title: Trends in cancer survivors' experience of patient-centered communication: results from the Health Information National Trends Survey (HINTS).
abstract: Two Institute of Medicine reports almost a decade apart suggest that cancer survivors often feel "lost in transition" and experience suboptimal quality of care. The six core functions of patient-centered communication: managing uncertainty, responding to emotions, making decisions, fostering healing relationships, enabling self-management, and exchanging information, represent a central aspect of survivors' care experience that has not been systematically investigated.
  
  
  
  Nationally representative data from four administrations of the Health Information National Trends Survey (HINTS) was merged with combined replicate weights using the jackknife replication method. Linear and logistic regression models were used to assess (1) characteristics of cancer survivors (N = 1794) who report suboptimal patient-centered communication and (2) whether survivors' patient-centered communication experience changed from 2007 to 2013.
  
  
  
  One third to one half of survivors report suboptimal patient-centered communication, particularly on core functions of providers helping manage uncertainty (48 %) and responding to emotions (49 %). In a fully adjusted linear regression model, survivors with more education (Wald F = 2.84, p = .04), without a usual source of care (Wald F = 11.59, p < .001), and in poorer health (Wald F = 9.08, p < .001) were more likely to report less patient-centered communication. Although ratings of patient-centered communication improved over time (p trend = .04), this trend did not remain significant in fully adjusted models.
  
  
  
  Despite increased attention to survivorship, many survivors continue to report suboptimal communication with their health care providers.
  
  
  
  Survivorship communication should include managing uncertainty about future risk and address survivors' emotional needs. Efforts to improve patient-centered communication should focus on survivors without a usual source of care and in poorer health.
authors.affiliation: Department of Natural and Applied Sciences, Bentley University, Jennison 103, 175 Forest Street, Waltham, MA, 02452, USA. danielleblanch@gmail.com.
authors.forename: Danielle
authors.initials: D
authors.lastname: Blanch-Hartigan
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
authors.forename: Neetu
authors.initials: N
authors.lastname: Chawla
authors.affiliation: Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Moser
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Lila J
authors.initials: LJ
authors.lastname: Finney Rutten
authors.affiliation: Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Bradford W
authors.initials: BW
authors.lastname: Hesse
authors.affiliation: Improving Health Systems, Patient-Centered Outcomes Research Institute, Washington, DC, USA.
authors.forename: Neeraj K
authors.initials: NK
authors.lastname: Arora
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends*; D017741:Survivors / Q000523:psychology*; D014481:United States; D055815:Young Adult
keywords: Cancer survivorship; Emotions; Patient-centered care; Patient-provider communication; Uncertainty