ASPO Abstracts
Patient Experience of Interpersonal Processes of Care and Subsequent Utilization of Hormone Therapy for Non-Metastatic Breast Cancer
Category: Behavioral Science & Health Communication
Conference Year: 2021
Abstract Body:
Purpose: We examined the association between patient experience of care and utilization of
hormone therapy (HT) in the treatment of non-metastatic hormone-receptor positive (HR+) breast
cancer.
Methods: Patients newly diagnosed with non-metastatic breast cancer were recruited from 2006 to
2010 for a longitudinal multisite cohort study in New York, NY, Detroit, MI, and Northern California.
Of 1,145 patients surveyed, 797 had HR+ tumors eligible for HT and all necessary data. We
assessed patient experience 4 to 8 weeks after recruitment using 6 subscales of the Interpersonal
Processes of Care (IPC) survey: compassion, discrimination, and hurriedness in communication,
as well as concern elicitation, result explanation, and patient-centered decision-making. Subscales
ranged from 1 to 5 where higher values indicated better experiences. HT for 5 years is standard
care for HR+ breast cancer so utilization was defined as time from diagnosis to HT initiation and
time from HT initiation to early discontinuation before 5 years as calculated from follow-up survey
responses. We evaluated the relationship between patient experience and utilization using Cox
proportional hazard models, controlling for education, income, insurance, marital status, social
support, site of care, age at diagnosis, stage, grade, tumor size, Charlson comorbidity index, and
chemotherapy.
Results: Median age at diagnosis was 59 years (interquartile range 51-66) with the majority
diagnosed at clinical stage 1 (54%) and with low or moderate grade disease (78%). Less hurried
communication was associated with increased probability of HT initiation (Hazards Ratio (HR)
1.15; 95% Confidence Interval (CI) 1.03, 1.30; p=0.018). Conversely, more patient-centered
decision-making was associated with increased probability of early discontinuation (HR 1.29; CI
1.03, 1.63; p=0.028). All other associations were null.
Conclusion: While unhurried communication was associated with initiation of hormone therapy,
patient-centered decision-making was associated with early discontinuation. Different aspects of
patient experience may have vastly different relationships with patient utilization of health services.
Actionable assessments of patient experience may require measurement along multiple
dimensions.
Keywords: patient experience, utilization, breast cancer, communication