Patient-physician concordance: preferences, perceptions, and factors influencing the breast cancer surgical decision.
OBJECTIVE
This study explored patient preferences for involvement in the breast cancer treatment decision and concordance between patients' and physicians' views on decisional role. The impact of demographic and psychosocial characteristics on patients' decisional role was also examined.


METHODS
Women with stage I or II breast cancer who were candidates for either mastectomy or lumpectomy were recruited from a university breast cancer treatment center. Patient interviews were obtained before meeting the surgical oncologist and again after the treatment decision was made but before surgical intervention. Clinician responses were obtained after the consultation.


RESULTS
The 101 participants were generally white (97%), married (80%), and well-educated. They reported moderate levels of depression and anxiety but good social support and self-efficacy in communicating with their physician. Before the consultation, 47% of women reported a preference for shared decision making; afterwards, 61% felt they had primary responsibility for the decision. Only 38% of patients agreed with the physician's assessment of how the treatment decision was made. In regression analyses, higher education was significantly associated with patients' preferred level of control (P = .01). There was a trend toward women with greater self-efficacy desiring more active decisional roles (P = .08). Patient preference for decision making did not impact time in the patient-physician encounter, but more influence did increase satisfaction.


CONCLUSIONS
Limited concordance between patient preference and patient perception and between patient and physician perception in how the treatment decision was made suggests the need for better communication between patient and clinician during a critical treatment encounter for breast cancer patients.
Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1420 Washington Heights, Ann Arbor, MI 48109-2029, USA. nkjanz@umich.edu
Nancy K
NK
Janz
Patricia A
PA
Wren
Laurel A
LA
Copeland
Julie C
JC
Lowery
Sherry L
SL
Goldfarb
Edwin G
EG
Wilkins
D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D003142:Communication; D003657:Decision Making; D003710:Demography; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D017533:Marital Status; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D017060:Patient Satisfaction; D010361:Patients / Q000523:psychology*; D010819:Physician's Role; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D011584:Psychology; D012380:Role; D020377:Self Efficacy; D012944:Social Support