Nancy K Janz1, Yun Li2, Brian J Zikmund-Fisher3,4,5, Reshma Jagsi6, Allison W Kurian7, Lawrence C An8, M Chandler McLeod2, Kamaria L Lee4, Steven J Katz4,9, Sarah T Hawley4,9,10. 1. Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 2830 SPH1, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA. nkjanz@umich.edu. 2. Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA. 3. Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 2830 SPH1, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA. 4. Division of General Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd, Building 16, Ann Arbor, MI, 48109, USA. 5. Center for Bioethics and Social Sciences in Medicine, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA. 6. Department of Radiation Oncology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA. 7. Departments of Medicine and Health Research and Policy, Stanford University, 900 Blake Wilbur, Stanford, CA, 94305, USA. 8. Center for Health Communications Research, Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd, Building 16, Ann Arbor, MI, 48109, USA. 9. Department of Health Management and Policy, University of Michigan, 2800 Plymouth Rd, Building 16, Ann Arbor, MI, 48109, USA. 10. Veterans Administration Center for Clinical Management Research, Ann Arbor VA Health Care System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.
Abstract
PURPOSE: Doctor-patient communication is the primary way for women diagnosed with breast cancer to learn about their risk of distant recurrence. Yet little is known about how doctors approach these discussions. METHODS: A weighted random sample of newly diagnosed early-stage breast cancer patients identified through SEER registries of Los Angeles and Georgia (2013-2015) was sent surveys about ~2 months after surgery (Phase 2, N = 3930, RR 68%). We assessed patient perceptions of doctor communication of risk of recurrence (i.e., amount, approach, inquiry about worry). Clinically determined 10-year risk of distant recurrence was established for low and intermediate invasive cancer patients. Women's perceived risk of distant recurrence (0-100%) was categorized into subgroups: overestimation, reasonably accurate, and zero risk. Understanding of risk and patient factors (e.g. health literacy, numeracy, and anxiety/worry) on physician communication outcomes was evaluated in multivariable regression models (analytic sample for substudy = 1295). RESULTS: About 33% of women reported that doctors discussed risk of recurrence as "quite a bit" or "a lot," while 14% said "not at all." Over half of women reported that doctors used words and numbers to describe risk, while 24% used only words. Overestimators (OR .50, CI 0.31-0.81) or those who perceived zero risk (OR .46, CI 0.29-0.72) more often said that their doctor did not discuss risk. Patients with low numeracy reported less discussion. Over 60% reported that their doctor almost never inquired about worry. CONCLUSIONS: Effective doctor-patient communication is critical to patient understanding of risk of recurrence. Efforts to enhance physicians' ability to engage in individualized communication around risk are needed.
PURPOSE: Doctor-patient communication is the primary way for women diagnosed with breast cancer to learn about their risk of distant recurrence. Yet little is known about how doctors approach these discussions. METHODS: A weighted random sample of newly diagnosed early-stage breast cancer patients identified through SEER registries of Los Angeles and Georgia (2013-2015) was sent surveys about ~2 months after surgery (Phase 2, N = 3930, RR 68%). We assessed patient perceptions of doctor communication of risk of recurrence (i.e., amount, approach, inquiry about worry). Clinically determined 10-year risk of distant recurrence was established for low and intermediate invasive cancer patients. Women's perceived risk of distant recurrence (0-100%) was categorized into subgroups: overestimation, reasonably accurate, and zero risk. Understanding of risk and patient factors (e.g. health literacy, numeracy, and anxiety/worry) on physician communication outcomes was evaluated in multivariable regression models (analytic sample for substudy = 1295). RESULTS: About 33% of women reported that doctors discussed risk of recurrence as "quite a bit" or "a lot," while 14% said "not at all." Over half of women reported that doctors used words and numbers to describe risk, while 24% used only words. Overestimators (OR .50, CI 0.31-0.81) or those who perceived zero risk (OR .46, CI 0.29-0.72) more often said that their doctor did not discuss risk. Patients with low numeracy reported less discussion. Over 60% reported that their doctor almost never inquired about worry. CONCLUSIONS: Effective doctor-patient communication is critical to patient understanding of risk of recurrence. Efforts to enhance physicians' ability to engage in individualized communication around risk are needed.
Entities:
Keywords:
Breast cancer; Physician communication; Risk perception; Worry about recurrence
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