title: Provider perspectives on patient-provider communication for adjuvant endocrine therapy symptom management.
abstract: Providers' communication skills play a key role in encouraging breast cancer survivors to report symptoms and adhere to long-term treatments such as adjuvant endocrine therapy (AET). The purpose of this study was to examine provider perspectives on patient-provider communication regarding AET symptom management and to explore whether provider perspectives vary across the multi-disciplinary team of providers involved in survivorship care.
  
  
  
  We conducted three one-hour focus groups with a multi-disciplinary group of health care providers including oncology specialists, primary care physicians, and non-physician providers experienced in caring for breast cancer survivors undergoing AET (n = 13). Themes were organized using Epstein and Street's (2007) Framework for Patient-Centered Communication in Cancer Care.
  
  
  
  The findings of this study suggest providers' communication behaviors including managing survivors' uncertainty, responding to survivors' emotions, exchanging information, and enabling self-management influences the quality of patient-provider communication about AET symptoms. Additionally, lack of systematic symptom assessment tools for AET requires providers to use discretion in determining which symptoms to discuss with survivors resulting in approaches that vary based on providers' discipline.
  
  
  
  There may be AET-specific provider communication skills and behaviors that promote effective patient-provider communication but additional research is needed to identify practices and policies that encourage these skills and behaviors among the many providers involved in survivorship care. Efforts are also needed to coordinate AET symptom assessment across providers, clarify providers' roles in symptom assessment, and determine best practices for AET symptom communication.
authors.affiliation: Department of Health Policy and Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 1105F McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC, USA. keat@email.unc.edu.
authors.forename: Kea
authors.identifier: http://orcid.org/0000-0002-7885-0879
authors.initials: K
authors.lastname: Turner
authors.affiliation: Department of Health Policy and Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 1105F McGavran-Greenberg Hall, CB#7411, Chapel Hill, NC, USA.|Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, USA.
authors.forename: Cleo A
authors.initials: CA
authors.lastname: Samuel
authors.affiliation: University of Pittsburgh Medical Center Cancer Center, School of Nursing, University of Pittsburgh, 415 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, USA.
authors.forename: Heidi As
authors.initials: HA
authors.lastname: Donovan
authors.affiliation: University of Pittsburgh Medical Center Health Plan, University of Pittsburgh, 600 Grant Street, Pittsburgh, PA, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Beckjord
authors.affiliation: University of Pittsburgh Medical Center Health Plan, University of Pittsburgh, 600 Grant Street, Pittsburgh, PA, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Cardy
authors.affiliation: Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, and Clinical and Translational Science, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, USA.
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.affiliation: Department of Medicine, University of Pittsburgh, A. 140 Cooper Pavilion, 5115 Centre Avenue, Pittsburgh, PA, USA.
authors.forename: G J
authors.initials: GJ
authors.lastname: van Londen
mesh_terms: D047072:Aromatase Inhibitors / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000523:psychology; D017024:Chemotherapy, Adjuvant; D003142:Communication; D005260:Female; D017144:Focus Groups; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011369:Professional-Patient Relations; D017741:Survivors / Q000523:psychology
chemical_list: D047072:Aromatase Inhibitors
keywords: Adjuvant endocrine therapy; Aromatase inhibitors; Breast cancer; Patient-centered communication; Patient-provider communication; Symptom management