Division of Health Services Management and Policy at the Ohio State University College of Public Health, and Faculty Affiliate of the James Comprehensive Cancer Center, Columbus, OH, United States of America.
Division of Health Services Management and Policy at the Ohio State University College of Public Health, Columbus, OH, United States of America.
PLoS One. 2023 Mar 1;18(3):e0278742. doi: 10.1371/journal.pone.0278742. eCollection 2023.
Women at high risk of breast cancer face complex decisions about how to manage those risks. Substantial gaps in current knowledge include how women make these decisions and how decision making may differ across sub-populations. Among these critical gaps are the questions of (a) whether racial differences exist between the experiences of high-risk women navigating breast cancer risk, and (b) what consequences those racial differences might have on women's ability to manage their cancer risks. The present study is designed to address these questions directly.
Fifty semi-structured interviews were conducted with high-risk Black (n = 20) and white women (n = 30) between May 2015 and March 2016 in person in Ohio and by phone. Transcribed data were analyzed using grounded theory methods.
Our analyses suggest that many of the core decision-making dynamics high-risk women navigate differ by race. The experiences of white and Black women in our study differ in terms of (a) contextualizing risk-how women make sense of their own breast cancer risk, the degree to which they worry about risk, and how they prioritize risk within the contexts of their broader lives; (b) conceptualizing risk management-how, how much, and from whom women learn about and conceptualize their options for preventing cancer and/or ensuring that cancer gets diagnosed early; and (c) constraints-the external barriers women face throughout their decision-making and risk-management processes. In sum, the Black women we interviewed reported feeling less well-situated to consider and cope actively with breast cancer risk, less well-informed about risk-management options, and more constrained in their use of these options.
High-risk women's accounts of the complex dynamics that shape breast cancer prevention decisions suggest that these dynamics vary substantially by race, such that Black women may experience disadvantages relative to whites.
患有乳腺癌高风险的女性在如何管理这些风险方面面临着复杂的决策。目前知识存在很大差距，包括女性如何做出这些决策以及决策在不同亚人群中可能存在差异。这些关键差距包括：（a）在高风险女性探索乳腺癌风险的经历中是否存在种族差异，以及（b）这些种族差异可能对女性管理癌症风险的能力产生哪些后果。本研究旨在直接解决这些问题。
2015 年 5 月至 2016 年 3 月，在俄亥俄州，我们以面对面和电话的方式对 50 名高风险的黑人（n = 20）和白人女性（n = 30）进行了半结构化访谈。使用扎根理论方法分析转录数据。
我们的分析表明，高风险女性所面临的许多核心决策动态因种族而异。我们研究中的白人女性和黑人女性的经历在以下方面存在差异：（a）风险情境化——女性如何理解自己的乳腺癌风险、对风险的担忧程度，以及她们如何在更广泛的生活背景下优先考虑风险；（b）风险管理概念化——女性了解和概念化预防癌症和/或确保癌症早期诊断的选择的方式、程度和来源；以及（c）约束——女性在整个决策和风险管理过程中面临的外部障碍。总的来说，我们采访的黑人女性报告说，她们感到自己在考虑和积极应对乳腺癌风险方面的处境较差，对风险管理选择的了解较少，并且在使用这些选择方面受到的限制较多。
高风险女性对塑造乳腺癌预防决策的复杂动态的描述表明，这些动态在很大程度上因种族而异，因此黑人女性可能相对于白人女性处于劣势地位。
