Spanish-preferent Latina women had the greatest odds of high decision dissatisfaction and regret controlling for other factors (OR 5.5, 95% CI: 2.9, 10.5 and OR 4.1, 95% CI: 2.2, 8.0, respectively). Low health literacy was independently associated with dissatisfaction and regret (OR 5.6, 95% CI: 2.9, 11.1 and OR 3.5, 95% CI 1.8, 7.1, respectively) and slightly attenuated associations between Latina-SP ethnicity and decision outcomes.
  
  
  CONCLUSIONS
  Despite similar clinical outcomes, patients report very different experiences with treatment decision making. Latina women, especially those who prefer Spanish, are vulnerable to poor breast cancer treatment decision outcomes.
  
  
  CONCLUSIONS
  Providers need to be aware of the role of ethnicity, acculturation and literacy in breast cancer treatment discussions.
authors.affiliation: Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor 48109-0429, USA. sarahawl@med.umich.edu
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Hawley
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Janz
authors.forename: Ann
authors.initials: A
authors.lastname: Hamilton
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Griggs
authors.forename: Amy K
authors.initials: AK
authors.lastname: Alderman
authors.forename: Mahasin
authors.initials: M
authors.lastname: Mujahid
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Katz
mesh_terms: D000069:Acculturation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000208:ethnology / Q000601:surgery*; D003144:Communication Barriers; D003657:Decision Making; D004522:Educational Status; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D016015:Logistic Models; D015141:Los Angeles; D008875:Middle Aged; D015999:Multivariate Analysis; D017060:Patient Satisfaction; D010817:Physician-Patient Relations
references.citation: Can J Nurs Res. 1997 Fall;29(3):21-43
references.pmid: 9505581
references.citation: Breast Cancer Res Treat. 2004 Jun;85(3):201-9
references.pmid: 15111757
references.citation: Health Expect. 2003 Mar;6(1):72-80
references.pmid: 12603630
references.citation: South Med J. 2007 Aug;100(8):812-20
references.pmid: 17713308
references.citation: J Clin Oncol. 2002 Mar 15;20(6):1473-9
references.pmid: 11896094
references.citation: Cancer. 2002 Sep 15;95(6):1185-90
references.pmid: 12216083
references.citation: J Clin Oncol. 2005 May 1;23(13):3001-7
references.pmid: 15860856
references.citation: Med Decis Making. 2003 Jul-Aug;23(4):281-92
references.pmid: 12926578
references.citation: Patient Educ Couns. 2007 Apr;66(1):119-22
references.pmid: 17140758
references.citation: J Health Care Poor Underserved. 2006 Aug;17(3):512-21
references.pmid: 16960319
references.citation: J Am Geriatr Soc. 2004 Jul;52(7):1138-45
references.pmid: 15209652
references.citation: Cancer. 2003 Mar 15;97(6):1517-27
references.pmid: 12627517
references.citation: Patient Educ Couns. 2007 Feb;65(2):158-65
references.pmid: 16870385
references.citation: J Psychosoc Oncol. 2006;24(3):19-52
references.pmid: 17088240
references.citation: Med Decis Making. 1996 Jan-Mar;16(1):58-64
references.pmid: 8717600
references.citation: Mt Sinai J Med. 2004 Oct;71(5):314-21
references.pmid: 15543432
references.citation: Health Serv Res. 2008 Aug;43(4):1366-87
references.pmid: 18384361
references.citation: J Clin Oncol. 2005 Aug 20;23(24):5526-33
references.pmid: 16110013
references.citation: J Community Health. 2006 Feb;31(1):69-77
references.pmid: 16482767
references.citation: Cancer. 2006 Sep 15;107(6):1313-20
references.pmid: 16909424
references.citation: Psychooncology. 2008 Feb;17(2):182-9
references.pmid: 17534866
references.citation: Ann Oncol. 2007 Mar;18(3):479-84
references.pmid: 17272832
references.citation: Cancer Nurs. 2002 Dec;25(6):417-24
references.pmid: 12464832
references.citation: Health Serv Res. 2005 Jun;40(3):745-67
references.pmid: 15960689
references.citation: J Clin Oncol. 2004 Aug 1;22(15):3091-8
references.pmid: 15284259
references.citation: Med Care. 2005 Oct;43(10):960-9
references.pmid: 16166865
references.citation: J Clin Oncol. 2002 Feb 15;20(4):1008-16
references.pmid: 11844824
references.citation: Patient Educ Couns. 2006 Dec;64(1-3):303-12
references.pmid: 16860523
references.citation: Qual Life Res. 2005 Aug;14(6):1467-79
references.pmid: 16110927
references.citation: Patient Educ Couns. 2007 Mar;65(3):387-95
references.pmid: 17156967
references.citation: Am J Public Health. 2005 Dec;95(12):2225-30
references.pmid: 16257945
references.citation: Cancer. 2008 Sep 1;113(5):1058-67
references.pmid: 18618494
references.citation: Psychooncology. 2008 Mar;17(3):244-51
references.pmid: 17534881
references.citation: J Gen Intern Med. 2005 Jun;20(6):531-5
references.pmid: 15987329
references.citation: Cancer. 2006 Feb 15;106(4):957-65
references.pmid: 16402372
references.citation: Ann Surg Oncol. 2006 Jun;13(6):788-93
references.pmid: 16614883