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Patient-Centered Communication During Oncology Follow-Up Visits for Breast Cancer Survivors: Content and Temporal Structure

Margaret F. Clayton

William N. Dudley

ONF 2009, 36(2), E68-E79. DOI: 10.1188/09.ONF.E68-E79

Purpose/Objectives: To understand the content and temporal structure of survivor-provider communication during breast cancer survivor follow-up visits.

Design: Descriptive correlational.

Setting: Private outpatient oncology practice.

Sample: 55 breast cancer survivors; 6 oncology providers.

Methods: A secondary analysis of audio recordings of survivor follow-up visits.

Main Research Variables: Survivors: demographics, uncertainty, mood, length of survival, years receiving care from providers, survivor expectations. Providers: demographics, medical uncertainty, specialty (physician, nurse practitioner, or physician assistant). Outcomes: time spent in patient-centered communication, perception of patient-centeredness.

Findings: Most visit time (55%) was spent waiting. Of the remaining 45%, silence represented the most time spent with providers, followed by symptom conversations. More specific survivor discussion plans predicted more time spent discussing symptoms and in reassurance interactions. More specificity of visit purpose predicted survivor perceptions of less patient-centeredness; however, more time in contextual conversations predicted a greater perception of patient-centeredness. Provider factors were not associated with time spent in patient-centered communication or survivor perceptions of patient-centeredness. All dimensions of patient-centered communication occurred during each visit section (before, during, and after the physical examination).

Conclusions: Discussing symptoms and concerns with providers offers reassurance about cancer recurrence. When visit expectations are very high, achieving a survivor perception of patient-centered communication may be difficult. However, time spent understanding a survivor within the context of her life can enhance survivor perceptions of patient-centeredness.

Implications for Nursing: Providers must be sensitive to concerns that are presented throughout a visit. When visit time is short, a second appointment may be necessary to address survivor concerns.

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