Breast Cancer Research and Treatment

, Volume 161, Issue 3, pp 525–535

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

  • Nancy K. Janz
  • Yun Li
  • Brian J. Zikmund-Fisher
  • Reshma Jagsi
  • Allison W. Kurian
  • Lawrence C. An
  • M. Chandler McLeod
  • Kamaria L. Lee
  • Steven J. Katz
  • Sarah T. Hawley
Epidemiology

DOI: 10.1007/s10549-016-4076-5

Cite this article as:
Janz, N.K., Li, Y., Zikmund-Fisher, B.J. et al. Breast Cancer Res Treat (2017) 161: 525. doi:10.1007/s10549-016-4076-5

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.

Keywords

Breast cancer Physician communication Risk perception Worry about recurrence 

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Nancy K. Janz
    • 1
  • Yun Li
    • 2
  • Brian J. Zikmund-Fisher
    • 1
    • 3
    • 4
  • Reshma Jagsi
    • 5
  • Allison W. Kurian
    • 6
  • Lawrence C. An
    • 7
  • M. Chandler McLeod
    • 2
  • Kamaria L. Lee
    • 3
  • Steven J. Katz
    • 3
    • 8
  • Sarah T. Hawley
    • 3
    • 8
    • 9
  1. 1.Department of Health Behavior and Health Education, School of Public HealthUniversity of MichiganAnn ArborUSA
  2. 2.Department of BiostatisticsUniversity of MichiganAnn ArborUSA
  3. 3.Division of General Medicine, Department of Internal MedicineUniversity of MichiganAnn ArborUSA
  4. 4.Center for Bioethics and Social Sciences in MedicineUniversity of MichiganAnn ArborUSA
  5. 5.Department of Radiation OncologyUniversity of MichiganAnn ArborUSA
  6. 6.Departments of Medicine and Health Research and PolicyStanford UniversityStanfordUSA
  7. 7.Center for Health Communications Research, Department of Internal MedicineUniversity of MichiganAnn ArborUSA
  8. 8.Department of Health Management and PolicyUniversity of MichiganAnn ArborUSA
  9. 9.Veterans Administration Center for Clinical Management ResearchAnn Arbor VA Health Care SystemAnn ArborUSA