Hossein Jajarmi, Seyedeh Belin Tavakoli Sani, Asma Pourtaheri, Mahdi Gholian-Aval, Habibollah Esmaily, Seyed Hamid Hosseini, Rezvan Rajabzadeh, Hadi Tehrani
A community based intervention to modify preventive behaviors of cutaneous leishmaniasis in children: a randomized controlled trial based on PRECEDE PROCEED model
BMC public health
declining treatment negatively affects health outcomes among patients cancer limited research investigated national trends factors associated treatment declination association overall survival os among patients breast cancer examine trends racial ethnic disparities treatment declination racial ethnic os differences stratified treatment decision us patients breast cancer retrospective crosssectional study used data patients breast cancer 2004 2020 national cancer database four treatment modalities assessed chemotherapy hormone therapy ht radiotherapy surgery chemotherapy cohort included patients stage iv disease ht cohort included patients stage iv hormone receptorpositive disease radiotherapy surgery cohorts included patients stage iii disease data analyzed march november 2023 race ethnicity sociodemographic clinicopathologic characteristics treatment decision categorized received declined modeled using logistic regression os modeled using cox regression models controlled year initial diagnosis age sex health insurance median household income facility type charlsondeyo comorbidity score histology american joint committee cancer stage molecular subtype tumor grade study included 2 837 446 patients mean sd age 616 134 years 991 female 17 american indian alaska native patients 35 asian pacific islander patients 112 black patients 56 hispanic patients 780 white patients 1 296 488 patients offered chemotherapy 124 721 96 declined 99 276 1 635 916 patients 61 declined radiotherapy 94 363 1 893 339 patients 50 declined ht 15 846 2 590 963 patients 06 declined surgery compared white patients american indian alaska native patients adjusted odds ratio aor 147 95 ci 126172 asian pacific islander patients aor 129 95 ci 115144 black patients aor 201 95 ci 189214 likely decline surgery american indian alaska native patients aor 113 95 ci 105121 asian pacific islander patients aor 121 95 ci 116127 likely decline chemotherapy black patients likely decline radiotherapy aor 105 95 ci 102108 asian pacific islander patients aor 081 95 ci 077085 black patients aor 086 95 ci 083089 hispanic patients aor 066 95 ci 063069 less likely decline ht furthermore black patients declined chemotherapy higher mortality risk white patients adjusted hazard ratio ahr 107 95 ci 102113 os differences black white patients declined ht ahr 105 95 ci 097113 radiotherapy ahr 098 95 ci 092104 crosssectional study highlights racial ethnic disparities treatment declination os suggesting need equityfocused interventions patient education treatment benefits improved patientclinician communication shared decisionmaking reduce disparities improve patient survival