Culture and Ethnic Variations in Breast Cancer Treatment

描述(申请人提供)：亚裔群体，特别是中国人和越南人，早期乳腺癌的乳房切除率较高，这引发了人们对可能的过度治疗的担忧。为了解决影响这些群体的治疗决策过程和随之而来的生活质量的因素，必须首先确定每个种族群体的社会文化、人口和临床因素的作用。在这项为期两年的发展性/先导性研究中，我们建议应用定性研究方法，为制定与治疗决策和生活质量相关的语言和文化上适当的问卷提供信息，并在最近被诊断为乳腺癌的非西班牙裔白人、中国人和越南妇女的人群样本中进行先导性测试。研究结果将成为规划更大规模、以人群为基础的流行病学研究的基础。研究的目的是：1)通过以下程序确定每个民族的治疗决策过程和生活质量中的社会文化、共同决策、提供者沟通和其他因素：a)对患者的焦点小组访谈，b)对患者的定性访谈，以及c)对患者共同决策者的定性访谈；2)通过提供者调查，确定提供者对治疗建议和决策过程的做法和看法；以及3)通过认知访谈和以人群为基础的患者样本的流行病学先导研究，制定和测试针对种族的流行病学调查问卷。预计将有43名白人患者、56名中国患者和43名越南患者；20名被确定为共同决策者的家人或朋友；以及60名提供者。由于人们对导致早期乳腺癌护理标准在不同种族之间存在差异的因素以及社会文化因素对治疗决策的贡献以及对生活质量的影响知之甚少，这项发展/试点研究应该有助于规划一项更大规模的研究，以了解特定种族群体的这些问题。

DESCRIPTION (provided by applicant): Asian ethnic subgroups, particularly Chinese and Vietnamese, have higher rates of mastectomy for early stage breast cancer, raising concerns about possible over-treatment. To address the factors affecting treatment decision-making processes and consequent quality of life in these groups, the roles of socio-cultural, demographic, and clinical factors must first be determined for each ethnic group. For this 2-year developmental/pilot study, we propose to apply qualitative research methods to inform the development of linguistically and culturally appropriate questionnaires related to treatment decision-making and quality of life, and to pilot test the instruments in a population-based sample of non-Hispanic White, Chinese, and Vietnamese women recently diagnosed with breast cancer. Study results will form the basis for planning a larger, population-based epidemiologic study. Study aims are to: 1) identify the socio-cultural, co-decision making, provider communication, and other factors in treatment decision-making processes and quality of life in each ethnic group through the following procedures: a) focus group interviews with patients, b) qualitative interviews with patients, and c) qualitative interviews with patients' co-decision makers; 2) determine provider practices and perceptions regarding treatment recommendations and decision-making processes via provider surveys; and 3) develop and test ethnic-specific epidemiologic questionnaires through cognitive interviews and an epidemiologic pilot study in a population-based patient sample. An overall enrollment of 43 White, 56 Chinese, and 43 Vietnamese patients; 20 family or friends identified as the co-decision maker; and 60 providers are expected. As little is known about factors contributing to disparities in standards of care for early-stage breast cancer among ethnic groups, and about the contributions of socio-cultural factors on treatment decisions, and impacts on quality of life, this developmental/pilot study should contribute the information necessary to plan a larger study to understand these issues for specific ethnic groups.