Latina patient perspectives about informed treatment decision making for breast cancer

Abstract

Objective: To evaluate Latina breast cancer patient perspectives regarding informed decision making related to surgical treatment decision making for breast cancer.

Methods: 2030 women with non-metastatic breast cancer diagnosed from 8/05 to 5/06 and reported to the Los Angeles metropolitan SEER registries were mailed a survey shortly after surgical treatment. Latina and African-American women were over-sampled. We conducted regression of four decision outcome to evaluate associations between race/ethnicity, demographic and clinical factors, and mechanistic variables (i.e., health literacy) and decision outcomes.

Results: Our analytic sample was 877 women: 24.5% Latina-Spanish speaking (Latina-SP), 20.5% Latina-English speaking, 24% African-American and 26.6% Caucasian. Approximately 28% of women in each ethnic group reported a surgeon-based, 36% a shared, and 36% a patient-based surgery decision. Spanish-preferent Latina women had the greatest odds of high decision dissatisfaction and regret controlling for other factors (OR 5.5, 95% CI: 2.9, 10.5 and OR 4.1, 95% CI: 2.2, 8.0, respectively). Low health literacy was independently associated with dissatisfaction and regret (OR 5.6, 95% CI: 2.9, 11.1 and OR 3.5, 95% CI 1.8, 7.1, respectively) and slightly attenuated associations between Latina-SP ethnicity and decision outcomes.

Conclusion: Despite similar clinical outcomes, patients report very different experiences with treatment decision making. Latina women, especially those who prefer Spanish, are vulnerable to poor breast cancer treatment decision outcomes.

Practice implications: Providers need to be aware of the role of ethnicity, acculturation and literacy in breast cancer treatment discussions.

Figure 1

Actual decision involvement by race/ethnicity^{1 1}percentages adjusted for age, education, marital status and clinical factors

Figure 2

Decision dissatisfaction and regret, by race/ethnicity¹ Percentages adjusted for age, education, marital status and clinical factors * Chi-square for racial/ethnic differences=127.7, p<0.001 ^ Chi-square for racial/ethnic differences=96.3, p<0.001