Racial/ethnic group differences in treatment decision-making and treatment received among older breast carcinoma patients

BACKGROUND. Health care disparities have been identified in the treatment of older and racial/ethnic minority breast carcinoma patients. The purpose of the current study was to examine racial/ethnic group differences ill the treatment decision-making process of older breast carcinoma patients and the differential impact on treatment received. METHODS. A cross-sectional survey was conducted of a population-based, consecutive sample identified by the Los Angeles Cancer Surveillance Program comprised of Latina (n = 99), African-American In = 66), and white (n = 92) women age 55 years (total n = 257) and who were between 3-9 months after their primary breast carcinoma diagnosis. RESULTS. Approximately 49% of less acculturated Latinas and 18% of more acculturated Latinas indicated that their family members determined the final treatment decision, compared with less than 4% of African-Americans and whites (P < 0.001). This disparity remained in multiple logistic regression analysis, controlling for potential confounders, including sociodemographic, physician-patient communication, social Support, and health variables. Compared with African-American and white women, Latina women were more likely to identify a family member as the final treatment decision-maker (adjusted odds ratio [AOR] of 7.97; 95% confidence interval [95% CI], 2.43-26.20, for less acculturated Latinas; and AOR of 4.48; 95% Cl, 1.09-18.45, for more acculturated Latinas). A multiple logistic regression model, controlling for sociodemographic and health characteristics, indicated that patients were less likely to receive breast-conserving surgery, (BCS) when the family made the final treatment decision (AOR of 0.39; 95% Cl, 0.18-0.85). CONCLUSIONS. Family appears to play a powerful role in treatment decision-making among older Latina breast carcinoma patients, regardless of the level of acculturation. This family influence appears to contribute to racial/ethnic group differences in treatment received. Physicians should acknowledge and educate patients' family members as potential key participants in medical decision-making, rather than merely as translators and providers of social support.