Patient-provider communication and decision making regarding adjuvant endocrine therapy-related symptom management: Provider perspectives.

Abstract

156 Background: Adjuvant endocrine therapy (AET)-related symptom management (SM) among breast cancer survivors (BCS) is greatly influenced by the quality of patient-provider communication; yet, few studies have examined provider perspectives on patient-provider communication and decision-making for AET-related SM. We assessed provider perspectives on AET-related SM to identify challenges and opportunities for improvement in patient-provider communication and decision-making. Methods: We conducted 3 focus groups (FGs) with a multidisciplinary group of health care providers (n = [6] physician; n = [7] non-physician) experienced in caring for BCS undergoing AET. We utilized semi-structured discussion guides to elicit provider perspectives on patient-provider communication and decision-making for AET-related SM as well as recommendations for improvement. All FGs were held at the University of Pittsburgh, audiotaped, and transcribed. We analyzed FG transcripts using qualitative software to identify key themes. Results: Providers described multiple challenges to patient-provider communication and decision-making for AET-related SM. Providers reported that BCS are often uncertain whether their symptoms are related to AET and unsure of whom to speak with about their symptoms. Providers also felt that patients are reluctant to bring up symptoms for fear that bringing up symptoms would detract from their care. Providers agreed that patient-provider communication influences BCS’ awareness and beliefs about SM. Providers indicated that provider communication strategies such as probing for symptoms, setting realistic treatment expectations, and assessing patient satisfaction with their SM plan enhances patient decision-making about AET-related SM. Conclusions: Although providers identified several challenges related to patient-provider communication and decision-making, many of these challenges are amenable to change through provider-level interventions. Future efforts aimed at improving AET-related SM should include strategies that address patient-provider communication and decision-making.