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Exploring Racial Differences in Treatment Decision-making in Chinese Immigrant and White American Breast Cancer Patients: the Role of Patient-Provider Communication

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Abstract

Chinese immigrant cancer patients report suboptimal patient-provider communication, which increases the likelihood of decisional conflict and unsatisfactory treatment decision-making (TDM) outcomes (e.g., low satisfaction and perceived control over cancer care). This cross-sectional study explored whether (1) communication and decisional conflict factors associated with TDM outcomes differed between Chinese immigrant and non-Hispanic White breast cancer patients, and (2) the association between patient-provider communication and the outcomes were mediated by TDM factors, regardless of race. Ninety-eight breast cancer patients, diagnosed at stage I–III participated in cross-sectional survey interviews. TDM outcomes and possible predictors of the outcomes (e.g., patient-provider communication, decisional conflict, preference for who makes the treatment decision) were assessed. Linear regression and mediational testing were performed to examine associations among variables of interest. Of the 98, 85 were included for analysis. Chinese patients with limited English proficiency (n = 37) had poorer patient-provider communication, higher decisional conflict, and preferred providers to make decisions than non-Hispanic White patients (n = 48; all p < .05). They also had lower satisfaction with their TDM process after controlling for predictors (e.g., patient-provider communication) (p < .001). There were no significant racial differences in perceived control, controlling for covariates. Regardless of race, patients who reported quality patient-provider communication reported less decisional conflict. These patients also reported increased satisfaction and perceived control. The disparities Chinese immigrant cancer patients experienced in the TDM process may be related to their cultural communication style with providers. Facilitating Chinese patients’ communication and partnership with providers may reduce decisional conflicts and increase their TDM outcomes.

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Acknowledgements

We thank Dr. Beth N. Peshkin for her comments on the manuscript, and Wen Cheng Deng, Alice Ting, Li-Hua Huang, and Tian Han for their help in patient enrollment, data collection, or data programming.

Funding

The project described was supported by the Georgetown University Lombardi Comprehensive Cancer Center-Nina Hyde Advancement Donations for Breast Cancer Research, and by the National Cancer Institute (NCI): the P30CA051008, the P30CA016059, and the R01CA142941 supplemental fund. The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Sect. 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000035C awarded to the University of Southern California.

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Authors and Affiliations

  1. Department of Oncology, Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA

    Ellen R. Huang, Joshua Longcoy & Judy Huei-yu Wang

  2. Department of Biostatistics, Epidemiology, and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA

    Joshua Longcoy

  3. UCLA Health, Los Angeles, CA, USA

    Jeannie Shen

  4. University of Southern California Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA

    Suh-Chen Hsiao

  5. Department of Social Work, Tzu Chi University, Hualien, Taiwan

    Hsin-Yi Hsiao

  6. Department of Oncology, Fisher Center for Hereditary Cancer and Clinical Genomics Research, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA

    Claudine Isaacs

  7. Department of Health Behavior and Policy, Massey Cancer Center Office of Health Equity Disparities Research, Virginia Commonwealth University School of Medicine, Richmond, VA, USA

    Vanessa B. Sheppard

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  1. Ellen R. Huang
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  2. Joshua Longcoy
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Correspondence to Judy Huei-yu Wang.

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The ideas and opinions expressed herein are solely the responsibility of the author(s). The content of this article does not represent the official views of the National Institutes of Health (NIH). Endorsement by the Georgetown University Medical Center, the State of California Department of Public Health, the National Cancer Institute and NIH or their Contractors and Subcontractors is not intended nor should be inferred.

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Huang, E.R., Longcoy, J., Shen, J. et al. Exploring Racial Differences in Treatment Decision-making in Chinese Immigrant and White American Breast Cancer Patients: the Role of Patient-Provider Communication. J Canc Educ 38, 66–73 (2023). https://doi.org/10.1007/s13187-021-02079-y

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