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Original Research: Lung Cancer |

Racial and Ethnic Differences in Beliefs About Lung Cancer CareLung Cancer Beliefs in Minorities

Sirisha Jonnalagadda, MD; Jenny J. Lin, MD; Judith E. Nelson, MD, JD, FCCP; Charles A. Powell, MD; John Salazar-Schicchi, MD; Andrew R. Berman, MD, FCCP; Steven M. Keller, MD, FCCP; Cardinale B. Smith, MD, MSCR; Linda Lurslurchachai, MPH; Ethan A. Halm, MD, MPH; Howard Leventhal, PhD; Juan P. Wisnivesky, MD, DrPH
Author and Funding Information

From the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School (Dr Jonnalagadda), Piscataway, NJ; Division of General Internal Medicine (Drs Lin and Wisnivesky and Ms Lurslurchachai); Division of Pulmonary, Critical Care and Sleep Medicine (Drs Nelson, Powell, and Wisnivesky); and Division of Hematology and Oncology (Dr Smith), Mount Sinai School of Medicine, New York, NY; Hertzberg Palliative Care Institute (Drs Nelson and Smith), Brookdale Department of Geriatrics and Palliative Medicine, The Mount Sinai Hospital, New York, NY; Division of Pulmonary and Critical Care Medicine (Dr Salazar-Schicchi), Columbia University, New York, NY; Division of Pulmonary and Critical Care Medicine (Dr Berman), University of Medicine and Dentistry of New Jersey, Newark, NJ; Department of Thoracic Surgery (Dr Keller), Albert Einstein College of Medicine, Bronx, NY; Department of Medicine (Dr Halm), University of Texas Southwestern, Dallas, TX; and Department of Psychology (Dr Leventhal), Rutgers University, New Brunswick, NJ.

Correspondence to: Juan P. Wisnivesky, MD, DrPH, Department of Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Pl, Box 1087, New York, NY 10029; e-mail: juan.wisnivesky@mssm.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Funding/Support: The study was supported by the American Cancer Society [RSGT-07-162-01-CPHPS]. Dr Jonnalagadda was supported by the Doris Duke Foundation for Clinical Research.


Chest. 2012;142(5):1251-1258. doi:10.1378/chest.12-0330
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Background:  Disparities in lung cancer treatment and palliative care are well documented. However, the mechanisms underlying these disparities are not fully understood. In this study, we evaluated racial and ethnic differences in beliefs and attitudes about lung cancer treatment and palliative care among patients receiving a new diagnosis of lung cancer.

Methods:  Patients were recruited from four medical centers in New York City and surveyed about their beliefs regarding lung cancer care, including disease-directed treatments, palliative and end-of-life care, and fatalistic and spiritual beliefs. We used univariate and multiple regression analyses to compare the distribution of beliefs among minority (black and Hispanic) and nonminority patients.

Results:  Of the 335 patients, 21% were black, 20% were Hispanic, and 59% were nonminority. Beliefs about chemotherapy and radiotherapy were similar across the three groups (P > .05), whereas black patients were more likely to believe that surgery might cause lung cancer to spread (P = .008). Fatalistic beliefs potentially affecting cancer treatment were more common among both minority groups (P ≤ .02). No significant differences were found in attitudes toward clinician communication about cancer prognosis (P > .05). However, both blacks and Hispanics were more likely to have misconceptions about advance directives and hospice care (P ≤ .02).

Conclusions:  Similarities and differences in beliefs about disease-directed treatment were observed between minority and nonminority patients with lung cancer. Minority patients hold more fatalistic views about the disease and misperceptions about advance care planning and hospice care. Further research is needed to assess the impact of these beliefs on decisions about lung cancer care and patient outcomes.


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