The impact of doctor–patient communication on patients’ perceptions of their risk of breast cancer recurrence

Abstract

Purpose Doctor-patient communication is the primary way women diagnosed with breast cancer 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) were 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, 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 doctors discussed risk of recurrence “quite a bit” or “a lot” while 14% said “not at all.” Over half of women reported 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 their doctor did not discuss risk. Patients with low numeracy reported less discussion. Over 60% reported 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.

Parent understanding of the risk of future limitations secondary to pediatric cancer treatment

“…Discrepant understandings of prognosis or risk of future limitations between patients or their surrogates and their providers have been previously described in oncology and critical illnesses, with patients or surrogates typically being more optimistic than providers. 10,18–20 These discrepant views have been attributed to misunderstandings, differences in beliefs, and lack of explicit discussions about risk, 18,19 and all of these elements are likely involved in parental misunderstanding of risk of impairment due to cancer and cancer treatment. While our study did not evaluate the reasons for limited parental understanding of risks of future limitations, previous work showed that late effects are discussed far less than acute effects of treatment in initial informed consent discussions.…”

Association of Germline Genetic Test Type and Results With Patient Cancer Worry After Diagnosis of Breast Cancer

“…As noted in our prior work, cancer-related worry was associated with younger age and lower educational level, but not clinical factors. 10,11…”

Chinese health literacy scale for tuberculosis patients: a study on development and psychometric testing

“…Groups with higher rates of low health literacy included patients from remote areas, patients having lower income or low education, patients with age over 65, were generally in poor health conditions [15, 16]. Compared to those with adequate health literacy, individuals with limited health literacy had less knowledge about disease and treatment plans [17], less ability to correctly manage medication [18–20], more problems in communicating with health care professionals [21, 22], poorer self-care skills [23, 24]. Patients with limited health literacy have high risk of delaying their decision to seek medical care, and experiencing negative health outcomes [25–30].…”