Katz Steven J, Wallner Lauren P, Abrahamse Paul H, Janz Nancy K, Martinez Kathryn A, Shumway Dean A, Hamilton Ann S, Ward Kevin C, Resnicow Kenneth A, Hawley Sarah T
Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan.
Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan.
Cancer. 2017 Aug 15;123(16):3022-3030. doi: 10.1002/cncr.30702. Epub 2017 Apr 11.
The authors examined racial/ethnic differences in patient perspectives regarding their breast cancer treatment experiences.
A weighted random sample of women newly diagnosed with breast cancer between 2013 and 2015 in Los Angeles County and Georgia were sent surveys 2 months after undergoing surgery (5080 women; 70% response rate). The analytic sample was limited to patients residing in Los Angeles County (2397 women).
The pattern of visits with different specialists before surgery was found to be similar across racial/ethnic groups. Low acculturated Latinas (Latinas-LA) were less likely to report high clinician communication quality for both surgeons and medical oncologists (<69% vs >72% for all other groups; P<.05). The percentage of patients who reported high satisfaction regarding how physicians worked together was similar across racial/ethnic groups. Latinas-LA were more likely to have a low autonomy decision style (48% vs 24%-50% for all other groups; P<.001) and were more likely to report receiving too much information versus other ethnic groups (20% vs <16% for other groups; P<.001). Patients who reported a low autonomy decision style were more likely to rate the amount of information they received for the surgery decision as "too much" (16% vs 9%; P<.001).
There appears to be moderate disparity in breast cancer treatment communication and decision-making experiences reported by Latinas-LA versus other groups. The approach to treatment decision making by Latinas-LA represents an important challenge to health care providers. Initiatives are needed to improve patient engagement in decision making and increase clinician awareness of these challenges in this patient population. Cancer 2017;123:3022-30. © 2017 American Cancer Society.
作者研究了患者对乳腺癌治疗经历的看法中的种族/民族差异。
对2013年至2015年在洛杉矶县和佐治亚州新诊断为乳腺癌的女性进行加权随机抽样，在她们接受手术后2个月发送调查问卷（共5080名女性；回复率为70%）。分析样本仅限于居住在洛杉矶县的患者（2397名女性）。
发现不同种族/民族群体在手术前拜访不同专科医生的模式相似。文化适应程度低的拉丁裔女性（洛杉矶拉丁裔）报告外科医生和医学肿瘤学家的临床沟通质量高的可能性较小（<69%，而其他所有群体>72%；P<0.05）。不同种族/民族群体中，报告对医生协作方式高度满意的患者比例相似。洛杉矶拉丁裔更有可能采用低自主性决策方式（48%，而其他所有群体为24%-50%；P<0.001），并且与其他种族群体相比，更有可能报告收到的信息过多（20%，而其他群体<16%；P<0.001）。报告采用低自主性决策方式的患者更有可能将她们在手术决策中收到的信息量评为“过多”（16%对9%；P<0.001）。
洛杉矶拉丁裔与其他群体在乳腺癌治疗沟通和决策经历方面似乎存在中度差异。洛杉矶拉丁裔的治疗决策方式对医疗保健提供者构成了重大挑战。需要采取措施提高患者在决策中的参与度，并增强临床医生对该患者群体中这些挑战情况的认识。《癌症》2017年；123:3022 - 30。©2017美国癌症协会
