Rose C Maly1, Barbara Leake, Rebecca A Silliman. 1. Department of Family Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90095, USA. rmaly@mednet.ucla.edu
Abstract
OBJECTIVES: To assess the impact of the patient-physician interaction on breast cancer care in older women. DESIGN: Cross-sectional survey. SETTING: Los Angeles County, California. PARTICIPANTS: Two hundred twenty-two consecutively identified breast cancer patients aged 55 and older who were within 6 months of breast cancer diagnosis and/or 1 month posttreatment. MEASUREMENTS: Dependent variables were patient breast cancer knowledge, treatment delay, and receipt of breast-conserving surgery (BCS). Key independent variables were five dimensions of the patient-physician interaction by patient report, including physician provision of tangible and interactive informational support, physician provision of emotional support, physician participatory decision-making style, and patient perceived self-efficacy in the patient-physician interaction. Age and ethnicity were additional important independent variables. RESULTS: In multiple logistic regression models, only physician interactive informational support had significant relationships with all three dependent variables, controlling for a wide range of patient sociodemographic and case-mix characteristics, visit length, number of physicians seen, social support, and physician sociodemographic and practice characteristics. Specifically, informational support positively predicted patient breast cancer knowledge (adjusted odds ratio (AOR)=1.18, 95% confidence interval (CI)=1.00-1.38), negatively predicted treatment delays (AOR=0.80, 95% CI=0.67-0.94), and positively predicted receipt of BCS (AOR=1.29, 95% CI=1.07-1.56). Age and ethnicity were not significant predictors in these models. CONCLUSION: One specific domain of the patient-physician interaction, interactive informational support, may provide an avenue to ensure adequate breast cancer knowledge for patient treatment decision-making, decrease treatment delay, and increase rates of BCS for older breast cancer patients, thereby potentially mitigating known healthcare disparities in this vulnerable population of breast cancer patients.
OBJECTIVES: To assess the impact of the patient-physician interaction on breast cancer care in older women. DESIGN: Cross-sectional survey. SETTING: Los Angeles County, California. PARTICIPANTS: Two hundred twenty-two consecutively identified breast cancerpatients aged 55 and older who were within 6 months of breast cancer diagnosis and/or 1 month posttreatment. MEASUREMENTS: Dependent variables were patientbreast cancer knowledge, treatment delay, and receipt of breast-conserving surgery (BCS). Key independent variables were five dimensions of the patient-physician interaction by patient report, including physician provision of tangible and interactive informational support, physician provision of emotional support, physician participatory decision-making style, and patient perceived self-efficacy in the patient-physician interaction. Age and ethnicity were additional important independent variables. RESULTS: In multiple logistic regression models, only physician interactive informational support had significant relationships with all three dependent variables, controlling for a wide range of patient sociodemographic and case-mix characteristics, visit length, number of physicians seen, social support, and physician sociodemographic and practice characteristics. Specifically, informational support positively predicted patientbreast cancer knowledge (adjusted odds ratio (AOR)=1.18, 95% confidence interval (CI)=1.00-1.38), negatively predicted treatment delays (AOR=0.80, 95% CI=0.67-0.94), and positively predicted receipt of BCS (AOR=1.29, 95% CI=1.07-1.56). Age and ethnicity were not significant predictors in these models. CONCLUSION: One specific domain of the patient-physician interaction, interactive informational support, may provide an avenue to ensure adequate breast cancer knowledge for patient treatment decision-making, decrease treatment delay, and increase rates of BCS for older breast cancerpatients, thereby potentially mitigating known healthcare disparities in this vulnerable population of breast cancerpatients.
Authors: Mara A Schonberg; Robyn L Birdwell; Brittany L Bychkovsky; Lindsay Hintz; Valerie Fein-Zachary; Michael D Wertheimer; Rebecca A Silliman Journal: Breast Cancer Res Treat Date: 2014-03-31 Impact factor: 4.872
Authors: Mónica E López; Celia P Kaplan; Anna M Nápoles; E Shelley Hwang; Jennifer C Livaudais; Leah S Karliner Journal: Patient Educ Couns Date: 2013-09-17
Authors: Caprice C Greenberg; Eric C Schneider; Stuart R Lipsitz; Clifford Y Ko; Jennifer L Malin; Arnold M Epstein; Jane C Weeks; Katherine L Kahn Journal: J Am Coll Surg Date: 2008-02-01 Impact factor: 6.113