Women's Health

Oncologists appear to communicate differently with breast cancer patients depending on women's age, race, education, and income

Oncologists tend to communicate differently with women newly diagnosed with breast cancer, depending on the women's age, race, education, and income, concludes a new study. Researchers audiotaped initial consultations between 58 oncologists at 14 practices with 405 women newly diagnosed with breast cancer. They also conducted interviews with patients and physicians immediately before and after consultations. Despite the inherently emotional nature of the medical visit, there was surprisingly little overt discussion about how the women felt about the diagnosis of breast cancer and how they were coping.

Both patients and physicians spent time trying to establish an interpersonal relationship with each other; however, oncologists spent more time engaged in building relationships with white patients than they did with those of other racial/ethnic groups, and with more educated and affluent patients than with less advantaged patients. The women who asked more questions were younger, white, had more than a high school education, and higher income. These women were also more likely to volunteer information to the physician unasked. Physicians also tended to ask them more questions than other women.

Racial differences occurred in almost every one of the communication categories examined. This may mean a less adequate decisionmaking process for women who are members of racial or ethnic minorities, or who are less affluent, older, or less educated. These communication differences may also lead to disparities in breast cancer outcomes, note the researchers. They suggest that clinicians should be trained during communication skills training to recognize their biases. The study was supported by the Agency for Healthcare Research and Quality (HS08516).

See "Cancer communication patterns and the influence of patient characteristics: Disparities in information-giving and affective behaviors," by Laura A. Siminoff, Ph.D., Gregory C. Graham, and Nahida H. Gordon, Ph.D., in the September 2006 Patient Education and Counseling 62, pp. 355-360.

Editor's note: Another AHRQ-supported article on a related topic found that physicians vary in their perspectives on end-of-life care, depending on their race and specialty. For more details, see Carter, C.L., Zapka, J.G., O'Neill, S., and others (2006). "Physician perspectives on end-of-life care: Factors of race, specialty, and geography." (AHRQ grant HS10871). Palliative and Supportive Care 4, pp. 257-271.

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