title: Behind closed doors: systematic analysis of breast cancer consultation communication and predictors of satisfaction with communication.
abstract: OBJECTIVE
  The purpose of this investigation was to explicate the content of primary adjuvant treatment consultations in breast oncology and examine the predictive relationships between patient and oncologist consultation factors and patient satisfaction with communication.
  
  
  METHODS
  The recorded consultations of 172 newly diagnosed breast cancer patients from four Canadian cancer centers were randomly drawn from a larger subset of 481 recordings and examined by three coders using the Medical Interaction Process System (MIPS); a system that categorizes the content and mode of each distinct utterance. The MIPS findings, independent observer ratings of patient and oncologist affective behavior, and derived consultation ratios of patient centeredness, patient directedness, and psychosocial focus, were used to predict patient satisfaction with communication post-consultation and at 12-weeks post-consultation.
  
  
  RESULTS
  Biomedical content categories were predominant in the consultations, accounting for 88% of all utterances, followed by administrative (6%) and psychosocial (6%) utterances. Post-consultation satisfaction with communication was significantly higher for older patients, those with smaller primary tumors and those with longer consultations. Smaller tumor, lack of patient assertiveness during the treatment consultation and having the consultation with a radiation rather than medical oncologist were significantly predictive of greater satisfaction at 12-weeks post-consultation.
  
  
  CONCLUSIONS
  Adjuvant treatment consultations are characterized by a high degree of information-giving by the physician, a predominance of biomedical discussion and relatively minimal time addressing patients' psychosocial concerns. Controlled trials are needed to further identify and address the contextual features of these consultations that enhance patient satisfaction.
authors.affiliation: Faculty of Nursing, University of Manitoba, Winnipeg, MB, Canada. thack@sbrc.ca
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Hack
authors.forename: Tom
authors.initials: T
authors.lastname: Pickles
authors.forename: J Dean
authors.initials: JD
authors.lastname: Ruether
authors.forename: Lorna
authors.initials: L
authors.lastname: Weir
authors.forename: Barry D
authors.initials: BD
authors.lastname: Bultz
authors.forename: Lesley F
authors.initials: LF
authors.lastname: Degner
mesh_terms: D001943:Breast Neoplasms / Q000523:psychology* / Q000628:therapy; D003142:Communication; D005260:Female; D006801:Humans; D008495:Medical Oncology / Q000592:standards; D008875:Middle Aged; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D012017:Referral and Consultation / Q000592:standards