Relationships Among Family Cancer Communication, Patient-Physician Communication, Reframing Coping, and Quality of Life Among Chinese- and Korean-American Breast Cancer Survivors

With the recent attention given to the quality cancer survivorship care, communication issues have gained increased interest. During the survivorship journey, effective family communication and patient-physician communication may play significant roles in determining survivors’ quality of life (QOL). However, little is known about the relationships among family and patient-physician communication, coping, and QOL among Chinese- and Korean-American Breast Cancer Survivors (BCS). The purpose of this study is 1) to investigate direct relationships among family cancer communication, patient-physician communication, reframing coping, and quality of life among Chinese- and Korean-American BCS, 2) to examine the mediating effect of reframing coping between communication and QOL, and 3) to explore the possible moderating role of acculturation on the overall relationship.

Using a cross-sectional survey design, a total of 157 Chinese- (n=86) and Korean-American BCS (n=71) who were 6 months to 6.5 years post-diagnosis were recruited from the California Cancer registry and local hospitals in Los Angeles County. Family cancer communication, patient-physician communication, reframing coping, and acculturation were measured using standardized instruments. A latent construct of QOL was assessed by the FACT-B measuring five QOL dimensions: physical, social, emotional, functional well-being and breast cancer-specific concerns. Participants were classified as either above or below the mean on acculturation score. Structural equation modeling (SEM) was conducted to test for direct and mediating effects. The significance of mediating effects was confirmed by Sobel tests. A multi-group SEM analysis was performed to explore whether these relations vary between low- and high-acculturated Chinese- and Korean-American BCS.

The mean age of participants was 55.31 years (SD=9.66). Of the 157 participants, 85 survivors had above acculturation mean scores and were classified as high-acculturated group and 71 survivors were included in low-acculturated group. Results of SEM analysis revealed that the structural model fits to the data (χ²(15) =27.88, CFI=.97, GFI=.96, RMSEA=.074, and SRMR=.049). SEM results revealed that better family cancer communication and patient-physician communication had direct effects on positive reframing coping and better QOL. Positive reframing coping had a direct positive effect on QOL. Results of SEM and Sobel tests revealed that reframing coping mediated the relationship between family cancer communication and QOL (z = 2.94, p <.001) and between patient-physician communication and QOL (z = 3.37, p<.001). Results of the multi-group SEM analysis showed the presence of model invariance across acculturation categories. However, findings suggest that path differences exist between low- and high-acculturated groups, thus, caution may be warranted in interpreting the results. Family cancer communication was related to reframing coping and QOL in the low-acculturated group, whereas patient-physician communication was related to reframing coping and QOL in the high-acculturated group.  

This study helps us better understand the direct and indirect relationships among family cancer communication, patient-physician communication, reframing coping, and QOL among Chinese- and Korean-American BCS. Study findings demonstrated better cancer communication with family and physician may increase reframing coping abilities, which may promote quality of life. The findings provide the rationale for targeting psychosocial interventions aimed at improving family and patient-physician communication for Chinese- and Korean-American BCS.