title: Consultations between patients with breast cancer and surgeons: a pathway from patient-centered communication to reduced hopelessness.
abstract: OBJECTIVE
  Patient-centered communication (PCC) affects psychosocial health outcomes of patients. However, these effects are rarely direct, and our understanding of such effects are largely based on self-report (v observational) data. More information is needed on the pathways by which concrete PCC behaviors affect specific psychosocial outcomes in cancer care. We hypothesized that PCC behaviors increase the satisfaction of patients with surgeons, which, in turn, reduces the postconsultation hopelessness of patients.
  
  
  METHODS
  In Portland, OR, we videotaped consultations between 147 women newly diagnosed with breast cancer and nine surgeons and administered surveys to participants immediately preconsultation and postconsultation. Consultations were coded for PCC behaviors. Multivariate regression models analyzed the association between PCC and the satisfaction of patients and between satisfaction and hopelessness.
  
  
  RESULTS
  Levels of hopelessness of patients significantly decreased from preconsultation to postconsultation (P < .001). Two PCC behaviors (ie, patient asserting treatment preference [odds ratio {OR}, 1.50/log unit; 95% CI, 1.01 to 2.23/log unit; P = .042] and surgeon providing good/hopeful news [OR, 1.62/log unit; 95% CI, 1.01 to 2.60/log unit; P = .047]) were independently significantly associated with the satisfaction of patients with surgeons, which, in turn, independently predicted reduced levels of postconsultation hopelessness (linear change, -0.78; 95% CI, 1.44 to -0.12; P = .02).
  
  
  CONCLUSIONS
  Although additional research is needed with larger and more-diverse data sets, these findings suggest the possibility that concrete and trainable PCC behaviors can lower the hopelessness of patients with breast cancer indirectly through their effects on patient satisfaction with care.
authors.affiliation: Portland State University, Communication, University Center Building, 520 SW Harrison St, Suite 440, Portland, OR 97201, USA. jeffreyr@pdx.edu
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Robinson
authors.forename: Donald R
authors.initials: DR
authors.lastname: Hoover
authors.forename: Maria K
authors.initials: MK
authors.lastname: Venetis
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Kearney
authors.forename: Richard L
authors.initials: RL
authors.lastname: Street
mesh_terms: D001240:Aspirations, Psychological; D001943:Breast Neoplasms / Q000523:psychology*; D003142:Communication; D005260:Female; D013502:General Surgery; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010820:Physicians