Breast cancer risk communication: assessment of primary care physicians by standardized patients.
OBJECTIVE
To assess primary care providers' communication about breast cancer risk.


METHODS
We evaluated 86 primary care providers' communication of risk using unannounced standardized (simulated) patients. Physicians were randomly assigned to receive one of three cases: (1) moderate risk case (n = 25), presenting with a breast lump and mother with postmenopausal breast cancer; (2) high-risk (maternal side) case (n = 28), presenting with concern about breast cancer risk; and (3) high-risk (paternal side) case (n = 33), presenting with an unrelated problem. After the appointment, three qualitative parameters were assessed by standardized patients on a 3-point scale (3 = highest satisfaction, 1 = lowest): whether the physician took adequate time; acknowledged her concerns; and offered reassurance.


RESULTS
Mean satisfaction with physician communication was higher for the moderate risk case (2.92) than for the high-risk paternal case (2.25) or high-risk maternal case (2.42) (P < 0.0001). The score was not influenced by session length, medical specialty, or physician gender.


CONCLUSIONS
Physicians more consistently provided a moderate risk standardized patients with reassurance and support compared with the high-risk cases. Primary care physicians may be more unprepared or uneasy addressing the issues raised by more complex scenarios and may benefit from training in the assessment and communication of breast cancer risk.
Culver
Julie O
JO
Department of Bioethics and Humanities, University of Washington, Seattle, Washington 98195, USA.
Bowen
Deborah J
DJ
Reynolds
Susan E
SE
Pinsky
Linda E
LE
Press
Nancy
N
Burke
Wylie
W
D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000523:psychology; D003142:Communication; D005260:Female; D005817:Genetic Counseling / Q000592:standards; D020022:Genetic Predisposition to Disease; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D016544:Patient Simulation; D010375:Pedigree; D010817:Physician-Patient Relations; D010821:Physicians, Family; D012306:Risk