Improving Communication Between Doctors and Breast Cancer Patients

Moira Stewart; Judith Belle Brown; Joanne Hammerton; Allan Donner; Alan Gavin; Ronald L. Holliday; Tim Whelan; Ken Leslie; Irene Cohen; Wayne Weston; Tom Freeman

doi:10.1370/afm.721

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Figure 1.
Diagram of participants in the study.

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Table 1.

Continuing Medical Education Program Course Outlines

Course Element	Intervention State-of-the-Art Course	Control Traditional Course
Length, hr	6	2
Literature on the benefits of patient- physician communication	✓	✓
Physicians’ perspective	✓	×
Patients’ perspective	✓	×
Video demonstration and discussion	✓	✓
Two interviews with standardized patients and subsequent video- tape review and feedback	✓	×

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Table 2.

Comparison of the Characteristics of the Intervention and Control Groups

Characteristic	Intervention Group (n=25)	Control Group (n=26)
* One control group doctor did not answer this question.
Type of doctor, No. (%)
Family physician	8 (32)	9 (34)
Surgeon	8 (32)	8 (30)
Oncologist	9 (36)	9 (34)
Total	25 (100)	26 (100)
Sex, No. (%)
Male	16 (64)	18 (69)
Female	9 (36)	8 (30)
Total	25 (100)	26 (100)
Year of graduation, No. (%)
Before 1986	13 (52)	12 (46)
1986 or after	12 (48)	14 (53)
Total	25 (100)	26 (100)
Communication courses, No. (%)
Yes	11 (44)	13 (52)
No	14 (56)	12 (48)
Total	25 (100)	25 (100)*
Baseline objective: communication	74.6 (12.10),	70.4 (11.94),
scores, mean (SD), 95% CI	69.61–79.60	65.57–75.21

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Table 3.

Analysis of Covariance: Objective Communication Subscores in Relation to Family Physician’s Intervention Status

	Intervention (n=8)		Control (n=9)
Family Physicians	Mean Score (SD)	CI	Mean Score (SD)	CI	P Value
Note: Analysis controlling for baseline objective communication score. Total score and each subscore ranged from 0 to 100.
* The support score is the only one expressed as a percentage, not a continuous variable.
Building relationships
Exploration of illness experience	65.0 (5.07)	57.85–71.68	56.3 (11.44)	50.04–63.08	.09
Validation of patients’ illness experience	79.1 (14.78)	67.54–91.39	71.7 (15.48)	60.13–82.59	.31
Offering support, %*	77.8 (n/a)		22.2 (n/a)		.02
Sharing information
Physician description and patient response	86.3 (18.29)	71.78–101.56	66.3 (19.23)	51.93–79.96	.05
Creating an experience of control
Mutual discussion of management plan	68.8 (45.81)	39.13–98.36	62.2 (31.26)	34.30–90.15	.74
Mastering the whole person experience
Exploration of whole person issues	82.8 (9.81)	69.12–92.34	58.7 (18.33)	49.60–71.39	.02
Validation of whole person issues	77.0 (15.97)	58.04–93.43	49.1 (26.31)	33.61–66.86	.05
Total score	75.6 (14.73)	62.90–84.99	60.2 (15.27)	51.29–72.07	.11

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Table 4.

Multivariable Analysis of the 4 Patient Outcome Measures in Relation to Doctor’s Intervention Status (n = 102)

Outcome Variable	Intervention Group	Control Group	Coefficient/SE	P Value
Note: Analysis controlling for patients’ education and number of medical conditions.
* Mean score and standard deviation are unadjusted.
† Mixed model linear regression with continuous outcome variable adjusting for clustering within doctor.
‡ Multiple logistic regression with the dichotomous outcome adjusting for clustering within doctor.
Patient perception of patient-centeredness, mean score (SD)*^†	3.28 (0.49)	3.14 (0.49)	−1.02	.32
Patient satisfaction with doctor’s information-giving and inter- personal skills, mean score (SD)*^†	82.06 (5.80)	77.78 (8.07)	−2.28	.03
Patients’ psychological distress, mean score (SD)*^†	0.40 (0.40)	0.46 (0.38)	1.18	.25
Patient perception of well-being (worse/same vs better), %^‡	88.2	70.6	−2.39	.02

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Table 5.

Mixed Model Linear Regression of Patient Satisfaction With Doctor’s Information-Giving and Interpersonal Skills in Relation to Doctor’s Intervention Status (n = 102)

Outcome: Satisfaction	Coefficient	SE	Coefficient/SE	P Value
Note: Analysis controlling for patients’ education and number of medical conditions and adjusting for clustering within doctor.
Independent variables
Group	−3.92	1.72	−2.28	.03
Education	0.65	1.39	0.47	.65
No. of medical conditions	0.43	0.56	0.77	.45
	Mean Score (SD)
Mean level of satisfaction by group
Intervention	82.06 (5.80)
Control	77.78 (8.07)

The Article in Brief

Improving Communication Between Doctors and Breast Cancer Patients

Moira Stewart, PhD , and colleagues

Background This study tests a new continuing medical education (CME) program aimed at improving communication between doctors and breast cancer patients. The program, based on needs described by patients, is 6 hours long and includes a discussion of patients' perspectives and a videotape review with individual feedback. It is compared with a traditional, 2-hour CME program that shows and discusses a videotaped patient-doctor visit.

What This Study Found There were no significant differences between the communication scores of 51 doctors (family physicians, surgeons, and oncologists) exposed to a traditional 2-hour CME program, compared with a new 6-hour intensive version. Among family physicians, however, those exposed to the longer program had higher communication scores than those exposed to the traditional 2-hour program. Patients of surgeons and oncologists who participated in the new 6-hour program were more satisfied and felt better than patients whose doctors participated in the 2-hour program.

Implications

This study contributes to our understanding of communication education. The new intensive 6-hour CME is effective but appears to have different effects on different types of doctors.