Provider Information Provision and Breast Cancer Patient Well-Being

ABSTRACT

Research continues to delineate and clarify specific communication behaviors associated with improved patient outcomes. In the context of breast cancer surgery, this exploratory study examined the effect of breast surgeon information provision on the immediate post-visit outcomes of patients’ anxious preoccupation, intention to adhere to treatment recommendations, and treatment plan satisfaction. Participants included 51 newly diagnosed breast cancer patients receiving care from one breast surgeon at a National Cancer Institute-designated cancer center in the northeastern United States. Participants completed pre- and post-visit questionnaires. Medical interactions were recorded, transcribed, and analyzed via multidimensional analysis, a method of linguistic analysis that uses exploratory factor analysis to identify how specific types of words are patterned and work to accomplish communicative goals (Biber, 1988). The multidimensional analysis identified constellations of language used by providers and patients. Although five linguistic dimensions emerged, one dimension, impersonal information provision, is of unique interest in understanding how providers communicate with patients. Impersonal information provision encompasses the ways in which the provider, using an impersonal tone, discussed the logistics, details, and implications of treatment options. Increased impersonal information provision was associated with patients’ decreased anxious preoccupation (β = –.22, t = −2.82, p = .007), increased treatment plan satisfaction (β = .36, t = 2.54, p = .012), and increased intention to adhere to treatment recommendations (β = .34, t = 2.45, p = .018). Findings suggest that specific provider behavior and types of information provided have unique and important effects on patients’ health outcomes.

Notes

¹ Although companion discourse was captured, due to the sporadic nature of companion dialogue across visits, we did not examine it as a speaker group.

² Correlation between Biber’s (1988) Dimension 1 scores and pre-visit anxious preoccupation: r = .17, p = .22; post-visit anxious preoccupation: r = .22, p = .08; treatment plan satisfaction: r = –.061, p = .67.

³ Oblique rotation is the appropriate choice as, with any linguistic data, we expect there to be correlation among the factors. The Kaiser–Meyer–Olkin Measure of Sampling Adequacy was .70, which is acceptable for factor analysis (Tabachnick & Fidell, 2007); p. 638; see also Biber, 1988, pp. 93–97; Conrad and Biber (2001), p. 13–42.

⁴ Levene’s test for Homogeneity of Variance was significant for Dimensions 1, 2, 4, and 5 (notably not for Dimension 3, which is the focus of our analysis). Thus, we used the t and p values for unequal variance.

⁵ Both visit word count and length of visit were accounted for within the study. The prior was a linguistic feature that was included in the factor analysis (see the Appendix). However, it did not emerge in the dimension of interest, impersonal information provisions (described in results). The latter, length of visit, was highly correlated with patient question asking (r = .71) and therefore was excluded as a potential covariate.

⁶ The frequency of it/its = 2817; he/his = 208; she/her/hers = 636; they/their/theirs/them = 1561.

⁷ As described in the methods, dimension scores are calculated by summing all positive and negative factor loadings (see Table 2).