Racial and Ethnic Variation in Partner Perspectives About the Breast Cancer Treatment Decision-Making Experience

Sarah E. Lillie

Nancy K. Janz

Christopher R. Friese

John J. Graff

Kendra Schwartz

Ann S. Hamilton

Brittany Bartol Gay

Steven J. Katz

Sarah T. Hawley

decision making, family and caregivers, breast cancer
ONF 2013, 41(1), 13-20. DOI: 10.1188/14.ONF.13-20

Purpose/Objectives: To characterize the perspectives of partners (husbands or significant others) of patients with breast cancer in the treatment decision-making process and to evaluate racial and ethnic differences in decision outcomes.

Design: A cross-sectional survey.

Setting: Los Angeles, CA, and Detroit, MI.

Sample: 517 partners of a population-based sample of patients with breast cancer four years post-treatment.

Methods: A self-administered mailed questionnaire. Chi-square tests and logistic regression were used to assess associations between race and ethnicity and decision outcomes.

Main Research Variables: Decision regret and three elements of the decision process: information received, actual involvement, and desired involvement.

Findings: Most partners reported receiving sufficient information (77%), being involved in treatment decisions (74%), and having sufficient involvement (73%). Less-acculturated Hispanic partners were more likely than their Caucasian counterparts to report high decision regret (45% versus 14%, p < 0.001). Factors significantly associated (p < 0.05) with high decision regret were insufficient receipt of treatment information, low involvement in decision making, and a desire for more involvement.

Conclusions: Partners were generally positive regarding their perspectives about participating in the breast cancer treatment decision-making process. However, less acculturated Hispanic partners were most vulnerable to decision regret. In addition, high decision regret was associated with modifiable elements of the decision-making process.

Implications for Nursing: Attention should be paid to ensuring racial and ethnic minority partners are sufficiently involved in breast cancer treatment decisions and receive decision support.

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    Adams, E., Boulton, M., & Watson, E. (2009). The information needs of partners and family members of cancer patients: A systematic literature review. Patient Education and Counseling, 77, 179-186.
    Alderman, A.K., Hawley, S.T., Janz, N.K., Mujahid, M.S., Morrow, M., & Hamilton, A.S., … Katz, S.J. (2009). Racial and ethnic disparities in the use of postmastectomy breast reconstruction: Results from a population-based study. Journal of Clinical Oncology, 27, 5325-5330. doi:10.1200/JCO.2009.22.2455
    Anema, M.G., & Brown, B.E. (1995). Increasing survey responses using the total design method. Journal of Continuing Education in Nursing, 26, 109-114.
    Arora, N.K., Johnson, P., Gustafson, D.H., McTavish, F., Hawkins, R.P., & Pingree, S. (2002). Barriers to information access, perceived health competence, and psychosocial health outcomes: Test of a mediation model in a breast cancer sample. Patient Education and Counseling, 47, 37-46. doi:10.1016/S0738-3991(01)00170-7
    Aziz, N.M., & Rowland, J.H. (2002). Cancer survivorship research among ethnic minority and medically underserved groups. Oncology Nursing Forum, 29, 789-801. doi:10.1188/02.ONF.789-801
    Banning, M. (2011). Black women and breast health: A review of the literature. European Journal of Oncology Nursing, 15, 16-22.
    Betancourt, J.R., Green, A.R., Carrillo, J.E., & Park E.R. (2005). Cultural competence and health care disparities: Key perspectives and trends. Health Affairs, 24, 499-505. doi:10.1377/hlthaff.24.2.499
    Brehaut, J.C., O'Connor, A.M., Wood, T.J., Hack, T.F., Siminoff, L., Gordon, E., & Feldman-Stewart, D. (2003). Validation of a decision regret scale. Medical Decision Making, 23, 281-292.
    Cabassa, L.J. (2003). Measuring acculturation: Where we are and where we need to go. Hispanic Journal of Behavioral Sciences, 25, 127-146. doi:10.1177/0739986303025002001
    Cochrane, B.B., Lewis, F.M., & Griffith, K.A. (2011). Exploring a diffusion of benefit: Does a woman with breast cancer derive benefit from an intervention delivered to her partner? Oncology Nursing Forum, 38, 207-214. doi:10.1188/11.ONF.207-214
    Conway, J., Johnson, B., Edgman-Levitan, S., Schlucter, J., Ford, D., Sodomka, P., & Simmons, L. (2006). Partnering with patients and families to design a patient- and family-centered health care system: A roadmap for the future. Retrieved from
    Cuellar, I., Arnold, B., & Maldonado, R. (1995). Acculturation rating scale for Mexican Americans-II: A revision of the original ARSMA scale. Hispanic Journal of Behavioral Sciences, 17, 275-304.
    Duric, V.M., Butow, P.N., Sharpe, L., Heritier, S., Boyle, F., Beith, J., … Stockler, M.R. (2008). Comparing patients' and their partners' preferences for adjuvant chemotherapy in early breast cancer. Breast Cancer Research and Treatment, 72, 239-245.
    Edgman-Levitan, S. (2003). Healing partnerships: The importance of including family and friends. In S. Frampton, L. Gilpin, & P. Charmel (Eds.), Putting patients first (pp. 51-69). San Francisco, CA: Jossey-Bass.
    Epstein, R.M., & Street, R.L. (2011). The values and value of patient-centered care. Annals of Family Medicine, 9, 100-103. doi:10.1370/afm.1239
    Fagerlin, A., Lakhani, I., Lantz, P.M., Janz, N.K., Morrow, M., & Schwartz, K., … Katz, S.J. (2006). An informed decision? Breast cancer patients and their knowledge about treatment. Patient Education and Counseling, 64, 303-312. doi:10.1016/j.pec.2006.03.010
    Frosch, D.L., & Elwyn, G. (2011). I believe, therefore I do. Journal of General Internal Medicine, 26, 2-4. doi:10.1007/s11606-010-1560-1
    Gallia, K.S., & Pines, E.W. (2009). Narrative identity and spirituality of African American church women surviving breast cancer survivors. Journal of Cultural Diversity, 16, 50-55.
    Gilbar, R., & Gilbar, O. (2009). The medical decision-making process and the family: The case of breast cancer patients and their husbands. Bioethics, 23, 183-192. doi:10.1111/j.1467-8519.2008.00650.x
    Gilovich, T., & Medvec, V.H. (1995). The experience of regret: What, when, and why. Psychological Review, 102, 379-395. doi:10.1037/0033-295X.102.2.379
    Hamilton, A.S., Hofer, T.P., Hawley, S.T., Morrell, D., Leventhal, M., & Deapen, D., … Katz, S.J. (2009). Latinas and breast cancer outcomes: Population-based sampling, ethnic identity, and acculturation assessment. Cancer Epidemiology, Biomarkers and Prevention, 18, 2022-2029. doi:10.1158/1055-9965.EPI-09-0238
    Hawley, S.T., Fagerlin, A., Janz, N.K., & Katz, S.J. (2008). Racial/ethnic disparities in knowledge about risks and benefits of breast cancer treatment: Does it matter where you go? Health Services Research, 43, 1366-1387. doi:10.1111/j.1475-6773.2008.00843.x
    Hawley, S.T., Griggs, J.J., Hamilton, A.S., Graff, J.J., Janz, N.K., Morrow, M., … Katz, S.J. (2009). Decision involvement and receipt of mastectomy among racially and ethnically diverse breast cancer patients. Journal of the National Cancer Institute, 101, 1337-1347. doi:10.1093/jnci/djp271
    Hawley, S.T., Janz, N.K., Hamilton, A., Griggs, J.J., Aldeman, A.K., Mujahid, M., & Katz, S.J. (2008). Latina patient perspectives about informed treatment decision making for breast cancer. Patient Education and Counseling, 73, 363-370. doi:10.1016/j.pec.2008.07.036
    Hilton, B.A., Crawford, J.A., & Tarko, M.A. (2000). Men's perspectives on individual and family coping with their wives' breast cancer and chemotherapy. Western Journal of Nursing Research, 22, 438-459. doi:10.1177/019394590002200405
    Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academies Press.
    Janz, N.K., Mujahid, M.S., Hawley, S.T., Griggs, J.J., Hamilton, A.S., & Katz, S.J. (2008). Racial/ethnic differences in adequacy of information and support for women with breast cancer. Cancer, 113, 1058-1067. doi:10.1002/cncr.23660
    Johnson, B., Abraham, M., Conway, J., Simmons, L., Edgman-Levitan, S., Sodomka, P., & Ford, D. (2008). Partnering with patients and families to design a patient- and family-centered health care system: Recommendations and promising practices. Retrieved from
    Kilpatrick, M.G., Kristjanson, L.J., Tataryn, D.J., & Fraser, V.H. (1998). Information needs of husbands of women with breast cancer. Oncology Nursing Forum, 25, 1595-1601.
    Lewis, F.M., Cochrane, B.B., Fletcher, K.A., Zahlis, E.H., Shands, M.E., Gralow, J.R., … Schmitz, K. (2008). Helping her heal: A pilot study of an educational counseling intervention for spouses of women with breast cancer. Psycho-Oncology, 17, 131-137. doi:10.1002/pon.1203
    Maly, R.C., Umezawa, Y., Leake, B., & Silliman, R.A. (2004). Determinants of participation in treatment decision-making by older breast cancer patients. Breast Cancer Research and Treatment, 85, 201-209.
    Maly, R.C., Umezawa, Y., Ratliff, C.T., & Leake, B. (2006). Racial/ethnic group differences in treatment decision making and treatment received among older breast carcinoma patients. Cancer, 106, 957-965.
    Marín, G., Sabogal, F., VanOss Marín, B., Otero-Sabogal, F., & Pérez-Stable, E.J. (1987). Development of a short acculturation scale for Hispanics. Hispanic Journal of Behavioral Sciences, 9, 183-205.
    Meissner, H.I., Anderson, D.M., & Odenkirchen, J.C. (1990). Meeting information needs of significant others: Use of the Cancer Information Service. Patient Education and Counseling, 15, 171-179.
    Moore, R.J., & Butow, P. (2004). Culture and oncology: Impact of context effects. New York, NY: Kluwer Academic.
    Mujahid, M.S., Janz, N.K., Hawley, S.T., Griggs, J.J., Hamilton, A.S., & Katz, S.J. (2009). The impact of sociodemographic, treatment, and work support on missed work after breast cancer diagnosis. Breast Cancer Research and Treatment, 119, 213-220.
    Northouse, L.L., Katapodi, M.C., Song, L., Zhang, L., & Mood, D.W. (2010). Interventions with family caregivers of cancer patients: Meta-analysis of randomized trials. CA: A Cancer Journal for Clinicians, 60, 317-339. doi:10.3322/caac.20081
    Öhlén, J., Balneaves, L.G., Bottorff, J.L., & Brazier, A.S.A. (2006). The influence of significant others in complementary and alternative medicine decisions by cancer patients. Social Science and Medicine, 63, 1625-1636. doi:10.1016/j.socscimed.2006.03.050
    Rees, C.E., & Bath, P.A. (2000). Exploring the information flow: Partners of women with breast cancer, patients, and healthcare professionals. Oncology Nursing Forum, 27, 1267-1275.
    Sandham, C., & Harcourt, D. (2007). Partner experiences of breast reconstruction post mastectomy. European Journal of Oncology Nursing, 11, 66-73. doi:10.1016/j.ejon.2006.05.004
    Shaller, D. (2007). Patient-centered care: What does it take? Washington, DC: The Commonwealth Fund.
    Sheehan, J., Sherman, K.A., Lam, T., & Boyages, J. (2007). Association of information satisfaction, psychological distress, and monitoring coping style with post-decision regret following breast reconstruction. Psycho-Oncology, 16, 342-351. doi:10.1002/pon.1067
    Stiggelbout, A.M., Jansen, S.J.T., Otten, W., Baas-Thijssen, M.C.M., van Slooten, H., & Van de Velde, C.J.H. (2007). How important is the opinion of significant others to cancer patients' adjuvant chemotherapy decision-making? Supportive Care in Cancer, 15, 319-325. doi:10.1007/s00520-006-0149-z
    Surbone, A. (2008). Cultural aspects of communication in cancer care. Supportive Care in Cancer, 16, 235-240.
    Word, D., & Perkins, J.R. (1996). Building a Spanish surname list for the 1990's—A new approach to an old problem. Washington, DC: U.S. Census Bureau.