title: Relationships as Medicine: Quality of the Physician-Patient Relationship Determines Physician Influence on Treatment Recommendation Adherence.
abstract: To determine whether quality of physician-patient relationships influences uptake of physician treatment recommendations in men with clinically localized prostate cancer (PCa).
  
  
  
  Data were collected July 2010 to August 2014 at two cancer centers and three community facilities.
  
  
  
  Analyses were prospective and cross-sectional. We modeled associations between quality of the patient-physician relationship and influence of physician recommendations on treatment choice using generalized estimating equations (GEE).
  
  
  
  Data were collected via survey and medical record abstraction.
  
  
  
  Participants (N = 1166) were 14.7 percent minority; 37.1 percent had low-, 47.5 percent had intermediate-, and 15.4 percent had high-risk PCa. Those reporting a better physician-patient relationship perceived that their physician's treatment recommendation was more influential (RR = 1.05, 95 percent CI = 1.04-1.05, p < .001) and were more likely to choose the recommended treatment (OR = 2.92, 95 percent CI = 2.39, 3.58, p < .001). A pattern of interactions emerged indicating that quality of the physician-patient relationship was more strongly associated with influence of recommendations for more, versus less aggressive treatment in those with low-risk, but not intermediate-risk disease.
  
  
  
  Prioritizing quality of the physician-patient relationship through training, practice change, and patient feedback may increase adherence. However, strategies need to align with efforts to reduce physician recommendations for inefficacious treatments to prevent overtreatment.
authors.affiliation: Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY.
authors.forename: Heather
authors.identifier: 0000-0002-0147-8378
authors.initials: H
authors.lastname: Orom
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Willie
authors.initials: W
authors.lastname: Underwood
authors.affiliation: Touro College of Osteopathic Medicine, Middletown, NY.
authors.forename: Zinan
authors.initials: Z
authors.lastname: Cheng
authors.affiliation: Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY.
authors.forename: D Lynn
authors.initials: DL
authors.lastname: Homish
authors.affiliation: Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY.
authors.forename: I'Yanna
authors.initials: I
authors.lastname: Scott
mesh_terms: D000368:Aged; D002173:Cancer Care Facilities / Q000458:organization & administration; D003151:Community Health Centers / Q000458:organization & administration; D003430:Cross-Sectional Studies; D003657:Decision Making; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010358:Patient Participation; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000628:therapy*; D012959:Socioeconomic Factors
keywords: Patient-centered care; adherence; overtreatment; physician-patient relationship; prostate cancer