Comparisons of Physician-Patient Communication and Shared Decision-Making Process for Treatment Between Chinese and Non-Hispanic White Women Breast Cancer Survivors: A Mixed-Method Study

Purpose: A large proportion of the Chinese American population (76%) are immigrants, who are more likely to be diagnosed with an advanced breast cancer stage and die from breast cancer than their US-born Chinese counterparts. Moreover, Chinese American breast cancer patients are less likely than NHW patients to initiate radiation and hormonal therapy which have proved to reduce breast cancer mortality rates in previous studies (Ragaz et al., 1997) and are more likely to experience adverse events from chemotheraphy than NHW patients(Bourdeanu et al., 2012). Patient-physician communication affects cancer patients’ initiation of adjuvant therapy and their treatment satisfaction (Yanez, Stanton, & Maly, 2012). However, there is a dearth of research investigating how Chinese breast cancer patients make adjuvant therapy treatment decisions and communicate with physicians about treatment-induced physical symptoms. Understanding Chinese cancer patients’ process of treatment decision making is essential in designing effective interventions to improve their breast cancer outcomes. The present study aims are to: 1) examine and compare patient-physician communication, using the RIAS medical coding system, to identify similarities and differences in decision making processes between Chinese and NHW breast cancer patients, and 2) examine whether or not patients’ satisfaction with their treatment decisions and physical and emotional functioning are related to communication with physicians, patients’ treatment knowledge, preference for shared decision making and physicians’ and caregivers’ attitudes toward SDM.

Method: Data were collected from patients, caregivers, physicians and system level to understand Chinese patients’ decision making process. Twenty-two Chinese and 22 NHW women over age 20 who were newly diagnosed with breast cancer at stage I-III from a breast cancer surgical clinic at a community hospital in Los Angeles. Patients participated in 1) audio-recordings of communication with their surgeon and oncologist at the initial and a follow-up visits and 2) baseline and six-month follow up surveys. Breast cancer patients with a recurrence or second cancer were ineligible for participation in the study.   

Results: Preliminary analysis of the data shows that after adjusting for language factors, disparities in quality of communication still exist between Chinese immigrant breast cancer survivors and NHW breast cancer survivors. Relative to NHW survivors, Chinese cancer survivors had a greater likelihood of leaving physicians’ offices with unanswered questions, being less engaged to ask questions about treatment, making fewer statements indicating reassurance or optimism, and playing passive roles during the medical encounter. Physician-patient communication was more physician-centered (more biomedical talk and less psychosocial/lifestyle talk) during the visits.  

Conclusions and Implications: To our knowledge, the present study is the first study investigating the treatment decision making process among newly diagnosed Chinese breast cancer patients. Data from this study provide vital information to advance the field of knowledge about ethnic variations in cancer treatment communication, treatment decision making process, the use of adjuvant therapy, and the roles of social workers in medical settings. The results will assist to develop effective intervention tools which will be the first culturally sensitive program that may ultimately promote more positive breast cancer outcomes in this population.