title: The importance of patient participation in second-line chemotherapy decisions: perspectives of African-American patients.
abstract: BACKGROUND
  Minority populations have been considered to be less-active participants in their health and, consequently, more vulnerable to having decisions made for them.
  
  
  METHODS
  We interviewed African-American patients (N=26) with cancer who had recently consented to second-line chemotherapy, offered when their disease was no longer responding to standard first-line regimen.
  
  
  RESULTS
  The majority (73%) reported involvement in the decision to start second-line chemotherapy. Forty-two percent reported making the decision together with their doctor. Support for autonomy was positively associated with education (p=0.01). Information seeking was considered more important than participating in decision-making. Patients who were less educated and had lower income reported stronger internal belief that their own actions and behaviors would determine their future health (p=0.04, p=0.007, respectively). Depression was identified in 35% of the study group and found not to be associated with any of the main outcomes.
  
  
  CONCLUSIONS
  Although the majority of patients report participating in the decision to begin second-line chemotherapy, there are a diversity of views towards autonomy, the importance of information seeking and determinants of future health. Understanding patients' beliefs and attitudes around the time of disease recurrence may assist clinicians in supporting patients during this stressful time.
authors.affiliation: Center for Urban Health Policy and Research, Alber Einstein Healthcare Network, Philadelphia, PA, USA. phippst@einstein.edu
authors.forename: Etienne
authors.initials: E
authors.lastname: Phipps
authors.forename: Nora
authors.initials: N
authors.lastname: Madison
authors.forename: Marcia
authors.initials: M
authors.lastname: Polansky
authors.forename: William
authors.initials: W
authors.lastname: Tester
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D003657:Decision Making; D004522:Educational Status; D005260:Female; D015438:Health Behavior; D006801:Humans; D007182:Income; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000208:ethnology; D010342:Patient Acceptance of Health Care; D010358:Patient Participation; D026684:Personal Autonomy; D055815:Young Adult