Health care disparities in older patients with breast carcinoma

Abstract

BACKGROUNDLittle is known about how disparities in the treatment of patients with breast carcinoma based on patient age and ethnicity are effected or mitigated at the patient‐physician interaction level. The objectives of this study were to document physician provision of informational support to patients at the time of a new diagnosis of breast carcinoma and to assess differences according to patient age and ethnic group in terms of the information received and desired.METHODSParticipants were 222 patients with breast carcinoma in Los Angeles County, California, age ≥ 55 years who were interviewed within 6 months of their diagnosis of breast carcinoma and/or within 1 month posttreatment. Respondents were asked about receipt and helpfulness of 10 tangible informational support items (e.g., whether booklets, videotapes, medical records, etc. were provided by physicians) and 15 interactive informational support items (e.g., whether physicians discussed breast cancer topics, such as risk of recurrence or treatment options). An index of the tangible informational support items and a scale of the interactive informational support items received were created for summary analyses. Patients' medical records were abstracted for breast carcinoma stage and treatment type; surgeons also were surveyed about sociodemographic and practice characteristics.RESULTSIn multiple linear regression analyses, older age (β coefficient [β] ± standard error [SE], − 0.08 ± 0.02; P = 0.001) and Latina ethnicity (β ± SE, − 1.21 ± 0.40; P = 0.003) had a negative association with physician provision of interactive informational support, controlling for patient and physician sociodemographic characteristics, practice characteristics, breast carcinoma stage, comorbidity, number of physicians seen, visit length, social support, and patient self‐efficacy in interacting with physicians (adjusted correlation coefficient [R2] for the model, 0.33; P < 0.00001). Both older patients and ethnic minority patients, as well as their respective comparison groups, rated most breast cancer information as at least as helpful. Both groups preferred interpersonal sources of information to written sources, although they received interpersonal sources less frequently.CONCLUSIONSOlder patients and Latina patients with breast carcinoma received less interactive informational support from their physicians compared with younger patients, differences that persisted after controlling for a wide range of sociodemographic, psychosocial, and physician factors. Improving the quality of communication at the patient‐physician interaction level may be an important avenue to reducing age and ethnic group treatment disparities among patients with breast carcinoma. Cancer 2003;97:1517–27. © 2003 American Cancer Society.DOI 10.1002/cncr.11211

Breast cancer disparities and decision-making among U.S. women

“…One advantage of the decision board over other informational aids such as multimedia interventions [55,56] is that it presents information in distinct, rather isolated and sequential pieces, limiting the amount of information to be processed at any one moment. The activity also is highly interactive, consistent with evidence that women facing breast cancer decisions desire interpersonal communication in health care decisions [2,62]. Cognitive retention issues are addressed as patient retain materials.…”

“…The literature suggests that ethnically diverse and disadvantaged women are less likely to receive culturally appropriate information from their physicians [2], to be involved in the therapeutic decision [3,4], and to receive definitive treatment for early stage breast cancer [5].…”

“…Yet breast cancer levies a high cost for women, particularly those in the ethnically and economic diverse populations least likely to be health literate. Not only can screening measures be underused and ineffective in these communities, but socioeconomic, racial, and ethnic disparities persist in the use of the best evidencebased treatments (with the best outcomes) for diagnosed breast cancer [1][2][3][4][5].…”

Racial and ethnic differences in breast cancer survival

“…41 Such differences may reflect the patient-physician relationship, patient preferences, and/or institutional and interpersonal racism across healthcare service provision. [41][42][43] Differences in quality may occur in some contexts more often than others, partially explaining why differences persist within stage II/III only for AA and white women. 41 For example, R/E differences in the quality of breast cancer care are unlikely to occur when all women are expected to do well or less well (ie, early/late stage) but become unmasked in situations in which timeliness and quality are more likely to affect outcomes (ie, stage II/III cancers).…”

Patients' Perceptions of Hospital Discharge Informational Content

“…Nonwhite patients have rated teaching about medications and health promotion as very important (Oermann, Harris, & Dammeyer, 2001) but have also reported receiving less interactive informational support than White patients (Maly, Leake, & Silliman, 2003) and less involvement in medical treatment decision making (Cooper-Patrick et al, 1999). Cultural differences may affect communication and understanding, especially when language barriers are present (Maly et al, 2003).…”