Decision Involvement and Receipt of Mastectomy Among Racially and Ethnically Diverse Breast Cancer Patients
Decision Involvement and Receipt of Mastectomy Among Racially and Ethnically Diverse Breast Cancer Patients
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DOI：
10.1093/jnci/djp271
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发表时间：
2009-10-07
影响因子：
10.3
通讯作者：
Katz, Steven J.
中科院分区：
文献类型：
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作者：
Hawley, Sarah T.;Griggs, Jennifer J.;Katz, Steven J.
很少有研究评估患者决策参与和手术之间的关系，在种族和民族多样化的患者或患者对手术的态度和家庭和朋友在手术治疗选择中的作用。和最终结果登记处在诊断后邮寄调查表（N = 3133）。拉丁美洲和非洲裔美国妇女被过度抽样。有效率为72.4%。分析样本（N = 1651）排除了患有IIIA期或更高疾病、自我报告的放射性保乳手术的临床禁忌症以及不清楚人种或种族的患者。因变量为最初接受乳房切除术。主要的独立变量是患者参与决策、种族或民族、对复发的态度、放射的影响、手术对身体形象的影响以及其他人在决策中的作用。拉丁裔被分为低或高文化适应。在控制其他独立变量的同时，使用逻辑回归评估患者参与决策和接受乳房切除术之间的关联。所有统计检验均为双侧，分析样本为23.9%拉丁裔（12.0%低文化适应，11.9%高文化适应），27.1%非洲裔美国人和48.9%白色，17.2%最初接受乳房切除术。对于每个种族或民族群体，报告基于患者的决定的女性比报告共享或基于外科医生的决定的女性更多地接受乳房切除术（对于低文化适应的拉丁裔，P = 0.022，其他群体P <0.001）。那些报告说对复发或辐射影响的担忧在他们的手术决定中非常重要的女性比那些不太担心的女性更有可能接受乳房切除术（对于复发问题，估计相对风险[RR] = 1.66，95%置信区间[CI] = 1.28至2.10;对于辐射问题，估计RR = 2.35，95% CI = 1.88至2.85）。那些报告说身体形象问题和配偶的意见在她们的手术决定中非常重要的妇女比那些不太关心身体形象或不太重视配偶意见的妇女更少接受乳房切除术（对于身体形象问题，估计RR = 0.47，95%CI = 0.30至0.74;配偶的意见，估计RR = 0.53，95%CI = 0.36至0.78）。患者对手术的态度以及家人和朋友的意见有助于乳腺癌患者做出手术选择。
Few studies have evaluated the association between patient decision involvement and surgery received among racially and ethnically diverse patients or patients' attitudes about surgery and the role of family and friends in surgical treatment choices.Women diagnosed with nonmetastatic breast cancer from June 2005 through February 2007 and reported to the Los Angeles or Detroit Surveillance, Epidemiology, and End Results registries were mailed a survey after diagnosis (N = 3133). Latina and African American women were oversampled. The response rate was 72.4%. The analytic sample (N = 1651) excluded those with stage IIIA or higher disease, self-reported clinical contraindications to breast-conserving surgery with radiation, and unclear race or ethnicity. The dependent variable was receipt of mastectomy initially. The primary independent variables were patient involvement in decision making, race or ethnicity, attitudes about recurrence, the effects of radiation, the impact of surgery on body image, and the role of others in decision making. Latinas were categorized as low or high acculturated. The association between patient involvement in decision making and the receipt of mastectomy was evaluated using logistic regression while controlling for other independent variables. All statistical tests were two-sided.The analytic sample was 23.9% Latina (12.0% low acculturated, 11.9% high acculturated), 27.1% African American, and 48.9% white, and 17.2% received a mastectomy initially. For each racial or ethnic group, more women who reported a patient-based decision received mastectomy than those who reported a shared or surgeon-based decision (P = .022 for low-acculturated Latinas, P < .001 for other groups). Women who reported that concerns about recurrence or radiation effects were very important in their surgery decision were more likely to receive mastectomy than those less concerned (for recurrence concerns, estimated relative risk [RR] = 1.66, 95% confidence interval [CI] = 1.28 to 2.10; for radiation concerns, estimated RR = 2.35, 95% CI = 1.88 to 2.85). Women who reported that body image concerns and their spouse's opinion were very important in their surgery decision less often received mastectomy than those less concerned about body image or who placed less weight on their spouse's opinion (for body image concerns, estimated RR = 0.47, 95% CI = 0.30 to 0.74; for spouse's opinion, estimated RR = 0.53, 95% CI = 0.36 to 0.78).Greater patient involvement in decision making was associated with receipt of mastectomy for all racial and ethnic groups. Patient attitudes about surgery and the opinions of family and friends contribute to surgical choices made by women with breast cancer.