Beliefs and Perceptions of Chemotherapy for Breast Cancer in a Latina Population
Funded June 2003 through the Special Populations Network developmental research projects, this project aims to understand which cultural beliefs and perceptions affect chemotherapy use in Latina breast cancer patients. Under-use of chemotherapy is one of the key problems in the quality of cancer care recently identified by the Institute of Medicine. The rate of chemotherapy use in women with local and regional breast cancer (where chemotherapy is usually indicated) is 56% in the District of Columbia. Although data are not routinely collected by ethnicity in the DC, MD, and VA, it is possible that the rate for Latinas is lower than for other groups, since Latinas under-use other health services. Little is known of the beliefs and perceptions or of the cultural norms that affect decisions about the use of chemotherapy in Latinas. Since it is well established that culture and acculturation affect general health care beliefs and utilization, a study of the beliefs and perceptions about chemotherapy in a diverse Latino population should identify important intervention targets for future interventions aimed at improving outcomes for this under-studied population. Since this area has not been studied before in Latinas, we will use inductive, qualitative methods to answer the research question: Which cultural beliefs and perceptions affect chemotherapy use in Latina breast cancer patients? We will focus on ideas that are amenable to change in future interventions. This pilot will capitalize on our multi-disciplinary expertise in breast cancer decision-making and qualitative methods and our familiarity with, and access to, the Hispanic medical community.
Twenty 60-90 minute, in-depth semi-structured interviews were done with newly diagnosed Latina breast cancer patients. These participants were recruited from local surgery and oncology practices utilized by the Special Populations Network sites. Eligible patients included those who were recently diagnosed (< 1 year) with stages where chemotherapy may have been offered for curative intent (local and regional disease). Ten family members and/or friends who were involved in the decision making process were also interviewed. The semi-structured interviews probed for beliefs, perceptions, and cultural norms about chemotherapy. The product of this study will be domains and concepts with which to develop a survey. The intended next step will be to request funding for a survey to confirm and extend our results in broad, representative samples of Latina breast cancer patients. Data from the pilot and a future survey will be necessary to develop interventions to improve indicated chemotherapy use in this vulnerable and understudies population.
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