What Health Care Providers Know and How They Communicate Breast Cancer Risk to Patients
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Racial disparities in breast cancer mortality continue, partly due to higher prevalence of an aggressive breast cancer subtype called basal-like breast cancer (BBC) in African-Americans. Health care providers (HCPs) are uniquely positioned to discuss cancer risk and prevention with patients. We investigated breast cancer knowledge and risk communication among HCPs to identify factors that influenced communication with patients. Interviews were conducted with 34 HCPs in North Carolina. We found limited evidence of breast cancer risk education, and specific subtypes of breast cancer were not discussed. Barriers to communication about prevention include limited time, perceived patient receptivity and education level, and scientific misinformation. Factors that prompted discussions included patient characteristics (age, race, and socioeconomic status). To broaden the conversation, HCPs must receive and communicate more accurate information on breast cancer risk. Given these barriers to breast cancer education, additional opportunities to intervene with high-risk populations must be identified.
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1. American Cancer Society. 2014. Cancer Facts & Figures 2013. Atlanta: American Cancer Society.
2. Petracci, E., Decarli, A., Schairer, C., et al. Risk factor modification and projections of absolute breast cancer risk. J Natl Cancer Inst. 2011.
3. Zhang, S.M., Lee, I.M., Manson, J.E., et al. Alcohol consumption and breast cancer risk in the Women's Health Study. Am J Epidemiol. 2007;165(6):667-76.
4. Wu, Y., Zhang, D., & Kang, S. Physical activity and risk of breast cancer: a meta-analysis of prospective studies. Breast Cancer Res Treat. 2013;137(3), 869-882.
5. Cuzick, J., DeCensi, A., Arun, B., et al. Preventive therapy for breast cancer: a consensus statement. Lancet Oncol. 2011;12(5), 496-503.
6. Herman, J. D., & Herman, S. M. Women's understanding of personal breast cancer risk: Does ethnicity matter?. In ASCO Annual Meeting Proceedings, 2013;(Vol. 31, No. 26_suppl, p. 4).
7. Manary, M. P., Boulding, W., Staelin, R., & et al. The patient experience and health outcomes. N Engl J Med. 2013;368(3), 201-203.
8. Cooper, L.A., and Barnes, D. Journey to eliminating health care disparities: the urgency of affirming values within our patients, profession, health care system, and society. Arch Intern Med. 2012;172, 1667-9.
9. Ledford, C. J., Ledford, C. C., & Childress, M. A. Extending Physician ReACH: Influencing patient activation and behavior through multichannel physician communication. Patient Educ Couns. 2013;91(1), 72-78.
10. Zolnierek, Kelly B. Haskard, and M. Robin DiMatteo. "Physician communication and patient adherence to treatment: a meta-analysis." Med Care. 2009;47.8:826.
11. Thorne, S.E., Bultz, B.D., Baile, W.F., et al. Is there a cost to poor communication in cancer care?: a critical review of the literature. Psychooncology. 2005;14, 875-84.
12. Weber, K.M., Solomon, D.H., and Meyer, B.J. A qualitative study of breast cancer treatment decisions: evidence for five decision-making styles. Health Commun. 2013;28, 408-21.
13. Street, R. L., Makoul, G., Arora, N. K., et al. How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient Educ Couns. 2009;74(3), 295-301.
14. Penner, L. A., Blair, I. V., Albrecht, T. L., et al. Reducing Racial Health Care Disparities A Social Psychological Analysis. Policy Insights Behav Brain Sci. 1(1), 2014;204-212.
15. Siminoff, L. A., Graham, G. C., & Gordon, N. H. Cancer communication patterns and the influence of patient characteristics: disparities in information-giving and affective behaviors. Patient Educ Couns. 2006;62(3), 355-360.
16. Blair, I.V., Steiner, J.F., Fairclough, D.L., et al. Clinicians' implicit ethnic/racial bias and perceptions of care among black and Latino patients. Ann Fam Med. 2013;11, 43-52.
17. Bao, Y., Fox, S.A., and Escarce, J.J. . Socioeconomic and racial/ethnic differences in the discussion of cancer screening: "between-" versus "within-" physician differences. Health Serv Res. 2007;42 (3 Pt 1), 950-70.
18. Dietze, E. C., Sistrunk, C., Miranda-Carboni, G., et al. Triple-negative breast cancer in African-American women: disparities versus biology. Nat Rev Cancer. 2015;15(4), 248-254.
19. Neilson, H. K., Friedenreich, C. M., Brockton, N. T., et al. Physical activity and postmenopausal breast cancer: proposed biologic mechanisms and areas for future research. Cancer Epidemiol Biomarkers Prev. 2009;18(1), 11-27.
20. Flegal, K. M., Carroll, M. D., Kit, B. K., et al. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012;307(5), 491-497.
21. Groth, S. W., Holland, M. L., Kitzman, H., et al. Gestational weight gain of pregnant African-American adolescents affects body mass index 18 years later. J Obstet Gynecol Neonatal Nurs. 2013;42(5), 541-550.
22. Centers for Disease Control and Prevention (CDC). Progress in increasing breastfeeding and reducing racial/ethnic differences-United States, 2000-2008 births. MMWR Morb Mortal Wkly Rep 2013;62(5), 77.
23. Partridge, A.H., Elmore, J.G., Saslow, D., et al. Challenges in ductal carcinoma in situ risk communication and decision-making: report from an American Cancer Society and National Cancer Institute workshop. CA Cancer J Clin. 2012;62, 203-10.
24. Guest G, MacQueen KM, Namey EE. Applied Thematic Analysis. Los Angeles (CA): Sage Publications. 2012.
25. Amir, E., Freedman, O. C., Seruga, B., et al. Assessing women at high risk of breast cancer: a review of risk assessment models. J Natl Cancer Inst. 2010;102(10), 680-691.
26. Meissner, H. I., Klabunde, C. N., Breen, N., et al. Breast and colorectal cancer screening: US primary care physicians' reports of barriers. Am J Prev Med. 2012;43(6), 584-589.
27. Yarnall, K. S., Pollak, K. I., Østbye, T., et al. Primary care: is there enough time for prevention? Am J Public Health. 2003;93(4), 635-641.
28. Haas, J. S., Sprague, B. L., Klabunde, C. N., et al. Provider attitudes and screening practices following changes in breast and cervical cancer screening guidelines. J Gen Intern Med. 2015;1-8.
29. McCuaig, J.M., Greenwood, C.M., Shuman, C., et al. Breast and ovarian cancer: the forgotten paternal contribution. J Genet Couns. 2011;20, 442-9.
30. Burke, W., Culver, J., Pinsky, L., et al. Genetic assessment of breast cancer risk in primary care practice. Am J Med Genet A. 2009;149A, 349-56.
31. Wheeler, S. B., Reeder-Hayes, K. E., & Carey, L. A. Disparities in breast cancer treatment and outcomes: biological, social, and health system determinants and opportunities for research. Oncologist. 2013;18(9), 986-993.
32. O'Brien, K.M., Cole, S.R., Tse, C.K., et al. Intrinsic breast tumor subtypes, race, and long-term survival in the Carolina Breast Cancer Study. Clin Cancer Res. 2010;16, 6100-10.
33. Mavaddat, N., Rebbeck, T.R., Lakhani, S.R., et al. Incorporating tumour pathology information into breast cancer risk prediction algorithms. Breast Cancer Res. 2010;12(3):R28.
34. Sterba, K. R., Burris, J. L., Heiney, S. P., et al. “We both just trusted and leaned on the Lord”: a qualitative study of religiousness and spirituality among African-American breast cancer survivors and their caregivers. Qual Life Res. 2014;23(7), 1909-1920.
35. Gullatte, M. M., Brawley, O., Kinney, A., et al. Religiosity, spirituality, and cancer fatalism beliefs on delay in breast cancer diagnosis in African-American women. J Relig Health. 2010;49(1), 62-72.
36. Sheppard, V. B., Adams, I. F., Lamdan, R., et al. The role of patient–provider communication for black women making decisions about breast cancer treatment. Psychooncology. 2011;20(12), 1309-1316.
37. Conway-Phillips, R., and Janusek, L. Influence of sense of coherence, spirituality, social support and health perception on breast cancer screening motivation and behaviors in African-American women. ABNF J. 2014;25(3), 72.
38. Aboumatar, H. J., Carson, K. A., Beach, M. C., et al. The impact of health literacy on desire for participation in healthcare, medical visit communication, and patient reported outcomes among patients with hypertension. J Gen Intern Med. 2013;28(11), 1469-1476.
39. Mazor, K. M., Rubin, D. L., Roblin, D. W., et al. Health literacy–listening skill and patient questions following cancer prevention and screening discussions. Health Expect. 2015.
40. DeNavas-Walt, Carmen, Bernadette D. Proctor, and Jessica C. Smith. Income and poverty in the United States: 2013. United States Census Bureau, 2014.
41. Shavers, V. L., Klein, W. M., & Fagan, P. Research on race/ethnicity and health care discrimination: where we are and where we need to go. Am J Public Health. 2012;102(5), 930-932.
42. Cooper, L. A., Roter, D. L., Carson, K. A., et al. The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. Am J Public Health. 2012;102(5), 979-987.
43. Quach, T., Nuru-Jeter, A., Morris, P., et al. Experiences and perceptions of medical discrimination among a multiethnic sample of breast cancer patients in the Greater San Francisco Bay Area, California. Am J Public Health. 2012;102, 1027-34.
44. Song, L., Hamilton, J.B., and Moore, A.D. Patient-healthcare provider communication: perspectives of African-American cancer patients. Health Psychol. 2012;31, 539-47.
45. Lin, M. Y., & Kressin, N. R. Race/ethnicity and Americans’ experiences with treatment decision making. Patient Educ Couns. 2015.
46. Williams, S. W., Hanson, L. C., Boyd, C., et al. Communication, decision making, and cancer: what African-Americans want physicians to know. J Palliat Med. 2008;11(9), 1221-1226.
47. Thornton, R. L. J., Powe, N. R., Roter, D., et al. Patient–physician social concordance, medical visit communication and patients’ perceptions of health care quality. Patient Educ Couns. 2011;85(3), e201-e208.
48. Epstein, R.M., and Street, R.L.J. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering. J Natl Cancer Inst, NIH Publication: Bethesda. 2007.
49. Yarnall, Kimberly SH, et al. "Primary Care: Is there Enough Time for Prevention?" Am J Public Health. 93.4 (2003): 635-641.
50. Davis, Terry C., et al. "Health Literacy and Cancer Communication." CA Cancer J Clin. 52.3 (2002): 134-149.