Patient assertiveness and physician decision-making among older breast cancer patients

被引:71
作者
Krupat, E
Irish, JT
Kasten, LE
Freund, KM
Burns, RB
Moskowitz, MA
McKinlay, JB [1 ]
机构
[1] Massachusetts Coll Pharm & Hlth Sci, Sch Arts & Sci, Boston, MA USA
[2] New England Res Inst, Watertown, MA 02172 USA
[3] Boston Med Ctr, Gen Internal Med Sect, Evans Dept Med, Boston, MA USA
[4] Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA USA
关键词
breast cancer; patient assertiveness; clinical decision-making; women's health;
D O I
10.1016/S0277-9536(99)00106-9
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
The objective of this study was to determine whether assertive patient behavior influences physician decisionmaking in the treatment of older breast cancer patients. One hundred and twenty-eight physicians saw videotapes depicting women seeking care for breast cancer and then recommended evaluation and treatment plans. Identical scripts were used, but the age, race, socioeconomic status, mobility, general health, and assertive behavior of the patients were experimentally varied along with the physician's specialty and length of practice. No direct effects of assertive patient behavior were seen. However, black, comorbid, and lower SES women were more likely to have full staging of their tumors ordered when they made an assertive request. Treatment recommendations also showed an interaction of assertiveness with patient's age and social class as well as physicians' specialty. The results indicate that a moderately assertive patient request may change provider behavior, although the effects of assertiveness vary most by what type of patient demonstrates this behavior. In particular, assertiveness led to more careful diagnostic testing for patients who came from groups that are "disadvantaged." (C) 1999 Elsevier Science Ltd. All rights reserved.
引用
收藏
页码:449 / 457
页数:9
相关论文
共 45 条
  • [1] ADELMAN RD, 1991, AGEING SOC, V11, P127, DOI DOI 10.1017/S0144686X00003974
  • [2] Treatment decision making in women newly diagnosed with breast cancer
    Beaver, K
    Luker, KA
    Owens, RG
    Leinster, SJ
    Degner, LF
    Sloan, JA
    [J]. CANCER NURSING, 1996, 19 (01) : 8 - 19
  • [3] Beisecker A.E., 1993, Health Communication, V5, P41, DOI [10.1207/S15327027HC0501_3, DOI 10.1207/S15327027HC0501_3]
  • [4] PATIENT INFORMATION-SEEKING BEHAVIORS WHEN COMMUNICATING WITH DOCTORS
    BEISECKER, AE
    BEISECKER, TD
    [J]. MEDICAL CARE, 1990, 28 (01) : 19 - 28
  • [5] ATTITUDES OF ONCOLOGISTS, ONCOLOGY NURSES, AND PATIENTS FROM A WOMENS CLINIC REGARDING MEDICAL DECISION-MAKING FOR OLDER AND YOUNGER BREAST-CANCER PATIENTS
    BEISECKER, AE
    HELMIG, L
    GRAHAM, D
    MOORE, WP
    [J]. GERONTOLOGIST, 1994, 34 (04) : 505 - 512
  • [6] Physician characteristics: Do they influence the evaluation and treatment of breast cancer in older women?
    Burns, RB
    Freund, KM
    Moskowitz, MA
    Kasten, L
    Feldman, H
    McKinlay, JB
    [J]. AMERICAN JOURNAL OF MEDICINE, 1997, 103 (04) : 263 - 269
  • [7] Childress J F, 1984, Theor Med, V5, P17, DOI 10.1007/BF00489243
  • [8] THE EFFECT OF AGE ON THE CARE OF WOMEN WITH BREAST-CANCER IN COMMUNITY HOSPITALS
    CHU, J
    DIEHR, P
    FEIGL, P
    GLAEFKE, G
    BEGG, C
    GLICKSMAN, A
    FORD, L
    [J]. JOURNALS OF GERONTOLOGY, 1987, 42 (02): : 185 - 190
  • [9] Cochran W.G. G.M. Cox., 1957, Experimental Design
  • [10] Information needs and decisional preferences in women with breast cancer
    Degner, LF
    Kristjanson, LJ
    Bowman, D
    Sloan, JA
    Carriere, KC
    ONeil, J
    Bilodeau, B
    Watson, P
    Mueller, B
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1997, 277 (18): : 1485 - 1492