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Communication in Cancer Care (PDQ®): Supportive care - Health Professional Information [NCI] - Factors Affecting Communication

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Several studies have investigated the relationship between race and communication in oncology. One study of 405 newly diagnosed cancer patients reported that physicians spent more time in relationship building with white patients than with nonwhite patients.[6] Another study found that black patients with lung cancer received significantly less information from their doctors and were less likely to prompt their doctors for information.[7] These patients also had lower postvisit trust in their physicians.[8] Clearly, this is an area of neglected importance in communication skills.

Socioeconomic Status

Younger and more educated patients are most likely to take an active role in medical decision making. Some researchers have observed that low-income women who are not as well educated do not communicate as well with their physicians about their treatment preferences or concerns and fears.[4,9,10,11] Being unmarried, having a lower socioeconomic status, and having treatment options discussed less frequently are risk factors that, in addition to older age, predicted receiving conservative primary tumor therapy.[11] Limited financial resources have been shown to be a barrier to receiving radiation therapy after lumpectomy. Transportation to and from a radiation therapy facility is another impediment. Additionally, research data suggest that differences in physician-patient communication patterns could contribute to variance in BCS rates among income strata.

Influence of Culture/Ethnicity/Language

Using culturally appropriate approaches to communicating about cancer may lessen levels of distress for the patient and/or members of the patient's family. Developing an awareness of cross-cultural practices regarding cancer disclosure issues allows the clinician to become more sensitive to the expectations of culturally and individually diverse cancer patients. When discussing diagnoses and treatment options with patients from different cultures, it is important for clinicians to consider how to balance a commitment to frank discussion and a respect for the cultural values of the patient.[12]

In general, patients whose dominant culture is derived from a Western philosophy subscribe to certainty, predictability, control, and obtainable outcomes.[13] This culture has engendered an approach that fosters self-determination and autonomy in making treatment decisions.[14] This patient-centered society values having fully informed patients who make accurate assessments about their health as a cultural prerogative.[12] Western cultural assumptions exist about what is good and just in medical care. One such assumption is the principle of self-determination and its importance in enabling patients to make autonomous treatment decisions.[15]

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