title: Racial/ethnic differences in breast cancer outcomes among older patients: effects of physician communication and patient empowerment.
abstract: OBJECTIVE
  To examine racial/ethnic disparities in older women's health-related quality of life (QoL) and type of breast cancer treatment as mediated by physician-level and individual-level variables.
  
  
  METHODS
  A cross-sectional survey of a population-based, consecutive sample identified through the Los Angeles Cancer Surveillance Program of Latina (n = 99), African American (n = 66), and White (n = 92) women aged 55 years or older (N = 257) between 3 and 9 months after primary breast cancer diagnosis and at least 1 month posttreatment. An exploratory, empirically developed latent variable model tested the relationships among demographic and physician-related variables, patient attitudes, and health-related outcomes. Health-related outcomes included QoL measures and receipt of breast conserving surgery (BCS).
  
  
  RESULTS
  Latinas reported less BCS and poorer QoL compared with Whites. Physician communication that can empower patients, in terms of patient efficacy in patient?physician interactions and breast cancer knowledge, mitigated racial/ethnic disparities in receipt of BCS. Physician emotional support was not related to patient cognitive empowerment and treatment outcomes. Medical mistrust in minority women was related to less self-efficacy and less positive coping, as well as, both directly and indirectly, to reduced QoL. Latinas reported poorer QoL in the tested model.
  
  
  CONCLUSIONS
  Physician communication style, specifically information giving and participatory decision making, may empower older women with breast cancer and help mitigate racial/ethnic disparities in surgical treatment received.
authors.affiliation: Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, California 90024, USA. rmaly@mednet.ucla.edu
authors.forename: Rose C
authors.initials: RC
authors.lastname: Maly
authors.forename: Judith A
authors.initials: JA
authors.lastname: Stein
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Umezawa
authors.forename: Barbara
authors.initials: B
authors.lastname: Leake
authors.forename: M Douglas
authors.initials: MD
authors.lastname: Anglin
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000208:ethnology* / Q000628:therapy*; D003142:Communication; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D015438:Health Behavior; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D010817:Physician-Patient Relations; D011209:Power, Psychological; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome