Article

Physicians' Decision-Making Style and Psychosocial Outcomes among Cancer Survivors

Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd, MSC 7344, EPN 4092, Bethesda, MD 20892-7344, USA.
Patient Education and Counseling (Impact Factor: 2.2). 11/2009; 77(3):404-12. DOI: 10.1016/j.pec.2009.10.004
Source: PubMed

ABSTRACT

We evaluated pathways linking physicians' decision-making style with cancer survivors' health-related quality of life (HRQOL).
We analyzed survey data from 623 survivors diagnosed with leukemia, colorectal, or bladder cancer in Northern California, 2-5 years prior to the study. Of these, 395 reported making a medical decision in the past 12 months and were asked about their physician's decision-making style. We evaluated the association of physician style with proximal communication outcomes (trust and participation self-efficacy), intermediate cognitive outcomes (perceived control and uncertainty), and distal health outcomes (physical and mental HRQOL).
Overall, 54% of survivors reported a sub-optimal decision-making style for their physician. With the exception of physical health, physician style was associated with all proximal, intermediate, and distal outcomes (p< or =0.01). We identified two significant pathways by which a participatory physician style may be associated with survivors' mental health: (1) by increasing survivors' participation self-efficacy and thereby enhancing their perceptions of personal control (p<0.01); (2) by enhancing survivors' level of trust and thereby reducing their perceptions of uncertainty (p<0.05).
A participatory physician style may improve survivors' mental health by a complex two-step mechanism of improving survivors' proximal communication and intermediate cognitive outcomes.
Physicians who adopt a participatory decision-making style are likely to facilitate patient empowerment and enhance patients' HRQOL.

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    • "These fears and uncertainties do not subside for long term survivors [17]. Survivors must make decisions about follow-up care preferences [18] [19]. Survivors report feeling abandoned, as many are tasked to communicate information about their cancer and treatment history with future healthcare providers [2]. "
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    • "A high degree of consensus within the FGs showed that the most important components underlying the need for good communication with and guidance of patients were: firstly, reassurance and prompt access to the diagnostic department as a way of coping with uncertainty following the detection of a symptom perceived as cancer risk; secondly, anticipatory information to supply patients with the tools that they required to cope with practical and emotional illness-related issues, thereby fostering understanding and opportunities for self-care before delivering treatments; thirdly, clinician guidance on the discussion of the different therapeutic options with patients, through use of clinical scenarios that showed the benefits and risks of each decision; and lastly, an approach providing supportive communication when ending treatments, eliciting the feeling of helplessness and emotional exhaustion that patients may experience, and addressing the management of potential treatment-related effects. Our study confirms previous research inasmuch as it highlights the fact that good communication can improve patients' experience [19] and, in accordance with the NCI framework, can impact on intermediate outcomes (engaging in health-enhancing lifestyles, etc.) [20] [21]. This conceptual framework possesses two main advantages, the first of which is the assumption of overlapping communication between the wide range of professionals and the patient, in contrast to most of the literature, which has traditionally focused on a dyadic patienteclinician relationship [3]. "
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