Treatment Decision Making in African American Women Diagnosed with Triple Negative Breast Cancer

Background: Breast cancer is the most diagnosed cancer in women across the globe. Women diagnosed with Triple Negative Breast Cancer (TNBC) have the highest mortality rate compared to other subtypes of breast cancer. After diagnosis, considerable attention is extended to decisions regarding treatment. These efforts include, but are not limited to, immediate emotional and mental management, resource availability, belief in treatment outcomes, and consideration of short and long-term quality of life outcomes. Treatment decision making (TDM) communicates how patients understand and attribute worth to their treatment options in relation to salient aspects of their interpersonal processing to the treatment staff. Research suggests African American/Black women diagnosed with breast cancer are more likely to engage in behavior contradictory to medical advice such as treatment delay or premature termination. In addition, African American/Black women are most susceptible to negative outcomes along the breast cancer continuum, including younger diagnosis compared to the national average and poor survival outcomes. Despite the devasting consolidation of diagnosis susceptibility, consequential health behavior and poor health outcomes, little attention has been extended to understand TDM in African American/Black women to identify influential determinants. Purpose: The purpose of the present study was to investigate current TNBC treatment acceptance rates and identify determinants of initial treatment intention and final treatment decision in African American/Black women. Methods: Thirty-three African American/Black women recently diagnosed with TNBC were recruited from an academic National Cancer Institute designated cancer center. The volunteer patients completed a two-part, time-specific online self-report assessment battery that measured the components of the Theory of Planned Behavior and a semi-structured interview within an online focus group. Logistic regression and the Constant Comparative Method of the Grounded Theory were utilized to identify the mechanisms of TDM in African American/Black women diagnosed with TNBC. Results: The ages of the volunteer participants ranged from 30 – 69 years of age and most were diagnosed at Stage 3 (85%). Most of the women were employed (71%), with private insurance (85%), and endorsed family history of cancer (77%). All volunteer participants selected the treatment recommendation as their final treatment decision. Thematic findings from the online focus groups identified four influential factors within their TDM process: health advocacy behavior (self-discovery of breast tumor, favorable research participation, and treatment recommendation agreeance), application of faith (religion, MDACC reputation, lack of caregiver influence), historical influences (family cancer history, environmental stressors), and ultimate deciding factor. Conclusion: African American/Black women may be agreeable to receipt of care of and treatment recommendations from treatment institutions that employ patient-centered communication strategies regarding trust in the treatment institution. Furthermore, TDM recommendations and guidelines should consider inclusion of external factors such as trust in treatment institution and interpersonal exposure to cancer experiences.