Patient assertiveness and physician decision-making among older breast cancer patients
Abstract
The objective of this study was to determine whether assertive patient behavior influences physician decision-making in the treatment of older breast cancer patients. One hundred and twenty-eight physicians saw videotapes depicting women seeking care for breast cancer and then recommended evaluation and treatment plans. Identical scripts were used, but the age, race, socioeconomic status, mobility, general health, and assertive behavior of the patients were experimentally varied along with the physician's specialty and length of practice. No direct effects of assertive patient behavior were seen. However, black, comorbid, and lower SES women were more likely to have full staging of their tumors ordered when they made an assertive request. Treatment recommendations also showed an interaction of assertiveness with patient's age and social class as well as physicians' specialty. The results indicate that a moderately assertive patient request may change provider behavior, although the effects of assertiveness vary most by what type of patient demonstrates this behavior. In particular, assertiveness led to more careful diagnostic testing for patients who came from groups that are "disadvantaged."
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A patient who demonstrates existing knowledge and has an active or assertive manner in dialogue with the HP can influence the HP decision-making by altering the HPs assumptions related to the warmth or competence of the patient.
“In the same way, a patient who demonstrates existing knowledge and has an active or assertive manner in dialogue with the HP can influence the HP decision-making by altering the HPs assumptions related to the warmth or competence of the patient.51”
From Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review (2024) · cites this paper as [51]
Krupat et al explored the effect of patient assertiveness in HP decision-making for older adults with breast cancer and similarly discovered that patients with low SES were more likely to have full staging of their cancer investigated when they made assertive requests.
“Krupat et al 51 explored the effect of patient assertiveness in HP decision-making for older adults with breast cancer and similarly discovered that patients with low SES were more likely to have full staging of their cancer investigated when they made assertive requests.”
From Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review (2024) · cites this paper as [51]
This interaction requires motivation for one or other party.
“This interaction, however, requires motivation for one or other party.51”
From Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review (2024) · cites this paper as [51]
The perceived power differential between the HP and the patient can inhibit shared decision-making because it negatively effects patient trust.
“Castaneda‐Guarderas et al 114 and Krupat et al 51 assert that the perceived power differential between the HP and the patient can inhibit shared decision-making because it negatively effects patient trust.114”
From Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review (2024) · cites this paper as [51]
Patients are less likely to participate in dialogue and shared decision-making if they perceive the HP as judgemental, in this way, HP bias can trigger the patient's bias in a dynamic way, adversely affecting dialogue and patient-centred care.
“Patients are less likely to participate in dialogue and shared decision-making if they perceive the HP as judgemental, in this way, HP bias can trigger the patient’s bias in a dynamic way, adversely affecting dialogue and patient-centred care.51”
From Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review (2024) · cites this paper as [51]
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References 41 · Cited by 101
- Authors
- Krupat, E., Irish, J. T., Kasten, L. E., Freund, K. M., Burns, R. B., Moskowitz, M. A., & McKinlay, J. B.
- Affiliations
- Massachusetts College of Pharmacy and Health Sciences (US)
- New England Research Institutes (US)
- Boston Medical Center (US)
- Beth Israel Deaconess Medical Center (US)
- Corresponding author
- McKinlay, John B
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 1999-08
- Volume
- 49
- Issue
- 4
- Pages
- 449-457
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W2053750602
- Cited by
- 101
- References
- 41
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 3 · 2022: 1 · 2020: 3 · 2019: 3 · 2017: 1 · 2016: 1 · 2014: 2 · 2013: 1 · 2012: 4
- FWCI
- 12.86
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- National Institutes of Health (5r01ag011352-03)
- National Institute on Aging (AG11352)
- Topics
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- physician decision-making, older women, breast cancer, treatment guidelines, tumor staging, socioeconomic status, racial disparities, comorbidities, physician specialty, patient-provider interaction, health disparities
- MeSH terms
- Aged, Aged, 80 and over, Breast Neoplasms, Decision Making, Factor Analysis, Statistical, Female, Humans, Monte Carlo Method, Patient Participation, Physician-Patient Relations, Socioeconomic Factors, Logistic Models
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