Primary Care Physician Involvement in Decision-Making in Breast Cancer

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Most women with breast cancer reported high primary care physician quality, engagement, and communication, with a minority reporting high levels of primary care physician participation in treatment decisions, according to a study reported by Lauren P. Wallner, PhD, MPH, of the University of Michigan, Ann Arbor, and colleagues in the Journal of Clinical Oncology. However, greater primary care physician involvement did not generally translate into higher patient satisfaction in ­decision-making.

The study involved a weighted random sample of women newly diagnosed with breast cancer in 2013 to 2014 in Surveillance, Epidemiology, and End Results (SEER) registries in Los Angeles, California, and Georgia. A total of 2,279 were sent a survey approximately 6 months after diagnosis, with a 71% response rate.

Most women reported the perception of high primary care physician quality (63.6%), breast cancer engagement (66.2%), and communication (69.1%). Primary care physician participation in treatment decisions was reported by 35.4%. In total, 43.9% of women reporting high primary care physician quality reported greater primary care physician participation in treatment decisions vs 12.3% of women who reported low primary care physician quality (P < .001).

Overall, women reporting high primary care physician quality were more likely to report high primary care physician engagement (odds ratio [OR] = 13.65, 95% confidence interval [CI] = 8.70–21.40), more frequent communication about cancer care (OR = 14.28, 95% CI = 9.43–21.63), and greater participation in treatment decisions (OR = 6.46, 95% CI = 3.99–10.47).

Decision-Making Satisfaction

In multivariate analysis, adjusted mean scores of patient-reported satisfaction with and degree of deliberation about surgical treatment decisions were compared across reported levels of primary care physician engagement, communication, and participation. Higher vs lower primary care physician engagement was associated with higher decision-making satisfaction (P = .003), but no significant associations were observed between decision-making satisfaction and high vs low primary care physician communication or participation. No significant associations were found between the degree of deliberation and high vs low engagement, communication, or participation.

The investigators concluded: “Patient perceptions of [primary care physician] quality and [primary care physician] involvement in breast cancer care during treatment are high for most women, and [primary care physicians] often participate in breast cancer treatment decisions. However, [primary care physician] involvement did not lead to meaningful improvements in patients’ appraisals of their decision making.”

The study was supported by the National Cancer Institute and others.

Wallner LP, et al: J Clin Oncol. October 3, 2016 (early release online).