Language barrier, cultural difference and patient involvement are key issues in patient-physician communication for Asian American breast cancer survivors.

1
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
Key Interview Questions
INTRODUCTION
Patients Perspective Oncologists Perspective
Language Barrier Language Barrier
Language was the biggest barrier to understanding information and making treatment decisions. Medical terms were a challenge even for those who were fluent in English. For some patients, they could only rely on guessing and body language in extreme situations. If the women cannot speak English then this serves as a large barrier for understanding information and communicating. Translation by family members may not be accurate. Some patients may neglect to ask questions due to concerns of burdening family members.
Cultural Differences Cultural Differences
Expected the doctor to be authority and were disappointed when questions were not answered. Dissatisfied with doctors 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 its 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 Decision-Making on Treatment
Physicians played a leading role in most cases. The influence from family members was more evident in participants who were limited in speaking English. Many expressed the desire to be actively involved in decision making. Some Asian patients are not very assertive and will not express their concerns. Asians in general are not very proactive or assertive. They do not want too much information from a physician, they expect the physician to be the expert and make the decisions for them. If they do not receive this they may even switch doctors.

• 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 1980s. (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)

OBJECTIVE
To explore patient-physician communication
process in Asian American breast cancer patients
from both patients and oncologists perspectives.
RESULTS

• Patient Characteristics
• n9 (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).

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.
• 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.

CONCLUSION, IMPLICATIONS NEXT STEP

• 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
  patient-physician communication.

Oncologist 1 Oncologist 2 Oncologist 3
Age (in years) 47 50 37
Country of birth Korea India US
Gender F F M
Language spoken (other than English) Korean, Spanish, Portuguese Tamil, Spanish Korean
Ever communicate with patients in language other than English? Yes Yes Yes
Years practicing medicine 22 22 14
Acknowledgments This research is a pilot project
supported by NIH-NCIs Community Network Program
Center, ACCHDC U54 CNPC (1U54CA 153513-01, PI
Grace Ma)