Provider Communication and Health in Breast Cancer Survivors

Institution: University of California, Berkeley
Investigator(s): Sara Fernandes-Taylor, BA -
Award Cycle: 2008 (Cycle 14) Grant #: 14GB-0143 Award: $65,744
Award Type: Dissertation Award
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side



Initial Award Abstract (2008)

The health concerns of cancer survivors and shortcomings in communication between cancer patients and their providers have created an imperative for studying the effect of physician-patient communication on breast cancer survivorsí long-term health. The proposed study explores how breast cancer survivorsí perceptions of their communication with healthcare providers affect their health behaviors and outcomes over the long-term. There is a need to examine whether breast cancer survivorsí perceived control over their health, health behaviors, and health outcomes over ten years are predicted by the quality of communication these women experience with their healthcare providers.

The aims of this project are to:

  1. Identify the specific components of physician-patient communication (e.g., information, emotional support) and how they relate to one another. This includes ascertaining whether different components of communication underlie a single construct or multiple, related constructs. We will also develop indices of communication based on preliminary analyses for use in multivariate models.
  2. Conduct cross-sectional and longitudinal analyses using data from the treatment period and 5-years survival and data from 5 and 10 years survival to discern the long-term impact of provider-patient communication on womenís perceived control over their health, health behaviors, and subsequent health outcomes.
  3. Examine relationships among breast cancer survivorsí perceptions of doctor-patient communication and individual characteristics, such as race/ethnicity, age, perceived social support, and self-esteem.
  4. Analyze data at ten years from survivors and a comparison cohort of women who have never had breast cancer (survivorsí female friends who were referred to the study) to identify differences between breast cancer survivorsí need for effective provider communication and other womenís needs.

This approach serves to improve the quality of survivorship care through reframing cancer as a chronic condition, informing patient and provider-based communication interventions, and bringing breast cancer survivorship care to the forefront of chronic care research.




Final Report (2010)

Breast cancer survivors' perceptions of their communication with health care providers may be associated with their health habits and their physical health over the long term. This research examined the relationship between breast cancer survivors' perceived communication with their doctors and their sense of control over their health, health habits, and physical health. In addition, the study examined the individual, health, and emotional characteristics of survivors that are associated with perceptions of provider communication. This project also addressed: (1) what women regret about their breast cancer treatment five years later, and (2) what characteristics of disease and treatment predict post-treatment regret.

The aims of the project were completed through the analysis of interviews provided by breast cancer survivors in the San Francisco Bay Area. Patients' perceptions of their communication with providers were not consistently associated with their sense of control over their health, their health behaviors, or health outcomes. When examining individual characteristics, problems with provider communication were associated with self-esteem and emotional support, rather than with socio-demographic characteristics, such as age, race, and education. An examination of regret revealed that women who were anxious about the future or had problems communicating with physicians during treatment were more likely to express regret 5 years later. In addition, women with new or recurrent cancers 5 years later were significantly more likely to regret some aspect of their primary treatment.

This research supports the need to address the psychosocial aspects of cancer care in the survivorship phase and the need to improve study design in physician-patient communication research. Evidence is also provided for addressing the unique emotional needs of women with recurrent cancers, who may experience an undue burden of regret.




Symposium Abstract (2010)

Co-author: Joan R. Bloom (mentor)

Objective: The study addresses: (1) what women regret about their breast cancer treatment 5 years later, and (2) what characteristics of disease and treatment predict post-treatment regret.

Method: Interviews were conducted with breast cancer survivors in the San Francisco Bay Area. Participants were interviewed following diagnosis. Five years later, women were asked whether they had any regrets about their cancer treatment (N =449). Qualitative analysis was used to identify regret content, and logistic regression was used to determine what characteristics of treatment predicted regret.

Results: Forty two point five percent women in the sample regretted some aspect of treatment. The most common regrets were primary surgery (24.1%), chemotherapy and/or radiation (21.5%), reconstruction (17.8%), and problems with providers (13.1%). In addition, women regretted inactions (59.2%) (actions that they did not take) more than actions that they did take (30.4%). This represents a novel finding in the study of post-treatment regret, which has largely focused on regrets over actions. Quantitative analysis revealed that women who were anxious about the future (OR=1.32; p<0.03) or had problems communicating with physicians (OR =1.26; p <0.02) during treatment were more likely to express regret 5 years later. In addition, women with new or recurrent cancers 5 years later were significantly more likely to regret some aspect of their treatment (OR = 5.81; p<0.001).

Conclusion: This research supports addressing the psychosocial aspects of cancer care and improving physician-patient communication. Evidence is also provided for addressing the unique emotional needs of women with recurrent cancers, who may experience an undue burden of regret.



Post-treatment regret among young breast cancer survivors.
Periodical:Psycho-oncology
Index Medicus:
Authors: Fernandes-Taylor, S and Bllom, JR
Yr: 2010 Vol: 28JUN 2010 Nbr: Abs: Pg:10.1002/pon.174