The largest study of how Latina breast cancer patients evaluate treatment options highlights the need to counteract language barriers, information overload and a tendency to defer to rather than partner with doctors.
The new research from the University of Michigan appears in the journal Cancer. It builds upon previous Michigan Medicine studies of doctor-patient communication and decision making in breast cancer.
‘More than 5,000 newly diagnosed women with breast cancer from Los Angeles County and the state of Georgia were surveyed.’
About the study
More than 5,000 newly diagnosed women with breast cancer from Los Angeles County and the state of Georgia were surveyed. In designing the study, nearly 100 survey tools were reviewed and considered to ensure that data collection accurately reflected the experiences of a population diverse in race, ethnicity, age, education and level of health literacy.
A primary objective was to record the experiences of breast cancer patients characterized as Latinas with low acculturation (Latina-LA). Compared with the other respondent groups, Latina LAs were younger, less educated, with lower health literacy and in poorer health.
"While there is a body of research exploring disparities in care between other groups, for example, comparing whites with African Americans, this is really the first significant look at the vulnerabilities and experiences of this growing group of breast cancer patients," says lead author Steven J. Katz, M.D., M.P.H., a U-M professor of medicine and of health management and policy.
Among the many factors measured:
Patients were asked how they learned of their diagnosis, with whom they consulted before surgery, the type of treatment they eventually received, and their perception of the communication and coordination of their care between clinicians and across specialties.
Patients' attitudes and beliefs about medical decision-making were probed, including how much patients wanted to participate in decisions versus deferring to their doctors.
Patients were asked about their informal decision support networks -- whether and how much family members or friends participated in their decision making, including attendance at appointments and taking notes.
The different patient groups surveyed were similar in several ways, including how they learned of their diagnosis, how many consulted with different specialists prior to surgery, and their relatively high opinions of how well providers worked with each other to coordinate care.
Significant differences were recorded for some measures, however, especially between Latina LAs and other patient groups. When reviewing treatment options, Latina LAs tended to ask fewer questions and leave treatment decisions to their doctors. They were also more likely to report receiving too much information about tests and treatments, and to give clinicians lower marks for the quality of their communication.
"On balance, the news is encouraging," says Katz. "While we see differences in how some patients comprehend the information we're providing, we don't see significant inequities in how we're providing it. That's something to build on."