Communication in Cancer Care (PDQ®): Supportive care - Health Professional Information [NCI] - Factors Affecting Communication
Age, Race, Ethnicity, and Communication
An important area of communication problems centers on the differences in communication between doctors and older women versus doctors and younger women. Better patient-physician communication has been associated with patient choice about treatment, satisfaction with care, and the quality of cancer care, particularly for older and disadvantaged patients. A study examining health care disparities in older patients with breast cancer found that older age and Latina ethnicity were negatively associated with physician provision of interactive informational support, and these patients received less interactive informational support from their physicians than did younger patients. The authors concluded that improving the quality of communication at the level of patient-physician interaction could be an important avenue to reducing age and ethnic group treatment disparities among patients with breast cancer.
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Research suggests that older patients with breast cancer who receive less-than-definitive care have higher recurrence rates and higher mortality rates than other women and remain at greater risk for receiving less-than-definitive treatment. In one investigation, patients aged 80 years and older reported receiving markedly less information about treatment options than did younger patients, were less likely to state that they were given a choice of breast cancer treatment, and were less likely to initiate communication or to perceive that their surgeons initiated communication. Another study  also highlighted the importance of communication between older patients with breast cancer and their physicians. Investigators found that although older women obtained information regarding breast cancer from different sources, they relied most heavily on their physicians for information. Despite this expectation, the knowledge about the importance of patient-physician communication, and the increasing use of breast-conserving surgery (BCS), older breast cancer patients undergo BCS less frequently than do younger women. In addition, within older populations, radiation therapy is sometimes omitted after BCS. Even though many factors could explain these patterns of care, it is possible that the quality of communication between older patients and their oncologists contributes to the observed treatment variability—though the traditional medical standard of care might account for physicians who do not recommend BCS, in addition to a possible geographic preference for recommended treatments. Nevertheless, a study has shown that discussing treatment options with physicians increased the probability of an older woman receiving definitive primary breast cancer therapy (defined as modified radical mastectomy or BCS with axillary dissection and radiation therapy).
Several studies have investigated the relationship between race and communication in oncology. One study of 405 newly diagnosed cancer patients reported that physicians spent more time in relationship building with white patients than with nonwhite patients. Another study found that black patients with lung cancer received significantly less information from their doctors and were less likely to prompt their doctors for information. These patients also had lower postvisit trust in their physicians. Clearly, this is an area of neglected importance in communication skills.