ReviewBreast cancer disparities and decision-making among U.S. women
Introduction
With widely available screening for early detection and definitive therapy with tested agents, breast cancer need not be a universally lethal diagnosis. Yet breast cancer levies a high cost for women, particularly those in the ethnically and economic diverse populations least likely to be health literate. Not only can screening measures be underused and ineffective in these communities, but socioeconomic, racial, and ethnic disparities persist in the use of the best evidence-based treatments (with the best outcomes) for diagnosed breast cancer [1], [2], [3], [4], [5].
Treatment decisions are complex for those fortunate women and families who have access to care, have health care coverage, and who possess adequate knowledge and skill in navigating the health care delivery system. For women who struggle with any of these factors, the task is even more troublesome. It is appreciated that treatment decisions are complex and linked to patient outcomes, but the interactive decision-making process between the patient, family, and health care team has not been studied in depth among those populations likely to have the poorest outcomes. Moreover, the role of treatment decision-making in contributing to breast cancer disparities is poorly understood. This paper serves to explore disparities in treatment and decision-making in U.S. women, specifically women of color, women who are disadvantaged, and minority women.
Section snippets
Methods
In the context of a larger project, searches were conducted on major health care databases (including MEDLINE, PubMed, OVID, and CINAHL), to identify articles concerning breast cancer (including incidence, treatment, and outcomes) in all populations of women. English language articles concerning breast cancer published in refereed medical, nursing, health education, epidemiology, and public health journals were included in the initial review. Reference lists were then used to pull past articles
Findings
The findings from this search resulted in several themes. These are described in detail below and include breast cancer disparities in the United States across ethnic and socioeconomic groups; treatment disparities; decision-making about treatment, level of involvement in the decision-making process; and the complexity of decision-making.
Discussion
Emerging patterns of complex interactions between health status, health care access and delivery, and decision-making create a maze of possibilities in which women tend to preserve their own identities and preferences, independent of the health care authority hierarchy. The health care system is not easy to use for anyone, and the fewer resources a women and her family have, the less manageable the system will be for extended periods of intervention. One would wonder if mistrust in the medical
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