title: Perceptions, expectations, and attitudes about communication with physicians among Chinese American and non-Hispanic white women with early stage breast cancer.
abstract: OBJECTIVE
  Asian Americans have consistently reported poorer communication with physicians compared with non-Hispanic Whites (NHW). This qualitative study sought to elucidate the similarities and differences in communication with physicians between Chinese and NHW breast cancer survivors.
  
  
  METHODS
  Forty-four Chinese and 28 NHW women with early stage breast cancer (stage 0-IIa) from the Greater Bay Area Cancer Registry participated in focus group discussions or individual interviews. We oversampled Chinese women because little is known about their cancer care experiences. In both interview formats, questions explored patients' experiences and feelings when communicating with physicians about their diagnosis, treatment, and follow-up care.
  
  
  RESULTS
  Physician empathy at the time of diagnosis was important to both ethnic groups; however, during treatment and follow-up care, physicians' ability to treat cancer and alleviate physical symptoms was a higher priority. NHW and US-born Chinese survivors were more likely to assert their needs, whereas Chinese immigrants accepted physician advice even when it did not alleviate physical problems (e.g., pain). Patients viewed all physicians as the primary source for information about cancer care. Many Chinese immigrants sought additional information from primary care physicians and stressed optimal communication over language concordance.
  
  
  CONCLUSIONS
  Physician empathy and precise information were important for cancer patients. Cultural differences such as the Western emphasis on individual autonomy vs. Chinese emphasis on respect and hierarchy can be the basis for the varied approaches to physician communication we observed. Interventions based on cultural understanding can foster more effective communication between immigrant patients and physicians ultimately improving patient outcomes.
authors.affiliation: Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA, jw235@georgetown.edu.
authors.forename: Judy Huei-Yu
authors.initials: JH
authors.lastname: Wang
authors.forename: Inez F
authors.initials: IF
authors.lastname: Adams
authors.forename: Rena J
authors.initials: RJ
authors.lastname: Pasick
authors.forename: Scarlett L
authors.initials: SL
authors.lastname: Gomez
authors.forename: Laura
authors.initials: L
authors.lastname: Allen
authors.forename: Grace X
authors.initials: GX
authors.lastname: Ma
authors.forename: Michael X
authors.initials: MX
authors.lastname: Lee
authors.forename: Ellen
authors.initials: E
authors.lastname: Huang
mesh_terms: D000368:Aged; D001213:Asian; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000208:ethnology* / Q000473:pathology / Q000523:psychology / Q000628:therapy; D002140:California; D003142:Communication; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010465:Perception; D010817:Physician-Patient Relations; D017741:Survivors; D044465:White People
references.citation: Gynecol Oncol. 2012 Mar;124(3):383-8
references.pmid: 22115854
references.citation: Health Educ Behav. 2008 Dec;35(6):806-20
references.pmid: 17602099
references.citation: J Gen Intern Med. 2004 Feb;19(2):101-10
references.pmid: 15009789
references.citation: Patient Educ Couns. 2007 Dec;69(1-3):63-75
references.pmid: 17851016
references.citation: Support Care Cancer. 2011 Dec;19(12):1975-82
references.pmid: 21080202
references.citation: Am J Public Health. 2004 Dec;94(12):2084-90
references.pmid: 15569958
references.citation: Breast Cancer Res Treat. 2010 Feb;119(3):707-16
references.pmid: 19449101
references.citation: Cancer. 1998 Aug 15;83(4):706-11
references.pmid: 9708934
references.citation: J Gen Intern Med. 2004 Feb;19(2):111-9
references.pmid: 15009790
references.citation: J Fam Pract. 2007 Sep;56(9 Suppl Building):S15-21
references.pmid: 18667135
references.citation: Cancer Epidemiol Biomarkers Prev. 2008 Aug;17(8):1968-73
references.pmid: 18708386
references.citation: Health Commun. 2008;23(3):207-21
references.pmid: 18569050
references.citation: JAMA. 2001 Dec 19;286(23):2993-3001
references.pmid: 11743841
references.citation: Health Soc Work. 2003 Feb;28(1):63-73
references.pmid: 12621934
references.citation: Am J Public Health. 2012 May;102(5):1027-34
references.pmid: 22420791
references.citation: Psychooncology. 2006 Nov;15(11):969-84
references.pmid: 16470910
references.citation: J Clin Oncol. 2010 Sep 20;28(27):4154-61
references.pmid: 20713876
references.citation: J Cancer Surviv. 2012 Dec;6(4):431-40
references.pmid: 22815086
references.citation: J Gen Intern Med. 2005 Nov;20(11):1050-6
references.pmid: 16307633
references.citation: J Clin Oncol. 2011 Apr 1;29(10):1280-9
references.pmid: 21357781
references.citation: Aust N Z J Psychiatry. 2002 Dec;36(6):717-32
references.pmid: 12406114
references.citation: Psychooncology. 2004 Jun;13(6):408-28
references.pmid: 15188447
references.citation: Psychooncology. 2002 Jan-Feb;11(1):35-46
references.pmid: 11835591
references.citation: J Gen Intern Med. 2003 Jan;18(1):44-52
references.pmid: 12534763
references.citation: Patient Educ Couns. 2011 Sep;84(3):398-405
references.pmid: 21388772
references.citation: Health Aff (Millwood). 2008 Mar-Apr;27(2):507-17
references.pmid: 18332509
references.citation: Annu Rev Public Health. 2004;25:439-55
references.pmid: 15015929
references.citation: Support Care Cancer. 2008 Mar;16(3):235-40
references.pmid: 18196291
references.citation: Br J Cancer. 2003 Mar 10;88(5):658-65
references.pmid: 12618870
references.citation: Med Care. 1987 May;25(5):437-51
references.pmid: 3695654