title: The impact of doctor-patient communication on patients' perceptions of their risk of breast cancer recurrence.
abstract: Doctor-patient communication is the primary way for women diagnosed with breast cancer to learn about their risk of distant recurrence. Yet little is known about how doctors approach these discussions.
  
  
  
  A weighted random sample of newly diagnosed early-stage breast cancer patients identified through SEER registries of Los Angeles and Georgia (2013-2015) was sent surveys about ~2 months after surgery (Phase 2, N = 3930, RR 68%). We assessed patient perceptions of doctor communication of risk of recurrence (i.e., amount, approach, inquiry about worry). Clinically determined 10-year risk of distant recurrence was established for low and intermediate invasive cancer patients. Women's perceived risk of distant recurrence (0-100%) was categorized into subgroups: overestimation, reasonably accurate, and zero risk. Understanding of risk and patient factors (e.g. health literacy, numeracy, and anxiety/worry) on physician communication outcomes was evaluated in multivariable regression models (analytic sample for substudy = 1295).
  
  
  
  About 33% of women reported that doctors discussed risk of recurrence as "quite a bit" or "a lot," while 14% said "not at all." Over half of women reported that doctors used words and numbers to describe risk, while 24% used only words. Overestimators (OR .50, CI 0.31-0.81) or those who perceived zero risk (OR .46, CI 0.29-0.72) more often said that their doctor did not discuss risk. Patients with low numeracy reported less discussion. Over 60% reported that their doctor almost never inquired about worry.
  
  
  
  Effective doctor-patient communication is critical to patient understanding of risk of recurrence. Efforts to enhance physicians' ability to engage in individualized communication around risk are needed.
authors.affiliation: Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 2830 SPH1, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA. nkjanz@umich.edu.
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Janz
authors.affiliation: Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
authors.forename: Yun
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 2830 SPH1, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.|Division of General Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd, Building 16, Ann Arbor, MI, 48109, USA.|Center for Bioethics and Social Sciences in Medicine, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Zikmund-Fisher
authors.affiliation: Department of Radiation Oncology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA.
authors.forename: Reshma
authors.initials: R
authors.lastname: Jagsi
authors.affiliation: Departments of Medicine and Health Research and Policy, Stanford University, 900 Blake Wilbur, Stanford, CA, 94305, USA.
authors.forename: Allison W
authors.initials: AW
authors.lastname: Kurian
authors.affiliation: Center for Health Communications Research, Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd, Building 16, Ann Arbor, MI, 48109, USA.
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: An
authors.affiliation: Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
authors.forename: M Chandler
authors.initials: MC
authors.lastname: McLeod
authors.affiliation: Division of General Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd, Building 16, Ann Arbor, MI, 48109, USA.
authors.forename: Kamaria L
authors.initials: KL
authors.lastname: Lee
authors.affiliation: Division of General Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd, Building 16, Ann Arbor, MI, 48109, USA.|Department of Health Management and Policy, University of Michigan, 2800 Plymouth Rd, Building 16, Ann Arbor, MI, 48109, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Katz
authors.affiliation: Division of General Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd, Building 16, Ann Arbor, MI, 48109, USA.|Department of Health Management and Policy, University of Michigan, 2800 Plymouth Rd, Building 16, Ann Arbor, MI, 48109, USA.|Veterans Administration Center for Clinical Management Research, Ann Arbor VA Health Care System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Hawley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy; D003131:Combined Modality Therapy; D003142:Communication; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016017:Odds Ratio; D010465:Perception; D010817:Physician-Patient Relations; D011159:Population Surveillance; D012306:Risk; D012307:Risk Factors; D018426:SEER Program
keywords: Breast cancer; Physician communication; Risk perception; Worry about recurrence