Communication and Shared Decision Making in the Breast Cancer Treatment Consultation: A Comparative Analysis of English- and Spanish-Speaking Patients

Abstract

Background. Communication in the breast cancer treatment consultation is complex. Language barriers may increase the challenge of achieving patient-centered communication and effective shared decision making. Design. We conducted a prospective cohort study among Spanish- and English-speaking women with stage 0 to 3 breast cancer in two urban medical centers in the Midwestern United States. Patient centeredness of care and decisional conflict were compared between Spanish- and English-speaking participants using the Interpersonal Processes of Care (IPC) and Decision Conflict Scale (DCS), respectively. Clinician behaviors of shared decision making were assessed from consultation audio-recordings using the 12-item Observing Patient Involvement in Decision Making (OPTION) scale. Multivariate regression analyses were conducted to control for differences in baseline characteristics and clinician specialty. Results. Fifteen Spanish-speaking and 35 English-speaking patients were enrolled in the study. IPC scores (median, interquartile range [IQR]) were higher (less patient centered) in Spanish- versus English-speaking participants in the domains of lack of clarity (2.5, 1-3 v. 1.5, 1-2), P = 0.028; perceived discrimination (1.1, 1-1 v. 1.0, 1-1), P = 0.047; and disrespectful office staff (1.25, 1-2 v. 1.0, 1-1), P < 0.0005 (Wilcoxon rank-sum test). OPTION scores (median, IQR) were lower in Spanish- versus English-speaking participants (21.9, 17.7-27.1 v. 31.3, 26.6-39.6), P = 0.001 (Wilcoxon rank-sum test). In multivariate analysis, statistically significant differences persisted in the IPC lack of clarity and disrespectful office staff between Spanish- and English-speaking groups. Conclusions. Our findings highlight challenges in cancer communication for Spanish-speaking patients, particularly with respect to perceived patient centeredness of communication. Further cross-cultural studies are needed to ensure effective communication and shared decision making in the cancer consultation.

Using Mixed Methods With Multiple Stakeholders to Inform Development of a Breast Cancer Screening Decision Aid for Women With Limited Health Literacy

“…This is consistent with work indicating that providers modify their risk discussions with patients with limited numeracy skills. 24 However, patients in our sample, the majority of whom scored incorrectly on numeracy items, identified risk information as a high priority for breast cancer SDM. Proven strategies may help overcome these expert and PCP-perceived numeracy-related barriers to sharing risk: Studies have shown precise risk estimates using decimals may be recalled less and perceived as less credible relative to an integer-based risk estimate.…”

Shared decision‐making in the treatment of adolescents diagnosed with depression: A cross‐sectional survey of mental health professionals in China

“…Whitney et al suggested that trust can be enhanced through communication training or SDM tools that emphasise relational communication (Whitney et al, 2021). Interestingly, according to Pearson correlation analysis, MHPs' discrimination had significant correlation with SDM practices, but it did not show significance in the multiple linear regression analysis, which is inconsistent with previous studies and the hypotheses (Schapira et al, 2019;Whitney et al, 2021). More researches are still needed to explore whether MHPs' discrimination towards consumers affects their practices and perceptions of SDM in the daily management of adolescents diagnosed with depression and the specific reasons (Altman et al, 2019;Progovac et al, 2020).…”

“…Research has shown that strong consumer‐provider alliances built on trust and mutual respect are essential for healthcare providers to understand, incorporate and consistently respect consumers' treatment preferences (Whitney et al., 2021). Consumers exposed to discrimination may face significant challenges in building trusting relationships with providers and participating in the SDM process (Schapira et al., 2019; Whitney et al., 2021). However, few studies have investigated whether MHPs' trust, discrimination and preference influence their SDM practices for adolescents diagnosed with depression.…”

Delays in Care Associated With Non–English-Speaking Patients With Breast Cancer

“…Some studies have shown a lack of clarity in communication for NES Latina patients during their breast cancer consultations; this issue is a potential target for addressing delays after diagnosis. 39 In addition, successful patient navigation, including coordinating appointments, transportation, telephone support, interpretation, and assistance with insurance paperwork, is another target that has been shown to decrease delays in breast cancer treatment. 40 The influence of language on delays in breast cancer care is particularly important in the United States, where the use of languages other than English increased by 148% from 1980 to 2009, especially Spanish, Vietnamese, and Russian.…”