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.
Similar content being viewed by others
Availability of Data and Material
Contact the corresponding author for study materials.
Code Availability
Not applicable.
References
Hack TF, Degner LF, Watson P, Sinha L (2006) Do patients benefit from participating in medical decision making? Longitudinal follow-up of women with breast cancer. Psychooncology 15(1):9–19. https://doi.org/10.1002/pon.907
O’Connor AM, Tugwell P, Wells GA, Elmslie T, Jolly E, Hollingworth G, McPherson R, Bunn H, Graham I, Drake E (1998) A decision aid for women considering hormone therapy after menopause: decision support framework and evaluation. Patient Educ Couns 33(3):267–279. https://doi.org/10.1016/s0738-3991(98)00026-3
Palmer NR, Kent EE, Forsythe LP, Arora NK, Rowland JH, Aziz NM, Blanch-Hartigan D, Oakley-Girvan I, Hamilton AS, Weaver KE (2014) Racial and ethnic disparities in patient-provider communication, quality-of-care ratings, and patient activation among long-term cancer survivors. J Clin Oncol 32(36):4087–4094. https://doi.org/10.1200/JCO.2014.55.5060
Ranchor AV, Wardle J, Steptoe A, Henselmans I, Ormel J, Sanderman R (2010) The adaptive role of perceived control before and after cancer diagnosis: a prospective study. Soc Sci Med 70(11):1825–1831. https://doi.org/10.1016/j.socscimed.2009.10.069
Shabason JE, Mao JJ, Frankel ES, Vapiwala N (2014) Shared decision-making and patient control in radiation oncology: implications for patient satisfaction. Cancer 120(12):1863–1870. https://doi.org/10.1002/cncr.28665
Gabay G (2015) Perceived control over health, communication and patient-physician trust. Patient Educ Couns. https://doi.org/10.1016/j.pec.2015.06.019
Kang S, Tucker CM, Wippold GM, Marsiske M, Wegener PH (2016) Associations among perceived provider cultural sensitivity, trust in provider, and treatment adherence among predominantly low-income Asian American patients. Asian Am J Psychol 7(4):295–304. https://doi.org/10.1037/aap0000058
Lee SCK, Knobf MT (2015) Primary breast cancer decision-making among Chinese American women: Satisfaction, regret. Nurs Res 64(5):391–401. https://doi.org/10.1097/NNR.0000000000000116
Wang J, Adams I, Pasick R, Gomez S, Allen L, Ma G et al (2013) Perceptions, expectations, and attitudes about communication with providers among Chinese American and non-Hispanic white women with early stage breast cancer. Support Care Cancer 21(12):3315–3325. https://doi.org/10.1007/s00520-013-1902-8
Anderson J, Moeschberger M, Chen MS Jr, Kunn P, Wewers ME, Guthrie R (1993) An acculturation scale for Southeast Asians. Soc Psychiatry Psychiatr Epidemiol 28(3):134–141. https://doi.org/10.1007/BF00801744
Schroy P, Emmons K, Peters E, Glick J, Robinson P, Lydotes M et al (2011) The impact of a novel computer-based decision aid on shared decision making for colorectal cancer screening: a randomized trial. Med Decis Making 31(1):93–107. https://doi.org/10.1177/02F0272989X10369007
Arora N, Hamilton A, Potosky A, Rowland J, Aziz N, Bellizzi K et al (2007) Population-based survivorship research using cancer registries: a study of non-Hodgkin’s lymphoma survivors. Journal of Cancer Survivorship: Research and Practice 1(1):49–63. https://doi.org/10.1007/s11764-007-0004-3
DiMatteo MR, Hays RD, Gritz ER, Bastani R, Crane L, Elashoff R et al (1993) Patient adherence to cancer control regimens: scale development and initial validation. Psychol Assess 5(1):102–112. https://doi.org/10.1037/1040-3590.5.1.102
O’Connor A (2010) User manual- Decisional Conflict Scale (16 item statement format). https://decisionaid.ohri.ca/docs/develop/User_Manuals/UM_Decisional_Conflict.pdf. Accessed 24 Sept 2019
Sawka CA, Goel V, Mahut CA, Taylor GA, Thiel EC, O’Connor AM et al (1998) Development of a patient decision aid for choice of surgical treatment for breast cancer. Health Expect 1(1):23–36. https://doi.org/10.1046/j.1369-6513.1998.00003.x
Massachusetts General Hospital (2010) Decision quality worksheet for chemotherapy and hormone therapy. https://mghdecisionsciences.org/tools-training/decision-quality-instruments. Accessed 24 September 2019
Chew LD, Griffin JM, Partin MR, Noorbaloochi S, Grill JP, Snyder A et al (2008) Validation of screening questions for limited health literacy in a large VA outpatient population. J Gen Intern Med 23(5):561–566. https://doi.org/10.1007/s11606-008-0520-5
Llewellyn-Thomas H, Mcgreal M, Thiel E, Fine S, Erlichman C (1991) Patients’ willingness to enter clinical trials: measuring the association with perceived benefit and preference for decision participation. Soc Sci Med 32(1):35–42. https://doi.org/10.1016/0277-9536(91)90124-U
Sherbourne CD, Stewart AL (1991) The MOS social support survey. Soc Sci Med 32(6):705–714. https://doi.org/10.1016/0277-9536(91)90150-B
Green S (1991) How many subjects does it take to do a regression analysis? Multivar Behav Res 26(3):499–510. https://doi.org/10.1207/s15327906mbr2603_7
Yung YF, Lamm M, Zhang W, Causal mediation analysis with the CAUSALMED procedure. Proceedings from the SAS Global Forum, (2018) Conference. SAS Institute Inc, Cary, NC
Obeidat RF, Homish GG, Lally RM (2013) Shared decision making among individuals with cancer in non-Western cultures: a literature review. Oncol Nurs Forum 40(5):454–463. https://doi.org/10.1188/13.ONF.454-463
Cox N, Bowmer C, Ring A (2011) Health literacy and the provision of information to women with breast cancer. Clin Oncol 23(3):223–227. https://doi.org/10.1016/j.clon.2010.11.010
Ishikawa H, Yano E (2008) Patient health literacy and participation in the health-care process. Health Expect 11(2):113–122. https://doi.org/10.1111/j.1369-7625.2008.00497.x
Torre LA, Sauer AM, Chen MS Jr, Kagawa-Singer M, Jemal A, Siegel RL (2016) Cancer statistics for Asian Americans, Native Hawaiians, and Pacific Islanders, 2016: Converging incidence in males and females. CA: A Cancer Journal for Clinicians 66(3):182–202. https://doi.org/10.3322/caac.21335
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare no competing interests.
Disclaimer
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.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
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
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13187-021-02079-y