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Wednesday, October 24, 2007
P4-20

LATINA PATIENT PERSPECTIVES ON INFORMED SURGICAL TREATMENT DECISION MAKING FOR BREAST CANCER

Sarah T. Hawley, PhD, MPH1, Nancy Janz, PhD2, Ann Hamilton, PhD3, Jennifer Griggs, MD4, and Steven Katz, MD1. (1) University of Michigan, Ann Arbor VA Health System, Ann Arbor, MI, (2) University of Michigan, School of Public Health, Ann Arbor, MI, (3) USC, Keck School of Medicine, Los Angeles, CA, (4) University of Michigan, Ann Arbor, MI

Background: Although increasing decisional involvement has been identified as a mechanism for reducing disparities in breast cancer treatment outcomes and improving the quality of care, little is known about these issues from the Latina perspective. Purpose: To evaluate Latina breast cancer patient perspectives about involvement in and informed decision making for surgical breast cancer treatment. Methods: 2030 women with non-metastatic breast cancer diagnosed from 8/05-5/06 and reported to the Los Angeles metropolitan SEER registries were mailed a survey approximately 7 months after surgical treatment. Latina women were over-sampled using a surname methodology developed by the U.S. Census. We report preliminary results on an 82% sample (N=1106). We evaluated ethnic differences in four outcomes related to the surgical treatment decision: involvement in the treatment decision, concordance between actual and preferred amount of involvement, decision satisfaction and decision regret. Independent variables included patient race/ethnicity (Latina-Spanish speaking, Latina-English speaking, African American, Caucasian), age, education, health literacy and clinical variables (tumor behavior, size and histology). Decision outcomes were categorized into dichotomous or 3-level outcomes and multivariate regression used to evaluate correlates of each decision outcome. Results: Approximately 28% of women in each ethnic group reported a surgeon-based, 33% a shared, and 38% a patient-based surgery decision. Spanish speaking Latinas were more likely to report wanting more involvement in the decision than any other ethnic group (P<0.001). All minority groups were less likely than white women to have high decision satisfaction (P<0.05). Spanish speaking Latina women were least likely to have high decision satisfaction and most likely to have high decision regret (P<0.001). Low health literacy was associated with low satisfaction and high regret. Multivariate analyses confirmed an independent effect of Latina race/ethnicity, low education and low health literacy on poor decision outcomes (P<0.05). Conclusions: Latina women face challenges in making informed breast cancer treatment decisions. Future research should explore the interplay between race/ethnicity, education and health literacy. Interventions to reduce disparities in breast cancer outcomes may need to be tailored to ethnicity and degree of acculturation.