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Breast Cancer Treatment in Older Women: Impact of the Patient-Physician Interaction

Authors

  • Rose C. Maly MD, MSPH,

    1. From the *Department of Family Medicine, David Geffen School of Medicine, and School of Nursing, University of California at Los Angeles, Los Angeles, CaliforniaGeriatrics Section, Department of Medicine, and §Department of Epidemiology, Boston University School of Medicine, Boston, Massachusetts.
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  • Barbara Leake PhD,

    1. From the *Department of Family Medicine, David Geffen School of Medicine, and School of Nursing, University of California at Los Angeles, Los Angeles, CaliforniaGeriatrics Section, Department of Medicine, and §Department of Epidemiology, Boston University School of Medicine, Boston, Massachusetts.
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  • Rebecca A. Silliman MD, PhD

    1. From the *Department of Family Medicine, David Geffen School of Medicine, and School of Nursing, University of California at Los Angeles, Los Angeles, CaliforniaGeriatrics Section, Department of Medicine, and §Department of Epidemiology, Boston University School of Medicine, Boston, Massachusetts.
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  • This research and Dr. Maly were supported by funds from the California Breast Cancer Research Program of the University of California, Grant 4PB-061, and by the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Program, Grant 036833.

Address correspondence to Rose C. Maly, MD, MSPH, Department of Family Medicine, David Geffen School of Medicine at UCLA, Box 951683, 50–071 CHS, Los Angeles, CA 90095. E-mail: rmaly@mednet.ucla.edu

Abstract

Objectives: To assess the impact of the patient-physician interaction on breast cancer care in older women.

Design: Cross-sectional survey.

Setting: Los Angeles County, California.

Participants: Two hundred twenty-two consecutively identified breast cancer patients aged 55 and older who were within 6 months of breast cancer diagnosis and/or 1 month posttreatment.

Measurements: Dependent variables were patient breast cancer knowledge, treatment delay, and receipt of breast-conserving surgery (BCS). Key independent variables were five dimensions of the patient-physician interaction by patient report, including physician provision of tangible and interactive informational support, physician provision of emotional support, physician participatory decision-making style, and patient perceived self-efficacy in the patient-physician interaction. Age and ethnicity were additional important independent variables.

Results: In multiple logistic regression models, only physician interactive informational support had significant relationships with all three dependent variables, controlling for a wide range of patient sociodemographic and case-mix characteristics, visit length, number of physicians seen, social support, and physician sociodemographic and practice characteristics. Specifically, informational support positively predicted patient breast cancer knowledge (adjusted odds ratio (AOR)=1.18, 95% confidence interval (CI)=1.00–1.38), negatively predicted treatment delays (AOR=0.80, 95% CI=0.67–0.94), and positively predicted receipt of BCS (AOR=1.29, 95% CI=1.07–1.56). Age and ethnicity were not significant predictors in these models.

Conclusion: One specific domain of the patient-physician interaction, interactive informational support, may provide an avenue to ensure adequate breast cancer knowledge for patient treatment decision-making, decrease treatment delay, and increase rates of BCS for older breast cancer patients, thereby potentially mitigating known healthcare disparities in this vulnerable population of breast cancer patients.

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