Center for Patient Care and Outcomes Research, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
Division of General Internal Medicine, Department of Medicine, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
J Cancer Educ. 2022 Dec;37(6):1684-1690. doi: 10.1007/s13187-021-02013-2. Epub 2021 Apr 26.
Patient-physician concordance about topics discussed in a clinic visit is essential for effective communication but may be difficult to achieve in cancer care. We conducted a multicenter, observational study at two Midwestern oncology clinics. A sample of 48 English-speaking or Spanish-speaking women with newly diagnosed stage 0-3 breast cancer completed surveys before and after a visit with an oncologist. Patient-physician dyads were coded as concordant if both patient and physician follow-up self-reports agreed whether (or not) specific treatments were discussed (i.e., treatment option concordance; mastectomy, lumpectomy, hormone therapy, neoadjuvant, and adjuvant chemotherapy) and whether risk was described using certain quantitative formats (i.e., quantitative format concordance; percentages, proportions out of 100 and 1000, graphs, pictures, evidence from clinical studies, cancer stage). Agreement was determined using percent agreement and prevalence-adjusted bias-adjusted kappa (PABAK). Pearson's correlations were used to determine relationships between anxiety and each measure concordance. Percent concordance was higher for treatment concordance (73.3%) compared to quantitative format concordance (64.5%), and PABAK scores tended to be higher for treatment options (PABAK = .21-.78). Both treatment and quantitative format concordance were negatively associated with pre-visit state anxiety, but only treatment concordance was statistically significant (treatment: r = - .504, p = .001; quantitative format: r = - .096, p = .523). Our study indicates moderate patient-physician concordance in early breast cancer care communication and that patient anxiety may impact the ability for patients and physicians to agree on the content communicated in a clinic visit.
患者与医生在就诊过程中讨论的话题达成一致对于有效的沟通至关重要，但在癌症治疗中可能难以实现。我们在中西部的两家肿瘤诊所进行了一项多中心、观察性研究。48 名英语或西班牙语母语的新诊断为 0-3 期乳腺癌的女性在与肿瘤医生就诊前后完成了调查。如果患者和医生的随访自我报告都同意特定的治疗方法是否进行了讨论（即治疗方案一致性；乳房切除术、肿瘤切除术、激素治疗、新辅助和辅助化疗），并且风险是否使用某些定量格式进行了描述（即定量格式一致性；百分比、百分之一百和千分之一、图表、图片、来自临床研究的证据、癌症分期），那么患者-医生二人组被编码为一致。使用百分比一致性和调整后的偏倚一致性kappa（PABAK）来确定一致性。使用皮尔逊相关系数来确定焦虑与每个测量一致性之间的关系。治疗一致性的一致性百分比（73.3%）高于定量格式一致性（64.5%），并且治疗方案的 PABAK 得分倾向于更高（PABAK=.21-.78）。治疗和定量格式的一致性均与就诊前的状态焦虑呈负相关，但只有治疗一致性具有统计学意义（治疗：r= -.504，p=.001；定量格式：r= -.096，p=.523）。我们的研究表明，早期乳腺癌护理沟通中存在中等程度的患者-医生一致性，并且患者的焦虑可能会影响患者和医生在就诊过程中就传达的内容达成一致的能力。
