Abstract A53: Racial and ethnic disparities in prostate cancer survivors' perceived engagement in treatment decision making
Authors: Palmer Nynikka R.A. , Gregorich Steven , Livaudais-Toman Jennifer , Kaplan Celia 
Published: March 2017

Objective: Shared decision making is especially important in prostate cancer as treatment decisions are inherently demanding and complex. There are multiple treatment options in which none are superior for survival. The complexity of treatment decision making in weighing pros and cons, considering patients' values and personal preferences, and physicians' recommendations is even more challenging for patients of low health literacy and/or limited English proficiency, both of which are disproportionately represented among racial and ethnic minorities. However, research is scant regarding the extent of minority patients' involvement in treatment decision making, particularly in prostate cancer where treatment options remain controversial and conflict of interest is inherent in clinical decision making. This study examines racial and ethnic disparities in prostate cancer survivors'perceived engagement in treatment decision making with their doctors, and factors associated with racial and ethnic disparities in a multiethnic sample.

Methods: Racially and ethnically diverse prostate cancer patients, age 18-75 years old, were identified through the California Cancer Registry. Participants completed a cross-sectional 30-minute telephone interview in English, Spanish, Cantonese, or Mandarin (N=855). Multivariable logistic regression models were used to investigate racial and ethnic disparities in (1) doctors asking patients to help decide treatment plan, (2) patients and doctors working out a treatment plan together, and (3) factors significantly associated with patient's perceived involvement in decision making, by race/ethnicity.

Results: Participants included African American (19%), Asian American (15%), Latino (24%), and White (42%) participants diagnosed with stage I or II prostate cancer. More than half were married/living with a partner (76%), college graduates (51%), from Northern California (59%), and English speakers (83%). A smaller portion of participants had public or no health insurance (20%), were of low health literacy (19%), and received treatment with hormone therapy or chemotherapy (15%). Asian American participants were less likely than Whites to have their doctors ask them to help decide on a treatment plan (OR=0.31; 95% CI=0.18-0.53), with Cantonese/Mandarin language being a significant contributing factor for these participants (OR=0.08; 95% CI=0.01-0.63). Similarly, Asian Americans were also less likely to work out their treatment plan with their doctors (OR=0.54; 95% CI=0.33-0.90), and Cantonese/Mandarin language was also significantly associated (OR=0.04; 95% CI=0.01-0.25). There were no significant differences in outcomes comparing African Americans or Latinos to White participants.

Conclusion: Asian American prostate cancer patients report less engagement in treatment decision making, with language being a significant contributing factor. This is concerning because patients' values and preferences need to be considered and weigh heavily in the decision. Providers should consider potential language barriers for newly diagnosed patients and seek resources to support these patients (e.g., translators, patient navigators, etc.). Additionally, providers may require additional training and resources to help them engage vulnerable patients, particularly Asian American cancer patients, in shared decision making, which requires skills in elicitation and risk communication. Future research is needed to explore strategies to best engage underserved patients and effectively support healthcare providers in shared treatment decision making.

Citation Format: Nynikka R.A. Palmer, Steven Gregorich, Jennifer Livaudais-Toman, Celia Kaplan. Racial and ethnic disparities in prostate cancer survivors' perceived engagement in treatment decision making. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A53.