title: Communication between physicians and older women with localized breast cancer: implications for treatment and patient satisfaction.
abstract: OBJECTIVE
  To identify factors associated with patient-physician communication and to examine the impact of communication on patients' perception of having a treatment choice, actual treatment received, and satisfaction with care among older breast cancer patients.
  
  
  METHODS
  Data were collected from 613 pairs of surgeons and their older (greater-than-or-equal 67 years) patients diagnosed with localized breast cancer. Measures of patients' self-reported communication included physician- and patient-initiated communication and the number of treatment options discussed. Logistic regression analyses were conducted to examine the relationships between communication and outcomes.
  
  
  RESULTS
  Patients who reported that their surgeons mentioned more treatment options were 2.21 times (95% confidence interval [CI], 1.62 to 3.01) more likely to report being given a treatment choice, and 1.33 times (95% CI, 1.02 to 1.73) more likely to get breast-conserving surgery with radiation than other types of treatment. Surgeons who were trained in surgical oncology, or who treated a high volume of breast cancer patients (greater-than-or-equal 75% of practice), were more likely to initiate communication with patients (odds ratio [OR] = 1.62; 95% CI, 1.02 to 2.56; and OR = 1.68; 95% CI, 1.01 to 2.76, respectively). A high degree of physician-initiated communication, in turn, was associated with patients' perception of having a treatment choice (OR = 2.46; 95% CI, 1.29 to 4.70), and satisfaction with breast cancer care (OR = 2.13; 95% CI, 1.17 to 3.85) in the 3 to 6 months after surgery.
  
  
  CONCLUSIONS
  Greater patient-physician communication was associated with a sense of choice, actual treatment, and satisfaction with care. Technical information and caring components of communication impacted outcomes differently. Thus, the quality of cancer care for older breast cancer patients may be improved through interventions that improve communication within the physician-patient dyad.
authors.affiliation: Department of Oncology, Georgetown University Medical Center, Washington, DC 20007, USA. liangw1@georgetown.edu
authors.forename: Wenchi
authors.initials: W
authors.lastname: Liang
authors.forename: Caroline B
authors.initials: CB
authors.lastname: Burnett
authors.forename: Julia H
authors.initials: JH
authors.lastname: Rowland
authors.forename: Neal J
authors.initials: NJ
authors.lastname: Meropol
authors.forename: Lynne
authors.initials: L
authors.lastname: Eggert
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Hwang
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Silliman
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Mandelblatt
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000523:psychology* / Q000601:surgery; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011787:Quality of Health Care