Abstract A16: Individual versus family decision making on breast cancer screening among Chinese American women
Authors: Lam Helen , Chandraskar Edwin , Kim Karen 
Published: May 2015

Objectives: Culture fundamentally shapes the way people derive meaning from illness, suffering, and how they make decisions regarding health care. The agricultural background and the teachings of Confucianism and Buddhism have had a profound influence on Eastern philosophical approaches to life and family interaction. Traditionally, Asian families place a high value on the family unit. There is an emphasis on harmonious interpersonal relationships, interdependence, and mutual obligations. The general differences between Asian and American culture can be summarized as autonomy versus family decision making, individual versus social/common good; and individual development versus family and filial piety. The purpose of this study was to explore how individual decision making and family decision making might influence Chinese-American women's breast cancer screening behaviors.

Methods: This was a cross-sectional study, using data collected from the Chicago Asian Community Survey (CACS). Participants were recruited from the Chinese Armour Square community in Chicago using a three-stage probability sampling strategy. The CACS consisted of face-to-face interviews using cultural and language- specific survey guidelines. The survey questionnaire was developed from several validated national health surveys, including the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System (BRFSS), National Health and Nutrition Examination Survey (NHANES), and the National Health Interview Survey (NHIS). The questionnaire also included questions on access to health care and demographics. The main dependent variable in this study was whether the participants have ever had a mammogram. To assess decision making regarding health care, participants were asked whether they made decisions about their own health care, or they depended on their family to make healthcare decisions for them or together.

Results: 383 Chinese community members met the inclusion criteria and completed the survey interview; of which 48% (n = 185) were female aged 40 or older. About 82% of these women reported having health insurance coverage and 88% had a regular place for health care. However, 43% of these women have never had a mammogram and only 40% reported having a mammogram within the last two years. About 46% of these women reported making their own health care decisions. Women who made their own health care decision were 4 times likely to report having a mammogram in the past compared to women who were not. Even after adjusting for social-economic status (insurance coverage, regular place for health care, age, years in the U.S., education level, family annual income and employment status), the difference remained significant (OR 2.98, 95% CI, 1.21 – 7.38).

Conclusion: In many Asian culture traditions, such as the Chinese, the individual, especially women, may have little input into the decision-making process. Health care decisions may be decided by other family members, such as husbands and elder sons, or family as a whole. Although there is an increasing understanding of ethnically diverse cultures, the study of cultural variation and health care decision making remains in its infancy. Our finding provided the first glance on how family decision making might influence breast cancer screening behaviors among Chinese Asian women. This study supports further exploration into family-centered, rather than patient-centered models of medical decision making in Asian patients.

Citation Format: Helen Lam, Edwin Chandraskar, Karen Kim. Individual versus family decision making on breast cancer screening among Chinese American women. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A16. doi:10.1158/1538-7755.DISP13-A16