Participatory decision-making for cancer care in a high-risk sample of low income Mexican-American breast cancer survivors: The role of acculturation.

BACKGROUND: Despite declining cancer incidence and mortality rates, Latina patients continue to have lower 5-year survival rates compared to their non-Hispanic white counterparts. Much of this difference has been attributed to lack of healthcare access and poorer quality of care. Research, however, has not considered the unique healthcare experiences of Latina patients. METHODS: Latina women with prior diagnoses of stage 0-III breast cancer were asked to complete a cross-sectional survey assessing several socio-demographic factors along with their experiences as cancer patients. Using a series of linear regression models in a sample of 68 Mexican-American breast cancer survivors, we examined the extent to which patients' ratings of provider interpersonal quality of care were associated with patients' overall healthcare quality, and how these associations varied by acculturation status. RESULTS: Findings for Latina women indicated that both participatory decision-making (PDM) (ß = 0.62, p < .0001) and trust (ß = 0.53, p = .02) were significantly associated with patients' ratings of healthcare quality. The interaction between acculturation and PDM further suggested that participating in the decision-making process mattered more for less acculturated than for more acculturated patients (ß = -0.51, p ≤ .01). CONCLUSIONS: The variation across low and high acculturated Latinas in their decision-making process introduces a unique challenge to health care providers. Further understanding the relationship between provider-patient experiences and ratings of overall healthcare quality is critical for ultimately improving health outcomes.

Complementary and alternative medicine (CAM) use among non-Hispanic white, Mexican American, and Vietnamese American patients with type 2 diabetes.

PURPOSE: This study examines the use of complementary and alternative medicine (CAM) by ethnicity/race among patients with type 2 diabetes. SUBJECTS AND METHODS: Four hundred and ten (410) patients with type 2 diabetes recruited from an academic-medical center completed a survey assessing CAM use, diabetes status, and sociodemographic characteristics. RESULTS: Several significant ethnic/racial differences were observed in CAM use (both in the types of providers seen as well as in the herbs and dietary supplements used). Although White patients reported using CAM in addition to their diabetes medication (mean [SD] 4.9 [0.4] on a scale from 1=never to 5=always) more frequently than Mexican American patients (3.1 [1.6], p<.05), Mexican American patients (1.4 [1.1]) used CAM instead of their diabetes medications more frequently than non-Hispanic White patients (1.0 [0.1], p<.05). More Mexican American (66.7%) and Vietnamese American patients (73.7%) than non-Hispanic Whites (11.8%, p=.002) described CAM practitioners as being closer to their cultural traditions than Western practitioners, whereas Vietnamese [End Page 1941] patients were more likely to describe use of herbs and supplements as closer to their cultural traditions (84.5% versus 15.3% for White and 30.9% for Mexican American patients, p <.001). CONCLUSIONS: Considering the variability and perceptions in CAM use, providers should discuss with their patients how their CAM use may influence diabetes management behaviors.