title: Treatment-related symptoms among underserved women with breast cancer: the impact of physician-patient communication.
abstract: Low-income, minority women are more likely to be undertreated for breast cancer (BC) treatment-related symptoms than whites. This study assessed the impact of patient-physician communication on symptom resolution. A cross-sectional, California statewide survey was conducted among 921 low-income women with BC. Ethnic/racial differences in BC treatment-related symptoms (pain, nausea/vomiting, depression) reporting and physician' awareness of these symptoms were assessed by patient report. Multivariate logistic regression models were used to investigate the impact of patient-physician communication on symptom resolution. Depression was the most common symptom reported by patients (66%), yet physicians were the least aware of it (26.3%), especially among less-acculturated Latinas (18.9%) and Asian/Pacific Islanders (14%; P < 0.001). Greater patient-perceived self-efficacy in communication with physicians and greater physician awareness of the symptom positively predicted pain resolution, controlling for sociodemographic variables, comorbidity, and treatment received (AOR = 1.05, P < 0.0001; AOR = 6.12, P < 0.001). Physician awareness was a significant determinant of depression resolution (AOR = 13.46, P < 0.001). Yet patient-perceived self-efficacy played a much more important role than physicians' awareness in nausea resolution (AOR = 1.04, P = 0.0002). Less-acculturated Latinas tended to achieve less symptom resolution than whites, while this negative impact disappeared or was moderated after patient-physician communication was considered. This study suggests that physicians under-recognized depression, especially among Latinas. The resolution of BC treatment-related symptoms can be addressed by appropriate educational interventions targeted at patient-physician communication. Effective patient-physician communication can moderate disparities in symptom resolution among Latinas, regardless of language acculturation.
authors.affiliation: Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd, Ste 1800, Los Angeles, CA 90024, USA. rmaly@mednet.ucla.edu
authors.forename: Rose C
authors.initials: RC
authors.lastname: Maly
authors.forename: Yihang
authors.initials: Y
authors.lastname: Liu
authors.forename: Barbara
authors.initials: B
authors.lastname: Leake
authors.forename: Amardeep
authors.initials: A
authors.lastname: Thind
authors.forename: Allison L
authors.initials: AL
authors.lastname: Diamant
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000208:ethnology* / Q000628:therapy*; D002140:California; D003142:Communication; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000208:ethnology* / Q000209:etiology; D005260:Female; D006801:Humans; D008507:Medically Underserved Area; D008875:Middle Aged; D009325:Nausea / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology; D010146:Pain / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology; D010817:Physician-Patient Relations; D011203:Poverty; D020377:Self Efficacy