Patient-centered care and breast cancer survivors’ satisfaction with information
Introduction
Breast cancer is often understood as a chronic illness; as with other chronic illnesses, quality of life is a central issue in the ongoing care of breast cancer survivors [1], [2], [3]. Patient satisfaction with information is an important component of quality of life, as patients who are satisfied with information experience better psychosocial outcomes, including less mood disturbance, fewer depressive symptoms, and lower levels of anxiety [4], [5], [6]. Patients who are satisfied with information are also more likely to comply with medical recommendations and treatments [7], [8], [9].
A challenge to physicians in meeting patients’ informational needs is that the type and amount of information needed by patients differs between individuals and within a single individual over time. Models of physician–patient communication have suggested that in order for physicians to adequately assess and respond to patients’ differing needs, physicians must involve patients in the medical consultation. On the most simplistic level, patients who take an active role in the medical consultation have an opportunity to ask questions and can elicit the information that is most important to them [10], [11]. Frequently, however, patients may be unable to conceptualize or articulate their questions, requiring physicians not only to allow their patients to participate in the consultation, but also to actively elicit and explore patients’ thoughts, feelings, ideas, and concerns, in order to gain insight into the patient's perspective. Physicians who engage in such exploration and help patients to clarify their needs for information are better able to respond to those needs [12]. Finally, even when physicians understand and respond to patients’ informational needs, patients may find medical information difficult to understand. Physicians who assess patients’ understanding of information and attempt to resolve confusion may improve patient satisfaction with information [13].
These techniques, such as involving the patient in the consultation, exploring the patient's ideas and concerns, and assessing and responding to the patient's understanding, have been described generally as elements of “patient-centered” communication [14], [15], [16]. Patient-centered communication – as distinguished from “physician-centered” or “disease-oriented” communication – focuses on the patient as a “whole person” in the context of his or her psychological and social circumstances. Patient-centered communication has been associated with higher levels of general satisfaction [17], [18], [19], [20] and improved biomedical and functional outcomes [14], [15], [16], [21], [22], [23], [24] With this work, we have attempted to expand upon earlier research by describing the relationship between patient-centered communication and patients’ satisfaction with information. Although prospective investigation will be necessary to fully understand causality, such complex relationships are rarely unidirectional, and simply establishing an association between physician–patient communication and patients’ satisfaction with information may provide insight into methods for better meeting patients’ information needs. For example, establishing an association between communication style and patient satisfaction may provide impetus for the development of educational interventions that assist physicians in accurately assessing and effectively fulfilling the ongoing information needs of women with a history of breast cancer.
The purposes of this study were two-fold. Our first goal was to describe breast cancer survivors’ satisfaction with information related to diagnosis, treatment, long-term health, and emotional and psychosocial needs. Our second purpose was to examine the association between breast cancer survivors’ perceptions of patient-centered communication and their satisfaction with information. We hypothesized that those women who perceived their interactions with their physician to be more patient-centered would be more satisfied with information, regardless of the type of information sought.
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Sample and procedure
Prior to the initiation of data collection, approval for this study was obtained from the University of Rochester Internal Review Board. Eligible patients were those who had completed active treatment (surgery, radiation therapy, and/or chemotherapy) for stage I, II, or III breast cancer at least 3 months prior to their enrollment in the study. From November 2002 to January 2004, women were recruited from two medical oncology practices and one radiation oncology practice at the James P. Wilmot
Patient characteristics
Data from 182 patients was analyzed; Table 1 describes the participant characteristics. The majority of the women in the sample were 50–69 years old (mean age = 58.0 years, standard deviation = 11.2), Caucasian race, married, and had at least some college education. Approximately half of the women were employed outside of the home. Income was the most frequently unreported demographic characteristic, but the data available suggests that most of the data clusters at the lowest and highest income
Discussion
A handful of existing studies show that breast cancer survivors are generally satisfied with information related to diagnosis and treatment but are less satisfied with information related to the psychological impact of the disease on themselves or family members and information related to long-term side effects of treatment [1]. The results of this study support these previous findings. The women surveyed in this study reported high satisfaction with information that they received about
Acknowledgement
This work was supported in part by Gilda's Club/Cancer Action of Rochester, NY.
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