title: Patient-centered communication during oncology follow-up visits for breast cancer survivors: content and temporal structure.
abstract: OBJECTIVE
  To understand the content and temporal structure of survivor-provider communication during breast cancer survivor follow-up visits.
  
  
  METHODS
  Descriptive correlational.
  
  
  METHODS
  Private outpatient oncology practice.
  
  
  METHODS
  55 breast cancer survivors; 6 oncology providers.
  
  
  METHODS
  A secondary analysis of audio recordings of survivor follow-up visits.
  
  
  METHODS
  Survivors: demographics, uncertainty, mood, length of survival, years receiving care from providers, survivor expectations. Providers: demographics, medical uncertainty, specialty (physician, nurse practitioner, or physician assistant).
  
  
  RESULTS
  time spent in patient-centered communication, perception of patient-centeredness.
  
  
  RESULTS
  Most visit time (55%) was spent waiting. Of the remaining 45%, silence represented the most time spent with providers, followed by symptom conversations. More specific survivor discussion plans predicted more time spent discussing symptoms and in reassurance interactions. More specificity of visit purpose predicted survivor perceptions of less patient-centeredness; however, more time in contextual conversations predicted a greater perception of patient-centeredness. Provider factors were not associated with time spent in patient-centered communication or survivor perceptions of patient-centeredness. All dimensions of patient-centered communication occurred during each visit section (before, during, and after the physical examination).
  
  
  CONCLUSIONS
  Discussing symptoms and concerns with providers offers reassurance about cancer recurrence. When visit expectations are very high, achieving a survivor perception of patient-centered communication may be difficult. However, time spent understanding a survivor within the context of her life can enhance survivor perceptions of patient-centeredness.
  
  
  CONCLUSIONS
  Providers must be sensitive to concerns that are presented throughout a visit. When visit time is short, a second appointment may be necessary to address survivor concerns.
authors.affiliation: College of Nursing, University of Utah, Salt Lake City, USA. margaret.clayton@nurs.utah.edu
authors.forename: Margaret F
authors.initials: MF
authors.lastname: Clayton
authors.forename: William N
authors.initials: WN
authors.lastname: Dudley
mesh_terms: D000328:Adult; D000359:Aftercare / Q000458:organization & administration / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000517:prevention & control / Q000523:psychology*; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000458:organization & administration; D008875:Middle Aged; D009722:Nurse Practitioners / Q000523:psychology; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D010353:Patient Education as Topic / Q000458:organization & administration; D018802:Patient-Centered Care / Q000458:organization & administration*; D010823:Physician Assistants / Q000523:psychology; D010820:Physicians / Q000523:psychology; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012044:Regression Analysis; D015144:Southeastern United States; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D013637:Tape Recording; D013996:Time and Motion Studies