Newswise — Women who prefer to speak Spanish in daily life are far unhappier with the decision-making process after having to choose between mastectomy and lumpectomy than Latinas who prefer to speak English, African-Americans and white women, finds a new U.S. study of breast cancer patients.

Spanish-choosing Latinas were 5.5 times more likely to be dissatisfied and 4.1 times more likely to regret their decision compared to whites, even when considering other factors including health literacy, said lead study author Sarah Hawley, Ph.D.

Hawley is an assistant professor of general medicine at the University of Michigan and an investigator for the Veterans Affairs Medical Center in Ann Arbor. The study appears in the November issue of the journal Patient Education and Counseling.

The researchers selected 877 women who were eligible for either type of surgery from a Los Angeles cancer registry. Study participants included Spanish-choosing Latinas, English-choosing Latinas, African-Americans, whites and others. All women underwent health literacy testing to determine whether they could fill out forms themselves or if they needed assistance.

The clinical outcomes for all the approaches and groups of women were equal, but the Spanish-preferring women were far more likely to report having either too much input into the decision, or too little, according to the study. These women, as a group, tended to rank lower in health literacy, but the researchers say this does not account for all of the dissatisfaction with their decision.

These data suggest that Spanish-using women did not understand their options or the information provided to them, Hawley said. "In a good proportion of these cases, we feel the health literacy and language needs were not attended to." For example, she said, these women could have a doctor who does not speak Spanish or receive a pamphlet that is not in Spanish or goes unexplained.

Another factor in the study findings may be that the patient is not able to express her questions and concerns, Hawley said, and the physician may not try to find out what the patient understands or thinks. "There is something else related to race or culture going on."

Susan Love, M.D., president of Dr Susan Love Research Foundation, was raised in Latin America for part of her childhood and speaks Spanish herself. She said these findings do not surprise her: "If you have breast cancer, you are anxious enough, but then you get an explanation in a language that you are not comfortable with?"

This is why the growing movement to assign health navigators to patients with serious diagnoses is a good one, she said.

The University of Michigan team is at work on a computer-based interactive decision-making tool that eventually will be available in Spanish. They are also re-contacting those in the study to see how they feel about their decision now, three years after their surgery.

Patient Education and Counseling is an international peer reviewed research journal publishing 15 issues per year by Elsevier. For more information on the journal please contact Sean Evans at Visit the journal website at

Hawley ST, et al. Latina patient perspectives about informed decision making for breast cancer. Patient Educ Couns 73(3), 2008.

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