title: Decisional control preferences of Hispanic patients with advanced cancer from the United States and Latin America.
abstract: BACKGROUND
  Understanding cancer patients' preferences in decisional roles is important in providing quality care and ensuring patient satisfaction. There is a lack of evidence on decisional control preferences (DCPs) of Hispanic Americans, the fastest growing population in the U.S.
  
  
  OBJECTIVE
  The primary aims of this study were to describe DCPs of Hispanics with advanced cancer in the U.S. (HUSs) and compare the frequency of passive DCPs in this population with that of Hispanics with advanced cancer in Latin America (HLAs).
  
  
  METHODS
  We conducted a prospective survey of patients with advanced cancer referred to outpatient palliative care clinics in the U.S., Chile, Argentina, and Guatemala. Information was collected on sociodemographic variables, Karnofsky Performance Scale scores, acculturation (Marin Acculturation Assessment Tool), and DCP (Control Preference Scale). Chi-square tests were used to determine the differences in DCPs between HUSs and HLAs.
  
  
  RESULTS
  A total of 387 patients were surveyed: 91 in the U.S., 100 in Chile, 94 in Guatemala, and 99 in Argentina. The median age of HUSs was 56 years, 59% were female, and the median Karnofsky Performance Scale score was 60; the corresponding values for HLAs were 60 years, 60%, and 80. HLAs used passive DCP strategies significantly more frequently than HUSs did with regard to the involvement of the family (24% vs. 10%; P=0.009) or the physician (35% vs. 16%; P<0.001), even after age and education were controlled for. Eighty-three percent of HUSs and 82% of HLAs preferred family involvement in decision making (P=non-significant). No significant differences were found in DCPs between poorly and highly acculturated HUSs (P=0.91).
  
  
  CONCLUSIONS
  HUSs had more active DCPs than HLAs did. Among HUSs, acculturation did not seem to play a role in DCP determination. Our findings confirm the importance of family participation for both HUSs and HLAs. However, HUSs were less likely to want family members to make decisions on their behalf.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Sriram
authors.initials: S
authors.lastname: Yennurajalingam
authors.forename: Henrique A
authors.initials: HA
authors.lastname: Parsons
authors.forename: Eva Rossina
authors.initials: ER
authors.lastname: Duarte
authors.forename: Alejandra
authors.initials: A
authors.lastname: Palma
authors.forename: Sofia
authors.initials: S
authors.lastname: Bunge
authors.forename: J Lynn
authors.initials: JL
authors.lastname: Palmer
authors.forename: Marvin Omar
authors.initials: MO
authors.lastname: Delgado-Guay
authors.forename: Julio
authors.initials: J
authors.lastname: Allo
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000069:Acculturation; D017677:Age Distribution; D000368:Aged; D003657:Decision Making; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007843:Latin America / Q000208:ethnology; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009369:Neoplasms / Q000208:ethnology* / Q000451:nursing; D010166:Palliative Care / Q000706:statistics & numerical data*; D010358:Patient Participation / Q000706:statistics & numerical data*; D057240:Patient Preference / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D015995:Prevalence; D017678:Sex Distribution; D012923:Social Class; D013727:Terminal Care / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology