title: Do breast cancer patients receive less support from physicians in German hospitals with high physician workload? A multilevel analysis.
abstract: OBJECTIVE
  Little is known about how organizational factors influence the patient-physician interaction. This study investigates the relationship between physician workload in hospitals and breast cancer patients' perceptions of the support provided by physicians.
  
  
  METHODS
  Data from 1844 newly diagnosed breast cancer patients treated in 35 breast cancer center hospitals in the German state of North Rhine-Westphalia in 2010 were combined with data from 348 physicians from the same hospitals. Multilevel logistic regression models were calculated using 31 hospitals with complete patient and physician data. Patients' perceptions of physician support were studied in relation to physician workload in hospitals.
  
  
  RESULTS
  Breast cancer patients perceived themselves as receiving less support from physicians when treated in hospitals where physicians reported working more overtime hours and having less time for patient care.
  
  
  CONCLUSIONS
  This study provides preliminary evidence of the association between the hospital work environment and physicians' ability to support patients. Future studies should investigate the extent to which physicians' interaction performance can be modified through hospital-level interventions aimed at managing workload.
  
  
  CONCLUSIONS
  By approaching the problem of physician staffing in hospitals and investing in the hospitals' working conditions, health policy and hospital management could create conditions conducive to better patient-physician interaction.
authors.affiliation: Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany. Electronic address: lena.ansmann@uk-koeln.de.
authors.forename: Lena
authors.initials: L
authors.lastname: Ansmann
authors.forename: Christoph
authors.initials: C
authors.lastname: Kowalski
authors.forename: Nicole
authors.initials: N
authors.lastname: Ernstmann
authors.forename: Oliver
authors.initials: O
authors.lastname: Ommen
authors.forename: Julia
authors.initials: J
authors.lastname: Jung
authors.forename: Adriaan
authors.initials: A
authors.lastname: Visser
authors.forename: Holger
authors.initials: H
authors.lastname: Pfaff
mesh_terms: D001943:Breast Neoplasms / Q000523:psychology* / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires; D013997:Time Factors; D016526:Workload / Q000706:statistics & numerical data*
keywords: Breast cancer; Health services research; Multilevel analysis; Patient–physician interaction; Support; Workload