Culture and Ethnic Variations in Breast Cancer Treatment

亚洲族裔亚组，特别是中国人和越南人，早期乳腺癌的乳房切除率较高，这引起了人们对可能过度治疗的担忧。为了解决这些群体中影响治疗决策过程和生活质量的因素，必须首先确定每个种族群体的社会文化，人口统计学和临床因素的作用。对于这项为期2年的发展/试点研究，我们建议采用定性研究方法，以告知语言和文化上适当的问卷调查的发展与治疗决策和生活质量，并试点测试的工具在人口为基础的样本，非西班牙裔白色，中国和越南妇女最近诊断为乳腺癌。研究结果将成为计划更大规模、基于人群的流行病学研究的基础。研究目的是：1）通过以下程序确定治疗决策过程中的社会文化、共同决策、提供者沟通以及每个种族群体的生活质量的其他因素：a）与患者的焦点小组访谈，B）与患者的定性访谈，以及c）与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关于治疗建议和决策过程的做法和看法; 3）通过认知访谈和基于人群的患者样本的流行病学试点研究，开发和测试种族特异性流行病学问卷。预计共入组43名白色患者、56名中国患者和43名越南患者; 20名家庭或朋友被确定为共同决策者; 60名提供者。由于对不同种族之间早期乳腺癌护理标准差异的影响因素、社会文化因素对治疗决策的影响以及对生活质量的影响知之甚少，因此，这项开发性/试点研究应提供必要的信息，以计划更大规模的研究，了解特定种族的这些问题。

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.