Skip to main content

Patient-Physician Concordance for Quantitative Formats and Treatment Options and the Relationship with State Anxiety

Journal of Cancer Education (2021)Cite this article

Abstract

Patient-physician concordance about topics discussed in a clinic visit is essential for effective communication but may be difficult to achieve in cancer care. We conducted a multicenter, observational study at two Midwestern oncology clinics. A sample of 48 English-speaking or Spanish-speaking women with newly diagnosed stage 0–3 breast cancer completed surveys before and after a visit with an oncologist. Patient-physician dyads were coded as concordant if both patient and physician follow-up self-reports agreed whether (or not) specific treatments were discussed (i.e., treatment option concordance; mastectomy, lumpectomy, hormone therapy, neoadjuvant, and adjuvant chemotherapy) and whether risk was described using certain quantitative formats (i.e., quantitative format concordance; percentages, proportions out of 100 and 1000, graphs, pictures, evidence from clinical studies, cancer stage). Agreement was determined using percent agreement and prevalence-adjusted bias-adjusted kappa (PABAK). Pearson’s correlations were used to determine relationships between anxiety and each measure concordance. Percent concordance was higher for treatment concordance (73.3%) compared to quantitative format concordance (64.5%), and PABAK scores tended to be higher for treatment options (PABAK = .21–.78). Both treatment and quantitative format concordance were negatively associated with pre-visit state anxiety, but only treatment concordance was statistically significant (treatment: r =  − .504, p = .001; quantitative format: r =  − .096, p = .523). Our study indicates moderate patient-physician concordance in early breast cancer care communication and that patient anxiety may impact the ability for patients and physicians to agree on the content communicated in a clinic visit.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Data Availability

Data and materials may be available by request.

References

  1. Ha JF, Longnecker N (2010) Doctor-patient communication: a review. Ochsner J 10:38–43

    PubMed  PubMed Central  Google Scholar 

  2. Greiner KA, Born W, Hall S et al (2008) Discussing weight with obese primary care patients: physician and patient perceptions. J Gen Intern Med 23:581–587. https://doi.org/10.1007/s11606-008-0553-9

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kreuter MW, Scharff DP, Brennan LK, Lukwago SN (1997) Physician recommendations for diet and physical activity. Prev Med 26:825–833. https://doi.org/10.1006/pmed.1997.0216

    CAS  Article  PubMed  Google Scholar 

  4. Janz NK, Wren PA, Copeland LA et al (2004) Patient-physician concordance: preferences, perceptions, and factors influencing the breast cancer surgical decision. J Clin Oncol 22:3091–3098. https://doi.org/10.1200/JCO.2004.09.069

    Article  PubMed  Google Scholar 

  5. Freidin RB (1980) Patient-physician concordance in problem identification in the primary care setting. Ann Intern Med 93:490. https://doi.org/10.7326/0003-4819-93-3-490

    CAS  Article  PubMed  Google Scholar 

  6. Maly RC, Leake B, Frank JC et al (2002) Implementation of consultative geriatric recommendations: the role of patient–primary care physician concordance. J Am Geriatr Soc 50:1372–1380. https://doi.org/10.1046/j.1532-5415.2002.50358.x

    Article  PubMed  Google Scholar 

  7. Desharnais S, Carter RE, Hennessy W et al (2007) Lack of concordance between physician and patient: reports on end-of-life care discussions. J Palliat Med 10:728–740. https://doi.org/10.1089/jpm.2006.2543

    Article  PubMed  Google Scholar 

  8. Quirt CF, Mackillop WJ, Ginsburg AD et al (1997) Do doctors know when their patients don’t? Lung Cancer 18:1–20. https://doi.org/10.1016/S0169-5002(97)00048-2

    CAS  Article  PubMed  Google Scholar 

  9. Schapira MM, Fletcher K, Ganschow PS, Jacobs E, Walker C, Gil D, Smallwood AJ et al (2016) Use and complexity of numeric concepts and terms in breast cancer treatment consultations. J Gen Int Med 31(Suppl 2): S452

  10. Schapira MM, Faghri A, Jacobs EA, Fletcher KE, Ganschow PS, Gil D, Smallwood AJ, Walker CM, Neuner JM (2019) Communication and Shared Decision Making in the Breast Cancer Treatment Consultation: A Comparative Analysis of English- and Spanish-Speaking Patients. Med Decis Making Online First: 1–10

  11. Schapira MM, Fletcher K, Ganschow PS, Jacobs E, Walker CM, Smallwood AJ, Gil D, Faghri A, Neuner JM (2016) Tailoring Communication to Health Numeracy in the Breast Cancer Treatment Consultation: Feasibility and Outcomes of a Web Based Screening Test for Use in the Clinical Setting. J Gen Int Med 31(Suppl 2): S452

  12. Whelan TJ, Mohide EA, Willan AR et al (1997) The supportive care needs of newly diagnosed cancer patients attending a regional cancer center. Cancer 80:1518–1524. https://doi.org/10.1002/(SICI)1097-0142(19971015)80:8%3c1518::AID-CNCR21%3e3.0.CO;2-7

    CAS  Article  PubMed  Google Scholar 

  13. Bar-Haim Y, Lamy D, Pergamin-Hight L et al (2007) Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study. [Meta-Analysis Research Support, Non-U.S. Gov’t]. Psychol Bull 133:1–24. https://doi.org/10.1037/0033-2909.133.1.1

    Article  PubMed  Google Scholar 

  14. Schapira MM, Fletcher KE, Ganschow PS et al (2019) Improving communication in breast cancer treatment consultation: use of a computer test of health numeracy. J Womens Health 28:1407–1417. https://doi.org/10.1089/jwh.2018.7347

    Article  Google Scholar 

  15. Schapira M, Walker CM, Cappaert KJ et al (2012) The numeracy understanding in medicine instrument: a measure of health numeracy developed using item response theory. Med Decis Making 32:851–865. https://doi.org/10.1177/0272989X12447239

    Article  PubMed  PubMed Central  Google Scholar 

  16. Spielberger CD, Richard LG, Robert EL, Peter RV, and Gerard AJ (2015) State-trait anxiety inventory for adults: Manual, instrument and scoring guide. Mind Garden

  17. Cunningham M (2009) More than just the kappa coefficient: a program to fully characterize inter-rater reliability between two raters. In: SAS global forum, vol 2009, paper 242-2009, pp 1–7

  18. Landis J, Koch G (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    CAS  Article  Google Scholar 

  19. Cicchetti DV, Feinstein AR (1990) High agreement but low kappa: II. Resolving the paradoxes. J Clin Epidemiol 43:551–558. https://doi.org/10.1016/0895-4356(90)90159-M

    CAS  Article  PubMed  Google Scholar 

  20. Reyna V (2008) A theory of medical decision making and health: fuzzy trace theory. Med Decis Making 28:850–865

    Article  Google Scholar 

  21. Edwards A, Elwyn G, Mulley A (2002) Explaining risks: turning numerical data into meaningful pictures. BMJ 324:827–830

    Article  Google Scholar 

  22. Eysenck M, Derakshan N, Santos R, Calvo M (2007) Anxiety and cognitive performance: attentional control theory. Emotion 7:336–353. https://doi.org/10.1037/1528-3542.7.2.336

    Article  PubMed  Google Scholar 

Download references

Funding

This study was funded by the American Cancer Society Research Scholar Grant RSG-11–104-01-CPPB.

Author information

Affiliations

  1. Center for Patient Care and Outcomes Research, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA

    Alicia J. Smallwood, Joan M. Neuner & Kathlyn E. Fletcher

  2. Division of General Internal Medicine, Department of Medicine, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA

    Joan M. Neuner

  3. Clement J. Zablocki VA Medical Center, 5000 W National Ave, Milwaukee, WI, 53295, USA

    Kathlyn E. Fletcher

  4. School of Education, Office of the Dean, Duquesne University, 600 Forbes Ave, Pittsburgh, PA, 15282, USA

    Cindy M. Walker

  5. Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Marilyn M. Schapira

  6. Center for Health Equity Research and Promotion, Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA

    Marilyn M. Schapira

Authors
  1. Alicia J. Smallwood
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joan M. Neuner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kathlyn E. Fletcher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cindy M. Walker
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marilyn M. Schapira
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception, design, and material preparation. Data collection and analysis were performed by Alicia J. Smallwood, Joan M. Neuner, and Marilyn M. Schapira. The first draft of the manuscript was written by Alicia J. Smallwood, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alicia J. Smallwood.

Ethics declarations

Ethics Approval

All study procedures were approved by the Medical College of Wisconsin’s and the John H. Stroger Jr. Hospital of Cook County’s Institutional Review Boards. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Consent to Participate

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

Competing Interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Online Resource 1

(DOCX 15 kb)

Online Resource 2

(DOCX 13 kb)

Online Resource 3

(DOCX 18 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Smallwood, A.J., Neuner, J.M., Fletcher, K.E. et al. Patient-Physician Concordance for Quantitative Formats and Treatment Options and the Relationship with State Anxiety. J Canc Educ (2021). https://doi.org/10.1007/s13187-021-02013-2

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s13187-021-02013-2

Keywords

  • Patient-physician concordance
  • Breast cancer
  • State anxiety
  • Cancer risk
  • Education
  • Quantitative communication