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The Surgeon-Patient Interaction in Older Women With Breast Cancer: What Are the Determinants of a Helpful Discussion?

¹ Departments of Family Medicine and Epidemiology and Biostatistics, Schulich School of Medicine, University of Western Ontario, 245-100 Collip Circle, London, Ontario N6G 4X8, Canada
² Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Box 957087, 10880 Wilshire Boulevard, Suite 1800, Los Angeles, California 90095-7087

Correspondence: Address correspondence and reprint requests to: Amardeep Thind, MD, PhD; E-mail: athind2{at}uwo.ca.

Background: 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. We analyzed data from 240 women with a new breast cancer diagnosis to better understand this interaction and to delineate the patient, surgeon, and surgeon-patient interaction-level characteristics affecting this interaction.

Methods: A cross-sectional survey was conducted in Los Angeles County of 240 women with a new breast cancer diagnosis aged 55 years. Women were asked to rate on a scale of 0 to 10 how helpful overall the way their surgeon discussed their breast cancer with them was. Logistic regression models were constructed to assess the relationship of patient, surgeon, and surgeon-patient interaction characteristics to the outcome variable.

Results: Forty-four percent of women said that they found the way their surgeon discussed their breast cancer with them extremely helpful. Women with a higher level of perceived self-efficacy, a longer consultation time with the surgeon, a higher interactive information-giving score, and a higher participatory decision-making score had significantly higher odds of reporting the discussion to be "extremely helpful."

Conclusions: Our results indicate that strategies to improve the patient’s perceived self-efficacy (preparing questions beforehand, practicing, watching a role model, and so on) will improve the surgeon-patient discussion. At a systems level, adequate time should be budgeted for the consultation, and we must ensure that adequate communication skills are imparted to surgeons during their educational training.

Key Words: Breast cancer • Surgeon-patient interaction • Helpful discussion • Older women