Transcript from Asian American Breast Cancer Patients

What Is Lacking in Patient-Physician Communication:
from Asian American Breast Cancer Patients’ and Oncologists’ Perspectives
Sunmin Lee,1 Grace X. Ma,2,3 Carolyn Y. Fang2,3,4 Lu Chen, 1 Youngsuk Oh,1 Lynn Scully1
1 Department
of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland
2 Department of Public Health, College of Health Professions, Temple University, Philadelphia, Pennsylvania
3 Center for Asian Health, Temple University, Philadelphia, Pennsylvania
4 Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania
INTRODUCTION
Breast cancer is the leading cancer in incidence and among top
five in mortality in Chinese & Korean women (CKW) in the U.S.
(Miller et al., 2008)
Rapid and steady increase of breast cancer incidence in CKW
since 1980’s. (Gormez et al., 2010)
Patient-physician communication and coordination is essential in
the quality of cancer survivorship care. (Arora et al., 2011)
Asian American patients have reported lower satisfaction with
health care compared to Whites and Blacks. (Saha, Arbelaez &
Cooper, 2003)
Key Interview Questions
Patients
Oncologists
• How did you feel about the interaction
between you and your doctor?
• Do you have any barriers in
communicating with your doctor?
• Were there cultural differences in your
communication? If so, what were they?
How would you want to improve this?
• When it came to the decision of your
care, what did you do?
• How did you feel about your role in the
decision making?
•How would you describe your Asian
patients’ interaction with you compared
with White patients in the following
areas:
•Making decisions
•Asking questions
•Talking about fear & distress
• Are there any difficulties other than
language?
• If you do face a language or
communication barrier, what do you
do?
• What is your advice for those who want
to be more actively involved in
treatment?
OBJECTIVE
To explore patient-physician communication process in Asian
American breast cancer patients from both patients and oncologists
perspectives.
METHODS
Study Design
 Face-to-face in-depth interviews with nine Chinese or Korean
breast cancer patients/survivors and three Asian oncologists
who routinely provided care for Asian patients in the
Washington DC metropolitan area.
Patients’ Perspective
Oncologists’ Perspective
Language Barrier
RESULTS
 Patient Characteristics
 n=9 (4 Chinese & 5 Koreans)
 Participants were between 40-69 years of age. Majority were married
(78%) and had college or above education (77%).
 Most of them have completed active cancer treatment (89%). More than
half were diagnosed with breast cancer within a year (56%).
Acknowledgments: This research is a pilot project
supported by NIH-NCI’s Community Network Program
Center, ACCHDC U54 CNPC (1U54CA 153513-01, PI: Grace
Ma)
Cultural Differences
• Expected the doctor to be
authority and were
disappointed when questions
were not answered.
• Dissatisfied with doctor’s
advice on physical activity and
diet which from the patients’
perspective was not
appropriate for Asians.
• In US culture, having breast
cancer is a badge of honor and
surviving is something to be
proud of. For some Asian
women it’s more of a stigma
and they are ashamed and
hesitant to discuss it.
• Many Asian patients want to
know very specifically what
they can and cannot eat, and
are surprised when told that
they should just eat a healthy
balanced diet.
Decision-Making on Treatment
• Physicians played a leading role • Some Asian patients are not
in most cases.
very assertive and will not
• The influence from family
express their concerns. Asians
members was more evident in
in general are not very
participants who were limited
proactive or assertive.
in speaking English.
• They do not want too much
• Many expressed the desire to
information from a physician,
be actively involved in decision
they expect the physician to be
making.
the expert and make the
decisions for them. If they do
not receive this they may even
switch doctors.
Participant Recruitment
 A convenience sample of Chinese and Korean breast cancer
survivors living in Washington D.C. metropolitan area.
 Patients were recruited from community based organizations,
posters on websites well known among Korean/Chinese
immigrants, and personal contacts.
 Oncologists were recruited from personal contacts. They
were not necessarily oncologists of women we interviewed.
Data Collection and Analysis
 Comprehensive interview guides were developed separately
for patients and oncologists based on literature review and
input from experts on breast cancer survivorship and
oncologists.
 Interviews were recorded, transcribed, and translated.
 Transcripts were analyzed by two independent coders and
their analysis was compared and contrasted, and finally
agreed upon in the research team.
• Language was the biggest
• If the women cannot speak
barrier to understanding
English then this serves as a
information and making
large barrier for understanding
treatment decisions.
information and
• Medical terms were a challenge communicating.
even for those who were fluent • Translation by family members
in English.
may not be accurate.
• For some patients, they could
• Some patients may neglect to
only rely on guessing and body ask questions due to concerns
language in extreme situations. of burdening family members.
CONCLUSION, IMPLICATIONS & NEXT STEP
 Oncologist Characteristics
Oncologist #1 Oncologist #2 Oncologist #3
Age (in years)
Country of birth
Gender
Language spoken (other
than English)
Ever communicate with
patients in language other
than English?
Years practicing medicine
47
50
37
Korea
India
US
F
F
M
Korean, Spanish,
Tamil, Spanish
Portuguese
Korean
Yes
Yes
Yes
22
22
14
Language barrier, cultural difference and patient involvement are
key issues in patient-physician communication for Asian American
breast cancer survivors.
Proper patient education with linguistically and culturally
appropriate information and tools may help improve communication
with physician and decision-making process.
As a next step, we plan to design and implement a theory-based,
culturally and linguistically appropriate intervention to Korean breast
cancer survivors. This will include skills to enhance patientphysician communication.