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

Breast Cancer Research and Treatment volume 161, pages 525–535 (2017)Cite this article

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.

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Acknowledgements

We acknowledge the work of our project staff (Mackenzie Crawford, M.P.H. and Kiyana Perrino, M.P.H. from the Georgia Cancer Registry; Jennifer Zelaya, Pamela Lee, Maria Gaeta, Virginia Parker, B.A. and Renee Bickerstaff-Magee from USC; Rebecca Morrison, M.P.H., Alexandra Jeanpierre, M.P.H., Stefanie Goodell, B.S., and Rose Juhasz, Ph.D. from the University of Michigan). We acknowledge with gratitude the breast cancer patients who responded to our survey.

Funding

This study was funded by Grant P01 CA163233 to the University of Michigan from the National Cancer Institute. The collection of Los Angeles County cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 5NU58DP003862-04/DP003862; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health, the National Cancer Institute, and the CDC or their contractors and subcontractors is not intended nor should be inferred. The collection of cancer incidence data in Georgia was supported by contract HHSN261201300015I, Task Order HHSN26100006 from the NCI and cooperative agreement 5NU58DP003875-04-00 from the CDC. The ideas and opinions expressed herein are those of the author(s) and endorsement by the States of California and Georgia, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be inferred.

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Authors and Affiliations

  1. Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 2830 SPH1, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA

    Nancy K. Janz & Brian J. Zikmund-Fisher

  2. Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA

    Yun Li & M. Chandler McLeod

  3. Division of General Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd, Building 16, Ann Arbor, MI, 48109, USA

    Brian J. Zikmund-Fisher, Kamaria L. Lee, Steven J. Katz & Sarah T. Hawley

  4. Center for Bioethics and Social Sciences in Medicine, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA

    Brian J. Zikmund-Fisher

  5. Department of Radiation Oncology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA

    Reshma Jagsi

  6. Departments of Medicine and Health Research and Policy, Stanford University, 900 Blake Wilbur, Stanford, CA, 94305, USA

    Allison W. Kurian

  7. Center for Health Communications Research, Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd, Building 16, Ann Arbor, MI, 48109, USA

    Lawrence C. An

  8. Department of Health Management and Policy, University of Michigan, 2800 Plymouth Rd, Building 16, Ann Arbor, MI, 48109, USA

    Steven J. Katz & Sarah T. Hawley

  9. Veterans Administration Center for Clinical Management Research, Ann Arbor VA Health Care System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA

    Sarah T. Hawley

Authors
  1. Nancy K. Janz
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  2. Yun Li
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  3. Brian J. Zikmund-Fisher
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  5. Allison W. Kurian
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  8. Kamaria L. Lee
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  10. Sarah T. Hawley
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Corresponding author

Correspondence to Nancy K. Janz.

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Conflicts of interest

Allison Kurian has received research funding for work performed outside of the current study from MyriadGenetics, Invitae, Ambry Genetics, GenDx, and Genomic Health. No other authors have 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 through their return of a completed survey.

Additional information

Sarah T. Hawley is the senior author.

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Janz, N.K., Li, Y., Zikmund-Fisher, B.J. et al. The impact of doctor–patient communication on patients’ perceptions of their risk of breast cancer recurrence. Breast Cancer Res Treat 161, 525–535 (2017). https://doi.org/10.1007/s10549-016-4076-5

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  • DOI: https://doi.org/10.1007/s10549-016-4076-5

Keywords

  • Breast cancer
  • Physician communication
  • Risk perception
  • Worry about recurrence