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Letter to the Editor: Primary Breast Cancer Decision-making Among Chinese American Women, Lee & Knobf (2015).

In a recent issue ofNursing Research, Lee and Knobf (2015) presented their findings relating medical decision-making for cancer treatment to satisfaction or regret in a Chinese American community in Primary Breast Cancer Decisionmaking Among Chinese American Women. The authors examined factors that lead to treatment decisions for breast cancer and correlated lower levels of satisfaction with decisional conflict, especially in socially or economically disadvantaged women who experience difficulty communicating with their physicians. I thoroughly enjoyed reading the paper and am pleased to learn of the progress regarding research in sparsely studied ethnic groups such as the Chinese American population. The theoretical framework centered on the Ottawa decision support framework (Légaré, O’Connor, Graham, Wells, & Tremblay, 2006), with emphasis on the expectancy value model, decisional conflict theory, and social support theory. The authors referred to the breast Cancer Decision-Making Questionnaire with Decisional Conflict and Regret scales that was made available in the Chinese language. This raises a question for me surrounding the use of this tool, which in its origin was validatedwith test subjects in Ottawa, Canada, with educated test subjects residing in a nation where healthcare is publicly funded. This leads me to question if a theoretical framework rooted in Westernized thought and experiences is fit for the population in this study. In addition, was the Chinese version of this tool validated in the population of interest? In my attempt to find this answer, I located two papers that addressed validation of this tool: one, in the United States regarding genetic testing (Katapodi, Munro, Pierce, & Williams, 2011) and another in Hong Kong (Lam et al., 2012) conducted among breast cancer patients. Both reported limitations of transferability, as the first studied a primarily homogenous, affluent, White population, and the second, although conducted in Chinese, removed the element of language barrier between patients and their respective providers. Lam et al. (2015) verified its reliability, but not its external validity, even stating, “The original proposed factor structure measuring decisional conflict may not be applicable across different populations (p. 218).”We learned fromWalker and Avant (2011) that many