Confidence in the ability to communicate with physicians among low-income patients with prostate cancer.
OBJECTIVE
To describe the confidence of low-income patients with prostate cancer in interacting with physicians. Men with prostate cancer need to communicate easily with their physicians when facing treatment decisions and symptom management; however, little is known about whether low-income men are confident in these interactions.


METHODS
We used validated instruments to measure self-efficacy in patient-physician interactions, emotional well-being, symptom distress, satisfaction with care, and health-related quality of life among low-income men receiving prostate cancer treatment through a statewide public assistance program. We abstracted clinical variables from medical records. We dichotomized self-efficacy scores empirically on the basis of the sample distribution and conducted univariate and multivariate analyses.


RESULTS
The self-efficacy scores were skewed toward the high scores, with 77% in the high range. Those (23%) with low self-efficacy were more likely to have poor emotional well-being, symptom distress, role limitations--emotional, low social function, and poor urinary, sexual, and bowel outcomes. In multivariate analysis, low-income men were more likely to have low self-efficacy if they were less satisfied with their care, did not have confidence in their provider, or had more symptom distress.


CONCLUSIONS
Among low-income patients with prostate cancer, low self-efficacy for interacting with physicians was best predicted by diminished overall satisfaction with care, low confidence in providers, and worse symptom distress. Men with low self-efficacy fared worse over a range of psychosocial outcomes and both general and disease-specific health-related quality of life.
Department of Urology, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California 90095-6900, USA.
Sally L
SL
Maliski
Lorna
L
Kwan
Tracey
T
Krupski
Arlene
A
Fink
James R
JR
Orecklin
Mark S
MS
Litwin
D000230:Adenocarcinoma / Q000150:complications / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology; D001294:Attitude to Health; D002140:California / Q000453:epidemiology; D003142:Communication; D003144:Communication Barriers; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D004644:Emotions; D005006:Ethnicity / Q000523:psychology; D006801:Humans; D007410:Intestinal Diseases / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D011203:Poverty / Q000523:psychology*; D011471:Prostatic Neoplasms / Q000150:complications / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D011632:Public Assistance; D011788:Quality of Life; D012649:Self Concept; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome; D014555:Urination Disorders / Q000453:epidemiology / Q000209:etiology