1.  Language barrier, cultural difference and patient involvement are key issues in patient-physician communication for Asian American breast cancer survivors.  Proper patient education with linguistically and culturally appropriate information and tools may help improve communication with physician and decision-making process.  As a next step, we plan to design and implement a theory-based, culturally and linguistically appropriate intervention to Korean breast cancer survivors. This will include skills to enhance patient- physician communication. What Is Lacking in Patient-Physician Communication: from Asian American Breast Cancer Patients’ and Oncologists’ Perspectives Sunmin Lee, 1 Grace X. Ma, 2,3 Carolyn Y. Fang 2,3,4 Lu Chen, 1 Youngsuk Oh, 1 Lynn Scully 1 1 Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland 2 Department of Public Health, College of Health Professions, Temple University, Philadelphia, Pennsylvania 3 Center for Asian Health, Temple University, Philadelphia, Pennsylvania 4 Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania What Is Lacking in Patient-Physician Communication: from Asian American Breast Cancer Patients’ and Oncologists’ Perspectives Sunmin Lee, 1 Grace X. Ma, 2,3 Carolyn Y. Fang 2,3,4 Lu Chen, 1 Youngsuk Oh, 1 Lynn Scully 1 1 Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland 2 Department of Public Health, College of Health Professions, Temple University, Philadelphia, Pennsylvania 3 Center for Asian Health, Temple University, Philadelphia, Pennsylvania 4 Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania Acknowledgments: This research is a pilot project supported by NIH-NCI’s Community Network Program Center, ACCHDC U54 CNPC (1U54CA 153513-01, PI: Grace Ma)  Patient Characteristics  n=9 (4 Chinese & 5 Koreans)  Participants were between 40-69 years of age. Majority were married (78%) and had college or above education (77%).  Most of them have completed active cancer treatment (89%). More than half were diagnosed with breast cancer within a year (56%).  Oncologist Characteristics Key Interview Questions To explore patient-physician communication process in Asian American breast cancer patients from both patients and oncologists perspectives.  Breast cancer is the leading cancer in incidence and among top five in mortality in Chinese & Korean women (CKW) in the U.S. (Miller et al., 2008)  Rapid and steady increase of breast cancer incidence in CKW since 1980’s. (Gormez et al., 2010)  Patient-physician communication and coordination is essential in the quality of cancer survivorship care. (Arora et al., 2011)  Asian American patients have reported lower satisfaction with health care compared to Whites and Blacks. (Saha, Arbelaez & Cooper, 2003)  Study Design  Face-to-face in-depth interviews with nine Chinese or Korean breast cancer patients/survivors and three Asian oncologists who routinely provided care for Asian patients in the Washington DC metropolitan area.  Participant Recruitment  A convenience sample of Chinese and Korean breast cancer survivors living in Washington D.C. metropolitan area.  Patients were recruited from community based organizations, posters on websites well known among Korean/Chinese immigrants, and personal contacts.  Oncologists were recruited from personal contacts. They were not necessarily oncologists of women we interviewed.  Data Collection and Analysis  Comprehensive interview guides were developed separately for patients and oncologists based on literature review and input from experts on breast cancer survivorship and oncologists.  Interviews were recorded, transcribed, and translated.  Transcripts were analyzed by two independent coders and their analysis was compared and contrasted, and finally agreed upon in the research team. Oncologist #1Oncologist #2Oncologist #3 Age (in years) 475037 Country of birth KoreaIndiaUS Gender FFM Language spoken (other than English) Korean, Spanish, Portuguese Tamil, SpanishKorean Ever communicate with patients in language other than English? Yes Years practicing medicine 22 14 INTRODUCTION OBJECTIVE METHODS RESULTS Patients How did you feel about the interaction between you and your doctor? Do you have any barriers in communicating with your doctor? Were there cultural differences in your communication? If so, what were they? How would you want to improve this? When it came to the decision of your care, what did you do? How did you feel about your role in the decision making? Oncologists How would you describe your Asian patients’ interaction with you compared with White patients in the following areas: Making decisions Asking questions Talking about fear & distress Are there any difficulties other than language? If you do face a language or communication barrier, what do you do? What is your advice for those who want to be more actively involved in treatment? CONCLUSION, IMPLICATIONS & NEXT STEP Patients’ Perspective Oncologists’ Perspective Language Barrier Language was the biggest barrier to understanding information and making treatment decisions. Medical terms were a challenge even for those who were fluent in English. For some patients, they could only rely on guessing and body language in extreme situations. If the women cannot speak English then this serves as a large barrier for understanding information and communicating. Translation by family members may not be accurate. Some patients may neglect to ask questions due to concerns of burdening family members. Cultural Differences Expected the doctor to be authority and were disappointed when questions were not answered. Dissatisfied with doctor’s advice on physical activity and diet which from the patients’ perspective was not appropriate for Asians. In US culture, having breast cancer is a badge of honor and surviving is something to be proud of. For some Asian women it’s more of a stigma and they are ashamed and hesitant to discuss it. Many Asian patients want to know very specifically what they can and cannot eat, and are surprised when told that they should just eat a healthy balanced diet. Decision-Making on Treatment Physicians played a leading role in most cases. The influence from family members was more evident in participants who were limited in speaking English. Many expressed the desire to be actively involved in decision making. Some Asian patients are not very assertive and will not express their concerns. Asians in general are not very proactive or assertive. They do not want too much information from a physician, they expect the physician to be the expert and make the decisions for them. If they do not receive this they may even switch doctors.