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Communication Between Physicians and Older Women With Localized Breast Cancer: Implications for Treatment and Patient Satisfaction

From the Departments of Oncology and Medicine and School of Nursing, Georgetown University Medical Center, Washington, DC; Office of Cancer Survivorship, National Cancer Institute, Bethesda, MD; Divisions of Medical Science and Population Science, Fox Chase Cancer Center, Philadelphia, PA; and Boston University Medical Center and Department of Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.

Address reprint requests to Wenchi Liang, MD, Department of Oncology, Georgetown University Medical Center, 2233 Wisconsin Ave NW, Ste 440, Washington, DC 20007; email: liangw1{at}georgetown.edu

PURPOSE: To identify factors associated with patient-physician communication and to examine the impact of communication on patients’ perception of having a treatment choice, actual treatment received, and satisfaction with care among older breast cancer patients.

MATERIALS AND METHODS: Data were collected from 613 pairs of surgeons and their older ( 67 years) patients diagnosed with localized breast cancer. Measures of patients’ self-reported communication included physician- and patient-initiated communication and the number of treatment options discussed. Logistic regression analyses were conducted to examine the relationships between communication and outcomes.

RESULTS: Patients who reported that their surgeons mentioned more treatment options were 2.21 times (95% confidence interval [CI], 1.62 to 3.01) more likely to report being given a treatment choice, and 1.33 times (95% CI, 1.02 to 1.73) more likely to get breast-conserving surgery with radiation than other types of treatment. Surgeons who were trained in surgical oncology, or who treated a high volume of breast cancer patients ( 75% of practice), were more likely to initiate communication with patients (odds ratio [OR] = 1.62; 95% CI, 1.02 to 2.56; and OR = 1.68; 95% CI, 1.01 to 2.76, respectively). A high degree of physician-initiated communication, in turn, was associated with patients’ perception of having a treatment choice (OR = 2.46; 95% CI, 1.29 to 4.70), and satisfaction with breast cancer care (OR = 2.13; 95% CI, 1.17 to 3.85) in the 3 to 6 months after surgery.

CONCLUSION: Greater patient-physician communication was associated with a sense of choice, actual treatment, and satisfaction with care. Technical information and caring components of communication impacted outcomes differently. Thus, the quality of cancer care for older breast cancer patients may be improved through interventions that improve communication within the physician-patient dyad.

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