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Perceptions, expectations, and attitudes about communication with physicians among Chinese American and non-Hispanic white women with early stage breast cancer

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Abstract

Purpose

Asian Americans have consistently reported poorer communication with physicians compared with non-Hispanic Whites (NHW). This qualitative study sought to elucidate the similarities and differences in communication with physicians between Chinese and NHW breast cancer survivors.

Methods

Forty-four Chinese and 28 NHW women with early stage breast cancer (stage 0-IIa) from the Greater Bay Area Cancer Registry participated in focus group discussions or individual interviews. We oversampled Chinese women because little is known about their cancer care experiences. In both interview formats, questions explored patients' experiences and feelings when communicating with physicians about their diagnosis, treatment, and follow-up care.

Results

Physician empathy at the time of diagnosis was important to both ethnic groups; however, during treatment and follow-up care, physicians' ability to treat cancer and alleviate physical symptoms was a higher priority. NHW and US-born Chinese survivors were more likely to assert their needs, whereas Chinese immigrants accepted physician advice even when it did not alleviate physical problems (e.g., pain). Patients viewed all physicians as the primary source for information about cancer care. Many Chinese immigrants sought additional information from primary care physicians and stressed optimal communication over language concordance.

Conclusions

Physician empathy and precise information were important for cancer patients. Cultural differences such as the Western emphasis on individual autonomy vs. Chinese emphasis on respect and hierarchy can be the basis for the varied approaches to physician communication we observed. Interventions based on cultural understanding can foster more effective communication between immigrant patients and physicians ultimately improving patient outcomes.

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Acknowledgments

This research was supported by a Lance Armstrong Foundation Young Investigator Award and the National Cancer Institute R21 Grant# CA139408. This research was also supported by the National Cancer Institute's Surveillance, Epidemiology and End Results Program under contract HHSN261201000040C awarded to the Cancer Prevention Institute of California. The collection of cancer incidence data used in this study was supported by the California Department of Health Services as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute's Surveillance, Epidemiology, and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention's National Program of Cancer Registries, under agreement #1U58 DP000807-01 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the authors, and endorsement by the State of California, the California Department of Health Services, the National Cancer Institute, or the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be inferred. We appreciate the field staff at CPIC, Pagan Morris, Mei-chin Kuo, Kathie Lau, and Daisy Lubag for their efforts in participant enrollment and preparation for focus groups. We sincerely thank Dr. Frances M. Lewis for her constructive comments on the interview guides to enhance our qualitative data collection.

Conflict of interest

None of the authors of this article have any conflicts of interest, as they have no financial affiliations with the organizations that sponsored the research to affect the ethical conduct of this study and authorship. The first author has full control of all primary data and agrees to allow the journal to review the data if requested.

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Authors and Affiliations

  1. Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA

    Judy Huei-yu Wang & Ellen Huang

  2. Department of Social and Behavioral Sciences, Harvard School of Public Health, 401 Park Drive, Room 403-E, Boston, MA, USA

    Inez F. Adams

  3. Department of Medicine, Division of General Internal Medicine, University of California San Francisco, 1450 3rd Street, San Francisco, CA, 94158, USA

    Rena J. Pasick

  4. Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94538, USA

    Scarlett L. Gomez & Laura Allen

  5. Department of Public Health and Center for Asian Health, Temple University, Philadelphia PA, 1301 Cecil B Moore Ave, 913 Ritter Annex, Philadelphia, PA, 19122, USA

    Grace X. Ma

  6. Division of Hematology and Oncology, University of California, San Francisco, 505 Parnassus Avenue, M 1286, Box 1270, San Francisco, CA, 94143, USA

    Michael X. Lee

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  1. Judy Huei-yu Wang
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Correspondence to Judy Huei-yu Wang.

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Wang, J.Hy., Adams, I.F., Pasick, R.J. et al. Perceptions, expectations, and attitudes about communication with physicians among Chinese American and non-Hispanic white women with early stage breast cancer. Support Care Cancer 21, 3315–3325 (2013). https://doi.org/10.1007/s00520-013-1902-8

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