title: Breast reconstructive surgery in medically underserved women with breast cancer: the role of patient-physician communication.
abstract: BACKGROUND
  Breast reconstructive surgery can improve mastectomy patients' emotional relationships and social functioning, but it may be underutilized in low-income, medically underserved women. This study assessed the impact of patient-physician communication on rates of breast reconstructive surgery in low-income breast cancer (BC) women receiving mastectomy.
  
  
  METHODS
  A cross-sectional, California statewide survey was conducted of women with income less than 200% of the Federal Poverty Level and receiving BC treatment through the Medicaid Breast and Cervical Cancer Treatment Program. A subset of 327 women with nonmetastatic disease who underwent mastectomy was identified. Logistic regression was used for data analysis. The chief dependent variable was receipt of or planned breast reconstructive surgery by patient report at 6 months after diagnosis; chief independent variables were physician interactive information giving and patient perceived self-efficacy in interacting with physicians.
  
  
  RESULTS
  Greater physician information giving about BC and its treatment and greater patient perceived self-efficacy positively predicted breast reconstructive surgery (OR=1.12, P=.04; OR=1.03, P=.01, respectively). The observed negative effects of language barriers and less acculturation among Latinas and lower education at the bivariate level were mitigated in multivariate modeling with the addition of the patient-physician communication and self-efficacy variables.
  
  
  CONCLUSIONS
  Empowering aspects of patient-physician communication and self-efficacy may overcome the negative effects of language barriers and less acculturation for Latinas, as well as of lower education generally, on receipt of or planned breast reconstructive surgery among low-income women with BC. Intervening with these aspects of communication could result in breast reconstructive surgery rates more consistent with the general population and in improved quality of life among this disadvantaged group.
authors.affiliation: Department of Family Medicine, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California 90095-7087, 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: Elaine
authors.initials: E
authors.lastname: Kwong
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 / Q000523:psychology* / Q000601:surgery*; D003142:Communication; D004522:Educational Status; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016462:Mammaplasty / Q000523:psychology* / Q000706:statistics & numerical data*; D008875:Middle Aged; D010817:Physician-Patient Relations; D011203:Poverty; D020377:Self Efficacy