title: Patient satisfaction with treatment of breast cancer: does surgeon specialization matter?
abstract: OBJECTIVE
  Experience and practice setting vary greatly among surgeons who treat breast cancer patients. However, less is known about how these factors influence patient satisfaction with their care.
  
  
  METHODS
  We surveyed all ductal carcinoma in situ patients and a 20% random sample of invasive breast cancer patients diagnosed in 2002 reported to the Detroit, MI, and Los Angeles, CA, Surveillance, Epidemiology, and End Results registries. Attending surgeons were surveyed, yielding dyad information for 64.6% of patients (n = 1,539) and 69.7% of surgeons (n = 318). Logistic regression was used to examine the associations between surgeon specialization (percentage of practice devoted to breast disease) and hospital cancer program status, with four domains of patient satisfaction: (1) the surgical decision, (2) decision-making process, (3) surgeon-patient relationship, and (4) surgeon-patient communication, adjusting for patient and surgeon demographics and disease stage.
  
  
  RESULTS
  In this sample, 34.5% of patients were treated by surgeons who devoted less than 30% (low volume) of their practice to breast disease, 32.5% by surgeons who devoted 30% to 60% (medium volume) of their practice to breast disease, and 33.0% by surgeons who devoted more than 60% (high volume) of their practice to breast disease. Compared to patients treated by low-volume surgeons, patients treated by higher volume surgeons were more satisfied with the decision-making process (medium volume, odds ratio [OR], 1.16; 95% CI, 0.80 to 1.67; high volume: OR, 1.79; 95% CI, 1.14 to 2.80) and with the surgeon-patient relationship (medium volume: OR, 1.13; 95% CI, 0.72 to 1.76; high volume: OR, 1.98; 95% CI, 1.08 to 3.61). Treatment setting was not associated with patient satisfaction after controlling for other factors.
  
  
  CONCLUSIONS
  Surgeon specialization is correlated with patient satisfaction. Examining the processes underlying these associations can inform strategies to improve breast cancer care.
authors.affiliation: Section of General Surgery, Department of Surgery; Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, MI, USA. filip@med.umich.edu
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Waljee
authors.forename: Sarah
authors.initials: S
authors.lastname: Hawley
authors.forename: Amy K
authors.initials: AK
authors.lastname: Alderman
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Katz
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000601:surgery*; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D013043:Specialties, Surgical / Q000706:statistics & numerical data