Maly Rose C, Umezawa Yoshiko, Ratliff Carl T, Leake Barbara
Department of Family Medicine, David Geffen School of Medicine, University of California at Los Angeles, 90095, USA.
Cancer. 2006 Feb 15;106(4):957-65. doi: 10.1002/cncr.21680.
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 in the treatment decision-making process of older breast carcinoma patients and the differential impact on treatment received.
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 (n = 66), and white (n = 92) women age > or = 55 years (total n = 257) and who were between 3-9 months after their primary breast carcinoma diagnosis.
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% CI, 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% CI, 0.18-0.85).
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.
在老年乳腺癌患者以及种族/族裔少数群体乳腺癌患者的治疗中，已发现存在医疗保健差异。本研究的目的是调查老年乳腺癌患者治疗决策过程中的种族/族裔差异以及对所接受治疗的不同影响。
对洛杉矶癌症监测项目确定的一个基于人群的连续样本进行横断面调查，样本包括99名拉丁裔、66名非裔美国人和92名白人女性，年龄≥55岁（共257人），且在原发性乳腺癌诊断后3至9个月之间。
约49%文化适应程度较低的拉丁裔和18%文化适应程度较高的拉丁裔表示，其家庭成员决定最终治疗方案，相比之下，非裔美国人和白人中这一比例不到4%（P<0.001）。在多因素逻辑回归分析中，在控制了包括社会人口统计学、医患沟通、社会支持和健康变量等潜在混杂因素后，这种差异依然存在。与非裔美国人和白人女性相比，拉丁裔女性更有可能将家庭成员视为最终治疗决策者（文化适应程度较低的拉丁裔调整优势比[AOR]为7.97；95%置信区间[95%CI]为2.43 - 26.20；文化适应程度较高的拉丁裔AOR为4.48；95%CI为1.09 - 18.45）。一个控制了社会人口统计学和健康特征的多因素逻辑回归模型表明，当家庭成员做出最终治疗决策时，患者接受保乳手术（BCS）的可能性较小（AOR为0.39；95%CI为0.18 - 0.85）。
无论文化适应程度如何，家庭在老年拉丁裔乳腺癌患者的治疗决策中似乎都起着重要作用。这种家庭影响似乎导致了所接受治疗的种族/族裔差异。医生应认识到并教育患者家属作为医疗决策潜在关键参与者的角色，而不仅仅是翻译人员和社会支持提供者。
