Advertisement

The role of patient-physician relationship on health-related quality of life and pain in cancer patients

  • Cleo A. SamuelEmail author
  • Olive Mbah
  • Jennifer Schaal
  • Eugenia Eng
  • Kristin Z. Black
  • Stephanie Baker
  • Katrina R. Ellis
  • Fatima Guerrab
  • Lauren Jordan
  • Alexandra F. Lightfoot
  • Linda B. Robertson
  • Christina M. Yongue
  • Samuel Cykert
Original Article

Abstract

Purpose

Health-related quality of life (HRQOL) and pain are important supportive cancer care outcomes. The patient-provider relationship, a modifiable care experience, has been linked to healthcare outcomes; however, less is known about associations between patient-provider relationship and supportive care outcomes in cancer patients. We examined the role of multiple aspects of the patient-provider relationship in explaining patterns of HRQOL and pain among breast and lung cancer patients.

Methods

Our analysis included 283 breast and lung cancer patients from two cancer centers. Clinical data and survey data on patient sociodemographic factors, physical and mental HRQOL, pain, and patient-physician relationship (i.e., doctor’s respectfulness, time spent with doctors, patient involvement in decision-making, satisfaction with care, and following doctor’s advice/treatment plan) were collected at baseline and during treatment. We estimated adjusted modified Poisson regression models to assess associations between patient-physician relationship factors and physical and mental HRQOL and pain.

Results

Compared with patients reporting suboptimal respect from doctors, patients reporting optimal respect were less likely to report below average physical HRQOL (adjusted risk ratio (ARR), 0.73; 95%CI, 0.62–0.86), below average mental HRQOL (ARR, 0.71; 95%CI, 0.54–0.93), and moderate-to-severe pain (ARR, 0.53; 95%CI, 0.35–0.79). Patients reporting optimal involvement in care decision-making and patients who reported following their doctor’s advice/treatment plan were less likely to report below average mental HRQOL than their respective counterparts (ARR, 0.64; 95%CI, 0.50–0.83; ARR, 0.65; 95%CI, 0.48–0.86).

Conclusion

Multiple patient-physician relationship factors account for variations in HRQOL and pain in cancer patients. These findings provide insight into potential targets for improving the patient-provider relationship and supportive cancer care outcomes.

Keywords

Quality of life Pain Patient-physician relationship Symptom management Equity 

Notes

Financial support

Cleo A. Samuel, Eugenia Eng, Samuel Cykert, and Linda B. Robertson

Author’s contribution

Conception and design: Cleo A. Samuel and Samuel Cykert. Collection and assembly of data: All authors. Data analysis and interpretation: Cleo A. Samuel and Olive Mbah. Manuscript writing: All authors. Final approval of manuscript: All authors. Administrative support: Cleo A. Samuel, Jennifer Schaal, Eugenia Eng, Samuel Cykert, and Christina M. Yongue.

Funding information

This study was conducted with funding support from the National Cancer Institute Award Diversity Supplement Award (grant number, 3 R01 CA150980-04S1) and the Mentored Research Scientist Development Award (grant number, 1 K01 CA218473-01A1).

Compliance with ethical standards

Conflicts of interest

Jennifer Schaal, MD, has stock or other ownership in Abbrie, Inc.; BristolMeyers Squibb; Pfizer; United Health Group; Merck&Co; Walgreens Boots; Johnson&Johnson, and Abbott Labs. All other authors have no conflicts of interests to report.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

520_2019_5070_MOESM1_ESM.docx (25 kb)
ESM 1 (DOCX 25 kb)

References

  1. 1.
    Agboola SO, Ju W, Elfiky A, Kvedar JC, Jethwani K (2015) The effect of technology-based interventions on pain, depression, and quality of life in patients with cancer: a systematic review of randomized controlled trials. J Med Internet Res 17(3):e65CrossRefPubMedGoogle Scholar
  2. 2.
    Baker F, Haffer SC, Denniston M (2003) Health-related quality of life of cancer and noncancer patients in Medicare managed care. Cancer 97(3):674–681CrossRefPubMedGoogle Scholar
  3. 3.
    Ciaramella A, Poli P (2001) Assessment of depression among cancer patients: the role of pain, cancer type and treatment. Psycho-Oncology 10(2):156–165CrossRefPubMedGoogle Scholar
  4. 4.
    Smith HR (2015) Depression in cancer patients: pathogenesis, implications and treatment. Oncol Lett 9(4):1509–1514CrossRefPubMedGoogle Scholar
  5. 5.
    Sinatra R (2010) Causes and consequences of inadequate management of acute pain. Pain Med 11(12):1859–1871CrossRefPubMedGoogle Scholar
  6. 6.
    Yee MK, Sereika SM, Bender CM, Brufsky AM, Connolly MC, Rosenzweig MQ (2017) Symptom incidence, distress, cancer-related distress, and adherence to chemotherapy among African American women with breast cancer. Cancer 123:2061–2069CrossRefPubMedGoogle Scholar
  7. 7.
    Cella D, Cappelleri JC, Bushmakin A, Charbonneau C, Li JZ, Kim ST, Chen I, Michaelson MD, Motzer RJ (2009) Quality of life predicts progression-free survival in patients with metastatic renal cell carcinoma treated with sunitinib versus interferon alfa. J Oncol Pract 5(2):66–70CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Matthias MS, Parpart AL, Nyland KA, Huffman MA, Stubbs DL, Sargent C, Bair MJ (2010) The patient–provider relationship in chronic pain care: providers’ perspectives. Pain Med 11(11):1688–1697CrossRefPubMedGoogle Scholar
  9. 9.
    Okunrintemi V, Spatz ES, Di Capua P, Salami JA, Valero-Elizondo J, Warraich H, Virani SS, Blaha MJ, Blankstein R, Butt AA, Borden WB (2017) Patient–provider communication and health outcomes among individuals with atherosclerotic cardiovascular disease in the United States: Medical Expenditure Panel Survey 2010 to 2013. Circ Cardiovasc Qual Outcomes 10(4).  https://doi.org/10.1161/CIRCOUTCOMES.117.003635
  10. 10.
    Li CC, Matthews AK, Dossaji M, Fullam F (2017) The relationship of patient-provider communication on quality of life among African-American and White Cancer survivors. J Health Commun 22(7):584–592CrossRefPubMedGoogle Scholar
  11. 11.
    Cerier E, Beal EW, Chakedis J, Chen Q, Paredes A, Sun S, Cloyd JM, Pawlik TM (2018) Patient-provider relationships and health outcomes among hepatopancreatobiliary patients. J Surg Res 228:290–298CrossRefPubMedGoogle Scholar
  12. 12.
    Farin E, Gramm L, Schmidt E (2013) The patient–physician relationship in patients with chronic low back pain as a predictor of outcomes after rehabilitation. J Behav Med 36(3):246–258CrossRefPubMedGoogle Scholar
  13. 13.
    Ruben MA, Meterko M, Bokhour BG (2018) Do patient perceptions of provider communication relate to experiences of physical pain? Patient Educ Couns 101(2):209–213CrossRefPubMedGoogle Scholar
  14. 14.
    Palmer NR et al (2014) Racial and ethnic disparities in patient-provider communication, quality-of-care ratings, and patient activation among long-term cancer survivors. J Clin Oncol 32(36):4087–4094CrossRefPubMedGoogle Scholar
  15. 15.
    Tamirisa NP, Goodwin JS, Kandalam A, Linder SK, Weller S, Turrubiate S, Silva C, Riall TS (2017) Patient and physician views of shared decision making in cancer. Health Expect 20(6):1248–1253CrossRefPubMedGoogle Scholar
  16. 16.
    Dorflinger L, Kerns RD, Auerbach SM (2013) Providers’ roles in enhancing patients’ adherence to pain self management. Transl Behav Med 3(1):39–46CrossRefPubMedGoogle Scholar
  17. 17.
    Cykert S, Eng E, Walker P, Manning MA, Robertson LB, Arya R, Jones NS, Heron DE (2019) A system-based intervention to reduce Black-White disparities in the treatment of early stage lung cancer: a pragmatic trial at five cancer centers. Cancer Med 8:1095–1102CrossRefPubMedGoogle Scholar
  18. 18.
    Dehal A, Abbas A, Johna S (2013) Racial disparities in clinical presentation, surgical treatment and in-hospital outcomes of women with breast cancer: analysis of nationwide inpatient sample database. Breast Cancer Res Treat 139(2):561–569CrossRefPubMedGoogle Scholar
  19. 19.
    The People’s Institute for Survial and Beyond (2017) Undoing racism. Available from: http://www.pisab.org/our-principles. Accessed 15 Feb 2019
  20. 20.
    Princeton Survey Review Associates (2002) Methodology: Survey on Disparities in Health Care Quality: Spring 2001. Princeton Survey Research Associates, PrincetonGoogle Scholar
  21. 21.
    Bevans M, Ross A, Cella D (2014) Patient-reported outcomes measurement information system (PROMIS): efficient, standardized tools to measure self-reported health and quality of life. Nurs Outlook 62(5):339–345CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Hays RD, Bjorner JB, Revicki DA, Spritzer KL, Cella D (2009) Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res 18(7):873–880CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Assessment Center (2010) Scoring PROMIS global short form. cited 2019. Available from: https://www.assessmentcenter.net/documents/Scoring PROMIS Global short form.pdf. Accessed 10 May 2019
  24. 24.
    Jones KR, Vojir CP, Hutt E, Fink R (2007) Determining mild, moderate, and severe pain equivalency across pain-intensity tools in nursing home residents. J Rehabil Res Dev 44(2):305–314CrossRefPubMedGoogle Scholar
  25. 25.
    Zou G (2004) A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 159(7):702–706CrossRefPubMedGoogle Scholar
  26. 26.
    Samuel CA et al (2018) Racial differences in symptom management experiences during breast cancer treatment. Support Care Cancer 26(5):1425–1435PubMedGoogle Scholar
  27. 27.
    Andersen RM (1995) Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 36(1):1–10CrossRefPubMedGoogle Scholar
  28. 28.
    Nease RF Jr, Brooks WB (1995) Patient desire for information and decision making in health care decisions: the Autonomy Preference Index and the Health Opinion Survey. J Gen Intern Med 10(11):593–600CrossRefPubMedGoogle Scholar
  29. 29.
    Dugdale DC, Epstein R, Pantilat SZ (1999) Time and the patient-physician relationship. J Gen Intern Med 14(Suppl 1):S34–S40CrossRefPubMedGoogle Scholar
  30. 30.
    Beach MC, Duggan PS, Cassel CK, Geller G (2007) What does ‘respect’ mean? Exploring the moral obligation of health professionals to respect patients. J Gen Intern Med 22(5):692–695CrossRefPubMedGoogle Scholar
  31. 31.
    Barry MJ, Edgman-Levitan S (2012) Shared decision making–pinnacle of patient-centered care. N Engl J Med 366(9):780–781CrossRefPubMedGoogle Scholar
  32. 32.
    Agency for Healthcare Research and Quality (2017) Strategy 6I: shared decision-making, in The CAHPS ambulatory care improvement guideGoogle Scholar
  33. 33.
    Austin CA, Mohottige D, Sudore RL, Smith AK, Hanson LC (2015) Tools to promote shared decision making in serious illness: a systematic review. JAMA Intern Med 175(7):1213–1221CrossRefPubMedGoogle Scholar
  34. 34.
    Spagnoletti CL, Arnold RM (2007) RESPECT: even more difficult to teach than to define. SpringerGoogle Scholar
  35. 35.
    Samuel CA, Pinheiro LC, Reeder-Hayes KE, Walker JS, Corbie-Smith G, Fashaw SA, Woods-Giscombe C, Wheeler SB (2016) To be young, black, and living with breast cancer: a systematic review of health-related quality of life in young Black breast cancer survivors. Breast Cancer Res Treat 160:1–15CrossRefPubMedGoogle Scholar
  36. 36.
    Pinheiro LC, Samuel CA, Reeder-Hayes KE, Wheeler SB, Olshan AF, Reeve BB (2016) Understanding racial differences in health-related quality of life in a population-based cohort of breast cancer survivors. Breast Cancer Res Treat 159(3):535–543CrossRefPubMedGoogle Scholar
  37. 37.
    Mills AM, Shofer FS, Boulis AK, Holena DN, Abbuhl SB (2011) Racial disparity in analgesic treatment for ED patients with abdominal or back pain. Am J Emerg Med 29(7):752–756CrossRefPubMedGoogle Scholar
  38. 38.
    Agency for Healthcare Research and Quality (2013) 2012 National healthcare disparities report. Washington, DCGoogle Scholar
  39. 39.
    Smedley B, Stith A, Nelson A (2003) Unequal treatment: confronting racial and ethnic disparities in healthcare. National Academies Press, Washington, DCGoogle Scholar
  40. 40.
    FitzGerald C, Hurst S (2017) Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics 18(1):19CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Burgess DJ, Gravely AA, Nelson DB, van Ryn M, Bair MJ, Kerns RD, Higgins DM, Partin MR (2013) A national study of racial differences in pain screening rates in the VA health care system. Clin J Pain 29(2):118–123CrossRefPubMedGoogle Scholar
  42. 42.
    Anderson KO, Green CR, Payne R (2009) Racial and ethnic disparities in pain: causes and consequences of unequal care. J Pain 10(12):1187–1204CrossRefPubMedGoogle Scholar
  43. 43.
    McGuire TG, Miranda J (2008) New evidence regarding racial and ethnic disparities in mental health: policy implications. Health Aff (Millwood) 27(2):393–403CrossRefGoogle Scholar
  44. 44.
    Balsa AI, McGuire TG, Meredith LS (2005) Testing for statistical discrimination in health care. Health Serv Res 40(1):227–252CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Basch E, Deal AM, Kris MG, Scher HI, Hudis CA, Sabbatini P, Rogak L, Bennett AV, Dueck AC, Atkinson TM, Chou JF, Dulko D, Sit L, Barz A, Novotny P, Fruscione M, Sloan JA, Schrag D (2016) Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial. J Clin Oncol 34(6):557–565CrossRefPubMedGoogle Scholar
  46. 46.
    Cleeland CS, Wang XS, Shi Q, Mendoza TR, Wright SL, Berry MD, Malveaux D, Shah PK, Gning I, Hofstetter WL, Putnam JB Jr, Vaporciyan AA (2011) Automated symptom alerts reduce postoperative symptom severity after cancer surgery: a randomized controlled clinical trial. J Clin Oncol 29(8):994–1000CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Seow H, Sussman J, Martelli-Reid L, Pond G, Bainbridge D (2012) Do high symptom scores trigger clinical actions? An audit after implementing electronic symptom screening. J Oncol Pract 8(6):e142–e148CrossRefPubMedGoogle Scholar
  48. 48.
    American Society of Clinical Oncology (2016) Facts & figures: diversity in oncology. Available from: https://www.asco.org/practice-guidelines/cancer-care-initiatives/diversity-oncology-initiative/facts-figures-diversity. Accessed 10 May 2018
  49. 49.
    Maddigan SL, Majumdar SR, Johnson JA (2005) Understanding the complex associations between patient-provider relationships, self-care behaviours, and health-related quality of life in type 2 diabetes: a structural equation modeling approach. Qual Life Res 14(6):1489–1500CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Cleo A. Samuel
    • 1
    Email author
  • Olive Mbah
    • 1
  • Jennifer Schaal
    • 2
  • Eugenia Eng
    • 3
  • Kristin Z. Black
    • 3
  • Stephanie Baker
    • 4
  • Katrina R. Ellis
    • 3
  • Fatima Guerrab
    • 5
  • Lauren Jordan
    • 1
  • Alexandra F. Lightfoot
    • 3
  • Linda B. Robertson
    • 6
  • Christina M. Yongue
    • 7
  • Samuel Cykert
    • 8
  1. 1.Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillUSA
  2. 2.The Partnership ProjectGreensboroUSA
  3. 3.Department of Health Behavior, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillUSA
  4. 4.Department of Public HealthElon UniversityElonUSA
  5. 5.Department of Public Health EducationNorth Carolina Central UniversityDurhamUSA
  6. 6.UPMC Hillman Cancer CenterUniversity of Pittsburgh School of MedicinePittsburghUSA
  7. 7.Department of Public Health EducationUniversity of North Carolina at GreensboroGreensboroUSA
  8. 8.Division of General Medicine and Clinical Epidemiology and The Lineberger Comprehensive Cancer CenterThe University of North Carolina School of MedicineChapel HillUSA

Personalised recommendations