Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880 Wilshire Blvd, Ste 1800, Los Angeles, CA 90024, USA.
Breast Cancer Res Treat. 2010 Feb;119(3):707-16. doi: 10.1007/s10549-009-0418-x. Epub 2009 May 16.
Low-income, minority women are more likely to be undertreated for breast cancer (BC) treatment-related symptoms than whites. This study assessed the impact of patient-physician communication on symptom resolution. A cross-sectional, California statewide survey was conducted among 921 low-income women with BC. Ethnic/racial differences in BC treatment-related symptoms (pain, nausea/vomiting, depression) reporting and physician' awareness of these symptoms were assessed by patient report. Multivariate logistic regression models were used to investigate the impact of patient-physician communication on symptom resolution. Depression was the most common symptom reported by patients (66%), yet physicians were the least aware of it (26.3%), especially among less-acculturated Latinas (18.9%) and Asian/Pacific Islanders (14%; P < 0.001). Greater patient-perceived self-efficacy in communication with physicians and greater physician awareness of the symptom positively predicted pain resolution, controlling for sociodemographic variables, comorbidity, and treatment received (AOR = 1.05, P < 0.0001; AOR = 6.12, P < 0.001). Physician awareness was a significant determinant of depression resolution (AOR = 13.46, P < 0.001). Yet patient-perceived self-efficacy played a much more important role than physicians' awareness in nausea resolution (AOR = 1.04, P = 0.0002). Less-acculturated Latinas tended to achieve less symptom resolution than whites, while this negative impact disappeared or was moderated after patient-physician communication was considered. This study suggests that physicians under-recognized depression, especially among Latinas. The resolution of BC treatment-related symptoms can be addressed by appropriate educational interventions targeted at patient-physician communication. Effective patient-physician communication can moderate disparities in symptom resolution among Latinas, regardless of language acculturation.
低收入、少数族裔女性在接受乳腺癌 (BC) 治疗相关症状治疗方面的可能性低于白人。本研究评估了医患沟通对症状缓解的影响。在加利福尼亚州进行了一项横断面、全州范围内的调查，调查对象为 921 名低收入乳腺癌女性。通过患者报告评估了 BC 治疗相关症状（疼痛、恶心/呕吐、抑郁）报告和医生对这些症状的认识方面的种族/民族差异。使用多变量逻辑回归模型调查了医患沟通对症状缓解的影响。患者报告的最常见症状是抑郁（66%），但医生对此的认识最低（26.3%），尤其是在文化程度较低的拉丁裔（18.9%）和亚裔/太平洋岛民（14%）中（P<0.001）。患者对与医生沟通的自我效能感越高，医生对症状的认识程度越高，这两者均能正向预测疼痛缓解，控制社会人口学变量、合并症和所接受的治疗后（优势比=1.05，P<0.0001；优势比=6.12，P<0.001）。医生对症状的认识是抑郁缓解的重要决定因素（优势比=13.46，P<0.001）。然而，与医生的认识相比，患者感知到的自我效能在缓解恶心方面发挥了更为重要的作用（优势比=1.04，P=0.0002）。文化程度较低的拉丁裔女性在症状缓解方面的效果往往不如白人，但在考虑了医患沟通之后，这种负面影响消失或被缓和。本研究表明，医生对抑郁的认识不足，尤其是在拉丁裔中。通过针对医患沟通的适当教育干预，可以解决 BC 治疗相关症状的缓解问题。有效的医患沟通可以缓和拉丁裔女性在症状缓解方面的差异，无论其语言文化程度如何。
