title: Physicians' decision-making style and psychosocial outcomes among cancer survivors.
abstract: OBJECTIVE
  We evaluated pathways linking physicians' decision-making style with cancer survivors' health-related quality of life (HRQOL).
  
  
  METHODS
  We analyzed survey data from 623 survivors diagnosed with leukemia, colorectal, or bladder cancer in Northern California, 2-5 years prior to the study. Of these, 395 reported making a medical decision in the past 12 months and were asked about their physician's decision-making style. We evaluated the association of physician style with proximal communication outcomes (trust and participation self-efficacy), intermediate cognitive outcomes (perceived control and uncertainty), and distal health outcomes (physical and mental HRQOL).
  
  
  RESULTS
  Overall, 54% of survivors reported a sub-optimal decision-making style for their physician. With the exception of physical health, physician style was associated with all proximal, intermediate, and distal outcomes (p< or =0.01). We identified two significant pathways by which a participatory physician style may be associated with survivors' mental health: (1) by increasing survivors' participation self-efficacy and thereby enhancing their perceptions of personal control (p<0.01); (2) by enhancing survivors' level of trust and thereby reducing their perceptions of uncertainty (p<0.05).
  
  
  CONCLUSIONS
  A participatory physician style may improve survivors' mental health by a complex two-step mechanism of improving survivors' proximal communication and intermediate cognitive outcomes.
  
  
  CONCLUSIONS
  Physicians who adopt a participatory decision-making style are likely to facilitate patient empowerment and enhance patients' HRQOL.
authors.affiliation: Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd, MSC 7344, EPN 4092, Bethesda, MD 20892-7344, USA. aroran@mail.nih.gov
authors.forename: Neeraj K
authors.initials: NK
authors.lastname: Arora
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Weaver
authors.forename: Marla L
authors.initials: ML
authors.lastname: Clayman
authors.forename: Ingrid
authors.initials: I
authors.lastname: Oakley-Girvan
authors.forename: Arnold L
authors.initials: AL
authors.lastname: Potosky
mesh_terms: D000223:Adaptation, Psychological; D015179:Colorectal Neoplasms; D003657:Decision Making; D005260:Female; D006801:Humans; D007938:Leukemia; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010817:Physician-Patient Relations; D010820:Physicians; D011594:Psychometrics; D011788:Quality of Life; D013315:Stress, Psychological; D001749:Urinary Bladder Neoplasms