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Recent reports suggest that Black breast cancer patients receive adjuvant therapies less often than their White counterparts; however, few studies have examined the self-reported experiences of Black breast cancer patients making treatment decisions. This study examined cultural beliefs and healthcare factors that impacted Black women's treatment decisions.In-depth interviews were conducted with 49 Black women with early stage breast cancer (stages 0-III). Participants resided in Washington, DC (n = 13), and Philadelphia, Pennsylvania (n = 36). Women's ages ranged from 26 to 85 (m = 53.9). All interviews were transcribed verbatim and then entered into a qualitative software program. Three coders independently read and coded transcripts using this software.The data did not reveal common cultural themes that influenced women's treatment decisions. Spiritual beliefs were important to all participants and did seem to help them cope with and reframe their illness experiences. The patient–provider relationship was the most notable factor that influenced treatment decisions. While most women reported that they were satisfied with their provider relationships, their narratives revealed that many lacked knowledge about their diagnoses and treatment regimens. Those patients who demonstrated a better understanding of their disease and treatments also seemed to adhere to recommendations for adjuvant therapy.Poor communication may impact treatment decision-making and, ultimately, outcomes. Important next steps will include quantifying Black women's patient–provider interactions and examining how these factors influence adherence behaviors. Ensuring that patients understand their diagnosis and treatment options will also be important for clinical practice. Copyright © 2010 John Wiley & Sons, Ltd.