Problems in doctor-patient communication: The case of younger women with breast cancer

Abstract

AB S T R A C T Communication between physicians and patients is considered to be a core component in the provision and receipt of appropriate medical care. However, previous research indicates that doctor-patient relationships can be problematic, with negative consequences for patients including higher levels of anxiety, distrust of medical providers, dissatisfaction with healthcare and lower quality of life. This research utilizes data collected from a series of focus groups involving 19 women with breast cancer aged 50 and under to examine the nature of problems that may arise in communication between physicians and younger patients concerning the detection, diagnosis and treatment of this life-threatening disease. Conducted according to the general principals of grounded theory generation, this analysis identi ed four central themes: (1) women's realization of medical uncertainty, (2) their rejection of physician paternalism, (3) women's desire for information, and(4) their preference for a greater role in decision making. Qualitative data are presented in the context of social in uences and cohort experiences that help to explain these dif culties. The results suggest that communication problems may be a consequence of incongruity between medical practice and patient expectations. Medical uncertainty regarding breast cancer in pre-menopause can lead to recognition of physician fallibility and rejection of expert authority. Socialized in an era of increasing patient autonomy and medical consumerism, results indicate that this cohort of women tends to prefer an active partner to passive patient role in the diagnostic and treatment decisionmaking process.

Doctor-patient communication in radiology: a great opportunity for future radiology

“…A 1994 study on the preferences of women undergoing mammography revealed that 90% of respondents agreed that the radiologist should give them the results directly on site [24]. This desire is confirmed by a public health journal with regard to young women affected by breast cancer and their desire to be informed of their fate [25]. In the same year, the concept was restated that information and a more direct involvement of the patient in decision making improved patient satisfaction as well as outcome, as it had a positive impact on functional recovery and quality of life and increased acceptance of oncological therapies [26].…”

“…Un'inchiesta eseguita nel 1994 sui desideri di donne sottoposte a mammografia dimostrò che più del 90% delle intervistate era d'accordo sul fatto che il radiologo dovesse fornire la diagnosi direttamente alle interessate [24]. La stessa aspirazione viene sancita su di una rivista di sanità pubblica a proposito della volontà di conoscere il proprio destino da parte di giovani donne affette da carcinoma mammario [25]. Nello stesso anno viene ribadito il concetto che già l'esperienza di molti aveva suggerito, che una migliore informazione e un più diretto coinvolgimento della paziente nelle decisioni dimostrava avere un effetto positivo sia nella soddisfazione della donna, sia nel suo out-come, ovvero come ricaduta positiva nel recupero funzionale e sulla qualità di vita, anche per una migliore accettazione delle terapie oncologiche [26].…”

Use of Complementary Therapies During Chemotherapy: Influence of Patients’ Satisfaction With Treatment Decision Making and the Treating Oncologist

“…[35][36][37][38][39] The results of a focus group study suggest that the physician-patient relationship can be problematic, however, for younger (defined as younger than 50 years) women with breast cancer. 11 Research on other patient populations shows that poor communication between physicians and patients is significantly associated with high levels of anxiety, distrust of health care providers, suspicion of therapy recommendations, and dissatisfaction with medical services [40][41][42][43][44] ; these factors may influence patients to try CT.…”

“…On average, satisfaction with treatment decision making was high, with a mean score of 15.6 (SD = 3.4; range, [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Most women reported that they were satisfied or very satisfied with the amount of time they had to make treatment decisions (92%) and with their degree of participation in the decision-making process (93%).…”

“…[7][8][9][10] While findings regarding the characteristics of women who use complementary therapy (CT) are relatively consistent across studies, not much is known about the stimuli that influence the decision to use CT during conventional cancer treatment. For example, while there is some evidence that patientphysician communication about breast cancer treatment decisions may be frustrating for women, 11,12 it is not yet clear how patient satisfaction with this exchange may be related to CT use. This article presents data on CT utilization among breast cancer patients undergoing chemotherapy with an emphasis on the relationship between CT use and patients' satisfaction with medical treatment decision making as well as with their medical oncologist.…”