Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #114073

Amardeep Thind, MD, PhD, Department of Family Medicine, University of Western Ontario, Center for Studies in Family Medicine, 245 - 100 Collip Circle, London, ON N6G 4X8, Canada, (519) 858 - 5028, athind2@uwo.ca and Rose Maly, MD, MSPH, Department of Family Medicine, University of California, Los Angeles, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA 90095.

Introduction: Surgery is a key modality in the treatment of breast cancer. The patient-physician interaction is a key determinant of a range of outcomes, but there is little work examining the surgeon – breast cancer patient interaction. A key element of medical practice today is shared decision making, which is based on the provision of information on the disease, treatment options and possible outcomes by the surgeon. We elucidate the patient, surgeon and surgeon-patient interaction level characteristics among women who reported that the way the surgeon discussed their breast cancer with them was ‘extremely helpful'.

Methods: The study was a cross-sectional data analysis of 240 newly diagnosed women with breast cancer aged 55 years or older in Los Angeles County. We surveyed patients' surgeons and abstracted their medical records. Women were asked to rate how helpful overall was the way the surgeon discussed their breast cancer with them. Responses were dichotomized to create a binary dependent variable. Independent variables were constructed for three domains: (a) patient level - age, race/ethnicity, education, income, cancer stage, insurance status, time from biopsy to surgery, general health, racial and medical mistrust, and perceived self efficacy in physician-patient interaction; (b) surgeon level - years in practice; and (c) surgeon-patient interaction - consultation time, interactive information giving and the surgeon's participatory decision making style. Logistic regression models were utilized to estimate the parameters; standard errors were corrected for clustering at the surgeon level.

Results: 44% of women responded that they found the way their surgeon discussed their breast cancer with them was ‘extremely helpful'. African-American women had 76% lesser odds of finding the discussion ‘extremely helpful' compared to white women. Women with a high level of perceived self-efficacy had nearly ten times the odds, and those with longer consultations had three times the odds, of reporting the discussion to be ‘extremely helpful'. Every additional topic discussed by the provider resulted in a 17% increase, and a unit increase in the participatory decision making score was associated with a 2% increase, in the odds of reporting the discussion to be ‘extremely helpful'.

Conclusions: Our results suggest that surgeons should spend more time with their breast cancer patients during consultations, and ensure that they increase the information conveyed to the patient regarding the disease, treatment and outcomes. Future training of surgeons should also include efforts to improve their participatory decision making styles.

Learning Objectives:

• At the conclusion of the session, participants will be able to articulate the factors that determine patient satisfaction in the surgeon-patient encounter in women with breast cancer.

Keywords: Breast Cancer, Patient Satisfaction

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.