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. 2008 Nov;27(6):728-36.
doi: 10.1037/0278-6133.27.6.728.

Racial/ethnic differences in breast cancer outcomes among older patients: effects of physician communication and patient empowerment

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Racial/ethnic differences in breast cancer outcomes among older patients: effects of physician communication and patient empowerment

Rose C Maly et al. Health Psychol. 2008 Nov.

Abstract

Objectives: To examine racial/ethnic disparities in older women's health-related quality of life (QoL) and type of breast cancer treatment as mediated by physician-level and individual-level variables.

Methods: A cross-sectional survey of a population-based, consecutive sample identified through the Los Angeles Cancer Surveillance Program of Latina (n = 99), African American (n = 66), and White (n = 92) women aged 55 years or older (N = 257) between 3 and 9 months after primary breast cancer diagnosis and at least 1 month posttreatment. An exploratory, empirically developed latent variable model tested the relationships among demographic and physician-related variables, patient attitudes, and health-related outcomes. Health-related outcomes included QoL measures and receipt of breast conserving surgery (BCS).

Results: Latinas reported less BCS and poorer QoL compared with Whites. Physician communication that can empower patients, in terms of patient efficacy in patient?physician interactions and breast cancer knowledge, mitigated racial/ethnic disparities in receipt of BCS. Physician emotional support was not related to patient cognitive empowerment and treatment outcomes. Medical mistrust in minority women was related to less self-efficacy and less positive coping, as well as, both directly and indirectly, to reduced QoL. Latinas reported poorer QoL in the tested model.

Conclusion: Physician communication style, specifically information giving and participatory decision making, may empower older women with breast cancer and help mitigate racial/ethnic disparities in surgical treatment received.

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Figures

Figure 1
Figure 1
Final structural equation model depicting the effect of physician communication and patient cognitive factors on treatment received and quality of life. Note: All estimated parameters are standardized. The large circles designate latent variables; the rectangles represent measured variables. One-headed arrows represent regression paths, two-headed arrows represent correlations. ap < .05; bp < .01; cp < .001. (PEPPI = Perceived Efficacy in Patient-Physician Interactions).

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