Racial/ethnic group differences in treatment decision-making and treatment received among older breast carcinoma patients
Racial/ethnic group differences in treatment decision-making and treatment received among older breast carcinoma patients
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DOI：
10.1002/cncr.21680
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发表时间：
2006-02-15
期刊：
影响因子：
6.2
通讯作者：
Leake, B
中科院分区：
文献类型：
--
作者：
Maly, RC;Umezawa, Y;Leake, B
背景在老年人和少数种族/族裔乳腺癌患者的治疗中，已经确定了医疗保健方面的差异。本研究的目的是探讨老年乳腺癌患者治疗决策过程中的种族/民族差异以及对接受治疗的差异影响。对洛杉矶癌症监测项目确定的基于人群的连续样本进行横断面调查，该样本包括拉丁裔（n = 99）、非洲裔美国人（n = 66）和白色（n = 92）女性，年龄55岁（共n = 257），在原发性乳腺癌诊断后3-9个月。大约49%的文化适应程度较低的拉丁裔和18%的文化适应程度较高的拉丁裔表示，他们的家庭成员决定了最终的治疗决定，而非洲裔美国人和白人的比例不到4%（P < 0.001）。这种差异仍然存在于多元logistic回归分析中，控制了潜在的混杂因素，包括社会人口统计学，医患沟通，社会支持和健康变量。与非洲裔美国人和白色女性相比，拉丁裔女性更可能将家庭成员确定为最终治疗决策者（文化适应度较低的拉丁裔女性的调整后比值比[AOR]为7.97; 95%置信区间[95% CI]为2.43-26.20;文化适应度较高的拉丁裔女性的AOR为4.48; 95% CI为1.09-18.45）。控制社会人口统计学和健康特征的多元Logistic回归模型表明，当家庭做出最终治疗决定时，患者不太可能接受保乳手术（BCS）（AOR为0.39; 95%CI，0.18-0.85）。家庭似乎在老年拉丁裔乳腺癌患者的治疗决策中发挥着重要作用，无论文化适应水平如何。这种家庭影响似乎促成了种族/族裔群体在接受治疗方面的差异。医生应承认并教育患者家属是医疗决策的潜在关键参与者，而不仅仅是翻译和社会支持的提供者。
BACKGROUND. Health care disparities have been identified in the treatment of older and racial/ethnic minority breast carcinoma patients. The purpose of the current study was to examine racial/ethnic group differences ill the treatment decision-making process of older breast carcinoma patients and the differential impact on treatment received.METHODS. A cross-sectional survey was conducted of a population-based, consecutive sample identified by the Los Angeles Cancer Surveillance Program comprised of Latina (n = 99), African-American In = 66), and white (n = 92) women age 55 years (total n = 257) and who were between 3-9 months after their primary breast carcinoma diagnosis.RESULTS. Approximately 49% of less acculturated Latinas and 18% of more acculturated Latinas indicated that their family members determined the final treatment decision, compared with less than 4% of African-Americans and whites (P < 0.001). This disparity remained in multiple logistic regression analysis, controlling for potential confounders, including sociodemographic, physician-patient communication, social Support, and health variables. Compared with African-American and white women, Latina women were more likely to identify a family member as the final treatment decision-maker (adjusted odds ratio [AOR] of 7.97; 95% confidence interval [95% CI], 2.43-26.20, for less acculturated Latinas; and AOR of 4.48; 95% Cl, 1.09-18.45, for more acculturated Latinas). A multiple logistic regression model, controlling for sociodemographic and health characteristics, indicated that patients were less likely to receive breast-conserving surgery, (BCS) when the family made the final treatment decision (AOR of 0.39; 95% Cl, 0.18-0.85).CONCLUSIONS. Family appears to play a powerful role in treatment decision-making among older Latina breast carcinoma patients, regardless of the level of acculturation. This family influence appears to contribute to racial/ethnic group differences in treatment received. Physicians should acknowledge and educate patients' family members as potential key participants in medical decision-making, rather than merely as translators and providers of social support.