Confidence in the ability to communicate with physicians among low-income patients with prostate cancer

Maliski, Sally L; Kwan, Lorna; Krupski, Tracey; Fink, Arlene; Orecklin, James R; Litwin, Mark S

doi:10.1016/j.urology.2004.03.042

« Previous Next »Urology
Volume 64, Issue 2 , Pages 329-334, August 2004

Confidence in the ability to communicate with physicians among low-income patients with prostate cancer☆

Sally L Maliski
- Department of Urology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
- Reprint requests: Sally L. Maliski, Ph.D., R.N., Department of Urology, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, David Geffen School of Medicine, Box 956900, Los Angeles, CA 90095-6900, USA
Lorna Kwan
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
Tracey Krupski
- Department of Urology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
Arlene Fink
- Department of Urology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
James R Orecklin
- Department of Urology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
Mark S Litwin
- Department of Urology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
- Department of Health Services, University of California, Los Angeles, School of Public Health, Los Angeles, California, USA

Received 8 December 2003; accepted 23 March 2004.

Abstract

Objectives

To describe the confidence of low-income patients with prostate cancer in interacting with physicians. Men with prostate cancer need to communicate easily with their physicians when facing treatment decisions and symptom management; however, little is known about whether low-income men are confident in these interactions.

Methods

We used validated instruments to measure self-efficacy in patient-physician interactions, emotional well-being, symptom distress, satisfaction with care, and health-related quality of life among low-income men receiving prostate cancer treatment through a statewide public assistance program. We abstracted clinical variables from medical records. We dichotomized self-efficacy scores empirically on the basis of the sample distribution and conducted univariate and multivariate analyses.

Results

The self-efficacy scores were skewed toward the high scores, with 77% in the high range. Those (23%) with low self-efficacy were more likely to have poor emotional well-being, symptom distress, role limitations—emotional, low social function, and poor urinary, sexual, and bowel outcomes. In multivariate analysis, low-income men were more likely to have low self-efficacy if they were less satisfied with their care, did not have confidence in their provider, or had more symptom distress.

Conclusions

Among low-income patients with prostate cancer, low self-efficacy for interacting with physicians was best predicted by diminished overall satisfaction with care, low confidence in providers, and worse symptom distress. Men with low self-efficacy fared worse over a range of psychosocial outcomes and both general and disease-specific health-related quality of life.