Shields, C.G., Ziner, K.W., Bourff, S.A., Schilling, K., Zhao, Q., Monahan, P., . . . Champion, V. (2010). An intervention to improve communication between breast cancer survivors and their physicians. Journal of Psychosocial Oncology, 28, 610–629.

To compare a coaching intervention that uses a prompt sheet with usual care to improve cancer provider and survivor communication about survivor worries

The study involved a telephone coaching session using a prompt sheet and a nurse guiding a participant in prioritizing concerns to be addressed at an upcoming oncologist visit.

• The sample was comprised of 44 survivors with breast cancer (100% female).
• Mean survivor age was 44.1 years.
• Mean age at diagnosis was 38.5 years; 20% were diagnosed at stage I, 53% at stage II, and 27% at stage III.
• Mean time since diagnosis was 5.5 years.
• All were disease-free at the time of enrollment.
• All survivors had undergone chemotherapy.
• The sample was 95% white.

• Outpatient setting
• University cancer center in Indiana

• Long-term follow-up phase
• Late effects/survivorship

A randomized controlled trial design was used.

• Breast Cancer Self-Efficacy Scale: 14-item scale with a five-point Likert-type response developed for the study (Cronbach’s alpha = 0.84, content validity confirmed by 12 breast cancer survivors, 4 clinical experts, and 2 cancer research experts)
• Spielberger State-Trait Anxiety Inventory (STAI)–State subscale
• Center for Epidemiological Studies Depression Scale (CES-D)
• Concerns About Recurrence Scale (CARS)

Most concerns centered around current symptoms, long-term effects of treatment, and recurrence of cancer. The prompt sheet and coaching did not have a significant effect on depression, anxiety, or worries. Survivor questions communicated worry about symptoms and long-term side effects experienced by young breast cancer survivors.

Self-efficacy may be a significant predictor of survivors’ state of anxiety and depression.

• Study findings are limited by sample demographics (mostly white, highly educated women).
• The study had no blinding or attentional control.
• The study’s lack of direct observation of communication between the survivor and oncologist limits the understanding of how the prompt sheet changed and/or facilitated communication.

This type of intervention may help survivors to think about their concerns prior to an office visit and organize their thoughts for the visit so that priority issues can be addressed. Whether this has an impact on outcomes has not been supported. Findings suggest that self-efficacy is predictive of role concerns and emotional outcomes such as state anxiety and depression.