Perceptions of cancer treatment decision making among American Indians/Alaska Natives and their physicians.
American Indian/Alaska Native (AI/AN) patients are significantly less likely than non-Hispanic whites to receive guideline-concordant cancer care. Our objective was to examine cancer treatment decision making among AI/AN patients and their providers.



From 2011 to 2014, AI/AN cancer patients and their surgeons were identified through a hospital registry in Washington State. Patients were invited to participate in a mailed survey that queried socio-demographics, cultural affiliation, everyday perceived discrimination, and trust in providers. Both patients and surgeons were queried about decision-making quality (collaboration and satisfaction). The primary outcome was association between patient and provider assessments of decision-making quality. The secondary outcome was non-adherence to treatment.



Forty-nine patients (62% response rate) and 14 surgeons (37% response rate) returned surveys. Half of patients had not completed high school; 41% were living in poverty. Half of patients reported a strong tribal affiliation and most reported experiencing some form of discrimination. Patients endorsed high trust in surgeons and a high quality decision-making process; and surgeons' rated decision-making quality even more highly than patients did in every domain. Non-adherence to treatment recommendations was common (26%) and was significantly associated with lower patient-reported collaboration and satisfaction with decision making.



Given the importance of adherence to cancer treatment for survival, the many non-clinical reasons for non-adherence, and the currently demonstrated association between decision-making quality and adherence, it would be worthwhile to investigate how to increase AI/AN patient satisfaction with decision making and whether improving satisfaction yields improved adherence to the cancer treatment plan. Copyright © 2016 The Authors. Psycho-Oncology Published by John Wiley & Sons Ltd.
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.
Arden M
AM
Morris
University of Washington School of Nursing, Department of Biobehavioral Nursing and Health Systems, Seattle, WA, USA.
Ardith Z
AZ
Doorenbos
University of New Mexico College of Nursing, Albuquerque, NM, USA.
Emily
E
Haozous
University of Washington School of Nursing, Department of Biobehavioral Nursing and Health Systems, Seattle, WA, USA.
Alexa
A
Meins
University of Washington, School of Medicine Department of Surgery, Seattle, WA, USA.
Sara
S
Javid
University of Washington, School of Medicine Department of Surgery, Seattle, WA, USA.
David R
DR
Flum
D000368:Aged; D000072957:Alaska Natives / Q000523:psychology*; D003657:Decision Making; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007198:Indians, North American / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D010465:Perception; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology; D012042:Registries; D011795:Surveys and Questionnaires; D035502:Trust; D014861:Washington
American Indian; cancer; decision making; disparities; oncology; patient reported outcomes