The Importance of Patient Engagement to Quality of Breast Cancer Care and Health-Related Quality of Life: A Cross-Sectional Study among Rural and Urban Latina Breast Cancer Survivors

Abstract

KEYWORDSPatient engagement, shared decision making, quality of care, quality of life, breast cancer, Latino/Hispanic Americans do not receive evidence-based care that meets their needs [1]. In patient-centered care, the patient's health needs and desired outcomes drive health care decisions and quality measurement [2]. Patient engagement and collaborative shared decision making are the cornerstones of patient-centered care. There is strong evidence that both patient engagement and shared decision making are associated with better patient outcomes, including greater patient satisfaction and better physical and mental well-being [3-5]. These associations are observed for cancer patients as well. Among cancer patients, patient engagement and shared decision making are associated with greater patient satisfaction, better treatment adherence, greater self-efficacy for managing health, better quality of life, and improved survival [6-10]. Compared to white breast cancer survivors and more acculturated Latinas, less acculturated Latina breast cancer survivors report less involvement in treatment decision making, greater treatment decision making regret, less satisfaction with breast cancer care information provided, a more limited understanding of their diagnosis and treatment, lower self-efficacy for interacting with physicians, and worse patient-physician relationships [11-16]. Among Latina breast cancer survivors, greater English proficiency was associated with better communication effectiveness specific to treatment decision making, and better communication predicted greater satisfaction, which, in turn, predicted better quality of life [17]. These studies suggest that compared to their English-speaking counterparts, Spanish-speaking Latina breast cancer survivors engage less with their physicians, are less satisfied with their care, and report poorer health-related quality of life.Initially, patients with low English proficiency may experience or prefer more provider-driven communication because they have a harder time understanding the information provided during visits and asking for clarification [4]. In qualitative studies, Spanish-speaking Latino patients reported feeling they are a burden to physicians, preferring to manage with difficulty on their limited Englishspeaking abilities, rather than request a medical interpreter [18].In addition to language factors, among Latina breast cancer survivors, cultural values related to role expectations and preferred communication styles could help explain why they are less involved in their care. Traditional Latino cultural factors such as "simpatia" and respect for authority figures could