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

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

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Psychological
  • Aged
  • Attitude to Health*
  • Breast Neoplasms / ethnology*
  • Breast Neoplasms / therapy*
  • Communication*
  • Cross-Sectional Studies
  • Decision Making
  • Female
  • Health Behavior*
  • Hispanic Americans / statistics & numerical data
  • Humans
  • Mastectomy
  • Middle Aged
  • Physician-Patient Relations*
  • Power, Psychological*
  • Socioeconomic Factors
  • Surveys and Questionnaires
  • Treatment Outcome