Second Opinion: Families' Role in Breast Cancer Treatment Decision-Making Among Older African American Women

Breast cancer is the most common type of cancer in African American women (American Cancer Society, 2007).  According to the National Institutes of Health and the Institute of Medicine, African Americans experience substantial disparities in the burden of disease and death when compared to White Americans. African Americans are at greater risk for nearly every leading cause of death, such as heart disease, cardiovascular disease, HIV infection/AIDS, stroke, and cancer.  With the rapidly aging population in the United States, cancer is expected to become the leading cause of death.  Cancer-related health disparities have been found in both African Americans and older patients.  For example, mortality rates from breast cancer increase for all women with age, but the mortality rates are highest among older African American women (American Cancer Society, 2007).  Hence, the combination of age and ethnicity puts older African American women at great risk for poor cancer outcomes.

Breast cancer patients often face an array of treatment options including chemotherapy, radiation, surgery, and experimental treatments.  Decision-making, particularly when dealing with a life-threatening illness such as cancer, is a complex area of research which requires attention to both intrinsic (individual) and social (interactive) factors involved in the decision-making process. 

Although mortality rates from breast cancer increase for all women with age, the mortality rates are highest among older African American women, due to the combination of age and ethnicity. Inadequate decisions regarding treatment have been identified as one possible factor contributing to cancer disparities. Studies suggest that family members play an important role in helping older African American women make decisions about breast cancer treatment. The purpose of this study was to understand the family’s role in the decision making process when older African American women are confronted with breast cancer. These findings are part of a larger study of breast cancer decision making among older African American women and their family members.  A qualitative phenomenological approach was utilized in this study. In-depth interviews were conducted with 15 older African American women (45 and older) who had been diagnosed with and received treatment for breast cancer and 15 family members as identified by the patients.  This report focuses specifically on experiences of the family members.  The Emerging themes include: 1) family’s desire for more aggressive treatment, 2) family member concern for own health, 3) family’s opinion of the doctors, 4) husbands less engaged in cancer care, 5) if you look for it, you will find it.  The findings of this study can have implications for family-focused interventions that would enhance the decision making process for breast cancer treatment among older African American women.