Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Surbone A (2008) Cultural aspects of communication in cancer care. Support Care Cancer 16:235–240

    Article  PubMed  Google Scholar 

  2. Neumann M, Wirtz M, Bollschweiler E, Mercer SW, Warm M, Wolf J, Pfaff H (2007) Determinants and patient-reported long-term outcomes of physician empathy in oncology: a structural equation modelling approach. Patient Educ Couns 69:63–75

    Article  PubMed  Google Scholar 

  3. Maly RC, Liu Y, Leake B, Thind A, Diamant AL (2010) Treatment-related symptoms among underserved women with breast cancer: the impact of physician–patient communication. Breast Cancer Res Treat 119:707–716

    Article  PubMed  Google Scholar 

  4. Zachariae R, Pedersen CG, Jensen AB, Ehrnrooth E, Rossen PB, von der MH (2003) Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease. Br J Cancer 88:658–665

    Article  PubMed  CAS  Google Scholar 

  5. Mager WM, Andrykowski MA (2002) Communication in the cancer 'bad news' consultation: patient perceptions and psychological adjustment. Psychooncology 11:35–46

    Article  PubMed  Google Scholar 

  6. Kornblith A (1998) Psychological adaptation to cancer. In: Holland J, Breitbart W, Jacobsen P, Lederberg M, Loscalzo M, Massie M, McCorkle R (eds) Psycho-Oncology. Oxford University Press, New York, pp 223–241

    Google Scholar 

  7. Epstein RM and Street RL Jr (2007) Patient-centered communication in cancer care: promoting healing and reducing suffering. National Cancer Institute, NIH Publication No. 07–6225. Bethesda, MD

  8. Roter DL, Hall JA, Katz NR (1987) Relations between physicians' behaviors and analogue patients' satisfaction, recall, and impressions. Med Care 25:437–451

    Article  PubMed  CAS  Google Scholar 

  9. Ngo-Metzger Q, Legedza AT, Phillips RS (2004) Asian Americans' reports of their health care experiences. Results of a national survey. J Gen Intern Med 19:111–119

    Article  PubMed  Google Scholar 

  10. Wang JH, Sheppard VB, Schwartz MD, Liang W, Mandelblatt J (2008) Disparaties in cervical cancer screening between Asian and non-Hispanic White women. Cancer Epidemiol Biomarkers Prev 17:1968–1973

    Article  PubMed  Google Scholar 

  11. Johnson RL, Saha S, Arbelaez JJ, Beach MC, Cooper LA (2004) Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. J Gen Intern Med 19:101–110

    Article  PubMed  Google Scholar 

  12. Ayanian JZ, Zaslavsky AM, Arora NK, Kahn KL, Malin JL, Ganz PA, van RM, Hornbrook MC, Kiefe CI, He Y, Urmie JM, Weeks JC, Harrington DP (2010) Patients' experiences with care for lung cancer and colorectal cancer: findings from the Cancer Care Outcomes Research and Surveillance Consortium. J Clin Oncol 28:4154–4161

    Article  PubMed  Google Scholar 

  13. Palmer NRA, Arora NK, Kent E, Forsythe L, Rowland JH, Aiz N, Weaver KE (2012) Racial-ethnic disparities in patient-provider communication and overall perceptions of follow-up care quality among adult cancer survivors. The fifth AACR conference in the Science of Cancer Health Disparities. San Diego, California

    Google Scholar 

  14. Dhooper SS (2003) Health care needs of foreign-born Asian Americans: an overview. Health Soc Work 28:63–73

    Article  PubMed  Google Scholar 

  15. Wang JH, Liang W, Schwartz MD, Lee MM, Kreling B, Mandelblatt JS (2008) Development and evaluation of a culturally tailored educational video: changing breast cancer-related behaviors in Chinese women. Health Educ Behav 35:806–820

    Article  PubMed  Google Scholar 

  16. Hsu WC, Yoon HH (2007) Building cultural competency for improved diabetes care: Asian Americans and diabetes. J Fam Pract 56:S15–S21

    PubMed  Google Scholar 

  17. Kagawa-Singer M, Blackhall LJ (2001) Negotiating cross-cultural issues at the end of life: "you got to go where he lives". JAMA 286:2993–3001

    Article  PubMed  CAS  Google Scholar 

  18. Kreuter MW, McClure SM (2004) The role of culture in health communication. Annu Rev Public Health 25:439–455

    Article  PubMed  Google Scholar 

  19. Wang JH, Adams I, Huang E, Ashing-Giwa K, Gomez SL, Allen L (2012) Physical distress and cancer care experiences among Chinese-American and non-Hispanic White breast cancer survivors. Gynecol Oncol 124:383–388

    Article  PubMed  Google Scholar 

  20. Pew Reseach Center (2012) The rise of Asian Americans. http://www.pewsocialtrends.org/files/2012/06/SDT-The-Rise-of-Asian-Americans-Full-Report.pdf. Accessed 18 Mar 2013

  21. Killoran M, Moyer A (2006) Surgical treatment preferences in Chinese-American women with early-stage breast cancer. Psychooncology 15:969–984

    Article  PubMed  Google Scholar 

  22. Ashing-Giwa KT, Padilla G, Tejero J, Kraemer J, Wright K, Coscarelli A, Clayton S, Williams I, Hills D (2004) Understanding the breast cancer experience of women: a qualitative study of African American, Asian American, Latina and Caucasian cancer survivors. Psychooncology 13:408–428

    Article  PubMed  Google Scholar 

  23. Quach T, Nuru-Jeter A, Morris P, Allen L, Shema SJ, Winters JK, Le GM, Gomez SL (2012) 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 102:1027–1034

    Article  PubMed  Google Scholar 

  24. Kvale S, Brinkmann S (2009) Interviews: learning the craft of qualitative research interviewing. Sage, Los Angeles, CA

    Google Scholar 

  25. Krueger RA, Casey MA (2009) Focus groups. A practical guide for applied research, 4th edn. Sage, Los Angeles

    Google Scholar 

  26. Bernard HR (2002) Research methods in anthropology qualitative and quantitative methods. AltaMira Press, Plymouth

    Google Scholar 

  27. Glanz K, Schwartz M (2008) Stress, coping, and health behavior. In: Glanz K, Rimer B, Viswanath K (eds) Health behavior and health education theory, research and practice. Jossey-Bass, San Francisco, CA, pp 212–236

    Google Scholar 

  28. Heaney C, Israel B (2008) Social networks and social support. In: Glanz K, Rimer B, Viswanath K (eds) Health behavior and health education theory, research and practice. Jossey-Bass, San Francisco, CA, pp 189–210

    Google Scholar 

  29. Saldana J (2009) The coding manual for qualitative researchers. Sage Publication, Thousand Oaks, CA

    Google Scholar 

  30. Fossey E, Harvey C, McDermott F, Davidson L (2002) Understanding and evaluating qualitative research. Aust N Z J Psychiatr 36:717–732

    Article  Google Scholar 

  31. LeCompte MD, Schensul JJ (1999) Analyzing and interpreting ethnographic data. In: Schensul JJ, LeCompte MD (eds) Ethnographer's Toolkit. Altamira Press, Baltimore MD, USA

    Google Scholar 

  32. Clayton MF, Dudley WN, Musters A (2008) Communication with breast cancer survivors. Health Commun 23:207–221

    Article  PubMed  Google Scholar 

  33. Miller LE (2012) Sources of uncertainty in cancer survivorship. J Cancer Surviv 6(4):431–440

    Article  PubMed  Google Scholar 

  34. Lawler S, Spathonis K, Masters J, Adams J, Eakin E (2011) Follow-up care after breast cancer treatment: experiences and perceptions of service provision and provider interactions in rural Australian women. Support Care Cancer 19:1975–1982

    Article  PubMed  Google Scholar 

  35. Arora NK, Reeve BB, Hays RD, Clauser SB, Oakley-Girvan I (2011) Assessment of quality of cancer-related follow-up care from the cancer survivor's perspective. J Clin Oncol 29:1280–1289

    Article  PubMed  Google Scholar 

  36. Institute of Medicine (2008) Cancer care for the whole patient: meeting psychosocial health needs. The National Academies Press, Washington, DC

    Google Scholar 

  37. Silliman RA, Dukes KA, Sullivan LM, Kaplan SH (1998) Breast cancer care in older women: sources of information, social support, and emotional health outcomes. Cancer 83:706–711

    Article  PubMed  CAS  Google Scholar 

  38. Butow P, Bell M, Goldstein D, Sze M, Aldridge L, Abdo S, Mikhail M, Dong S, Iedema R, Ashgari R, Hui R, Eisenbruch M (2011) Grappling with cultural differences; communication between oncologists and immigrant cancer patients with and without interpreters. Patient Educ Couns 84:398–405

    Article  PubMed  Google Scholar 

  39. Blendon RJ, Buhr T, Cassidy EF, Perez DJ, Sussman T, Benson JM, Herrmann MJ (2008) Disparities in physician care: experiences and perceptions of a multi-ethnic America. Heal Aff 27:507–517

    Article  Google Scholar 

  40. Tom LASH (2001) Health and health care for Chinese American Elder. University of Hawaii. http://www.stanford.edu/group/ethnoger/chinese.html. Accessed 19 Mar 2013.

  41. Green AR, Ngo-Metzger Q, Legedza AT, Massagli MP, Phillips RS, Iezzoni LI (2005) Interpreter services, language concordance, and health care quality. Experiences of Asian Americans with limited English proficiency. J Gen Intern Med 20:1050–1056

    Article  PubMed  Google Scholar 

  42. Johnson RL, Roter D, Powe NR, Cooper LA (2004) Patient race/ethnicity and quality of patient-physician communication during medical visits. Am J Public Health 94:2084–2090

    Article  PubMed  Google Scholar 

  43. Cooper LA, Roter DL (2003) Patient–provider communication: the effect of race ethnicity on process and outcomes of healthcare. In: Smedley BD, Stith AY, Nelson AR (eds) Unequal treatment: confronting racial and ethnic disparities in health care. National Academic Press, Washington, pp 552–593

    Google Scholar 

  44. Ngo-Metzger Q, Massagli MP, Clarridge BR, Manocchia M, Davis RB, Lezzoni LI, Philips RS (2003) Linguistic and cultural barriers to care: perspectives of Chinese and Vietnamese immigrants. J Gen Intern Med 18:44–52

    Article  PubMed  Google Scholar 

Download references

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.

Author information

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

Authors
  1. Judy Huei-yu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Inez F. Adams
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rena J. Pasick
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Scarlett L. Gomez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Laura Allen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Grace X. Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael X. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ellen Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Judy Huei-yu Wang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-013-1902-8

Keywords

Search

Navigation