Table 1.
Cohort characteristics and unadjusted associations with patient-reported quality and ratings of physician communication
| No. of patients (%) | No. of decisions for group rating treatment quality† (%) | % reporting excellent treatment quality | P* | No. of decisions for group rating physician communication (%) | % reporting top rating | P* | |
|---|---|---|---|---|---|---|---|
| All patients | N=5315 | N=8191 (5170 patients) | 67.8% | N=4825 (4825 patients) | 55.8% | ||
| Preferred role | |||||||
| Patient-controlled | 1921 (36) | 2910 (36) | 67.0% | 0.13 | 1739 (36) | 55.6% | <0.001 |
| Shared | 3080 (58) | 4790 (59) | 68.6% | 2799 (58) | 57.3% | ||
| Physician-controlled | 314 (6) | 491 (6) | 64.0% | 287 (6) | 42.5% | ||
| Actual role | |||||||
| Patient-controlled | --- | 3262 (40) | 68.1% | <0.001 | 1914 (40) | 57.3% | <0.001 |
| Shared control | --- | 3855 (47) | 70.0% | 2264 (47) | 59.0% | ||
| Physician-controlled | --- | 1074 (13) | 58.5% | 647 (13) | 40.5% | ||
| Decision type | |||||||
| Surgery | --- | 3920 (48) | 67.9% | <0.001 | 3222 (67) | 58.4% | <0.001 |
| Chemotherapy | --- | 2991 (37) | 66.1% | 1603 (33) | 50.5% | ||
| Radiation | --- | 1280 (16) | 71.3% | --- | N/A‡ | ||
| Received treatment corresponding to decision† | |||||||
| No | --- | 0 (0) | N/A | N/A | 309 (6) | 53.1% | 0.32 |
| Yes | --- | 8191 (100) | 67.8% | 4516 (94) | 56.0% | ||
| Not ascertained | --- | 0 (0) | N/A | 0 (0) | N/A | ||
| Cancer type | |||||||
| Colorectal | 2958 (56) | 4767 (58) | 67.8% | 0.15 | 2754 (57) | 57.4% | 0.04 |
| Non-small cell lung | 2110 (40) | 3027 (37) | 67.0% | 1858 (39) | 53.8% | ||
| Small cell lung | 247 (5) | 397 (5) | 72.5% | 213 (4) | 53.1% | ||
| Stage at diagnosis | |||||||
| I | 1428 (27) | 1685 (21) | 70.2% | 0.002 | 1377 (29) | 60.1% | <0.001 |
| II | 1043 (20) | 1614 (20) | 68.1% | 1009 (21) | 57.8% | ||
| III | 1535 (29) | 2872 (35) | 68.7% | 1453 (30) | 53.1% | ||
| IV | 1058 (20) | 1653 (20) | 65.2% | 986 (20) | 51.8% | ||
| Unknown | 251 (5) | 367 (5) | 59.4% | 0 (0) | N/A | ||
| Age at diagnosis in years | |||||||
| < 54 | 1001 (19) | 1801 (22) | 66.1% | 0.002 | 928 (19) | 53.7% | 0.16 |
| 54–61 | 1111 (21) | 1854 (23) | 67.9% | 1041 (22) | 53.7% | ||
| 62–68 | 1098 (21) | 1745 (21) | 71.2% | 994 (21) | 58.1% | ||
| 69–75 | 1076 (20) | 1512 (18) | 69.0% | 964 (20) | 56.4% | ||
| >75 | 1029 (19) | 1279 (16) | 63.6% | 898 (19) | 57.4% | ||
| Sex | |||||||
| Male | 2835 (53) | 4443 (54) | 69.2% | 0.008 | 2592 (54) | 54.9% | 0.19 |
| Female | 2480 (47) | 3748 (46) | 66.0% | 2233 (46) | 56.8% | ||
| Race | |||||||
| White | 3704 (70) | 5633 (69) | 71.1% | <0.001 | 3375 (70) | 55.9% | <0.001 |
| African-American | 713 (13) | 1135 (14) | 63.0% | 627 (13) | 64.8% | ||
| Other | 898 (17) | 1423 (17) | 58.2% | 823 (17) | 48.5% | ||
| Marital status | |||||||
| Married/partnered | 3298 (62) | 5179 (63) | 69.5% | <0.001 | 3029 (63) | 56.5% | 0.24 |
| Unmarried | 2014 (38) | 3012 (37) | 64.7% | 1796 (37) | 54.7% | ||
| Not ascertained | 3 (0) | 0 (0) | 0 (0) | ||||
| Education attained | |||||||
| Less than high school | 887 (17) | 1345 (16) | 62.2% | <0.001 | 786 (16) | 57.1% | 0.045 |
| High school graduate | 3101 (58) | 4788 (58) | 69.1% | 2805 (58) | 56.8% | ||
| College graduate | 1320 (25) | 2049 (25) | 68.4% | 1228 (25) | 52.8% | ||
| Missing data | 7 (0) | 9 (0) | 6 (0.1) | ||||
| Region | |||||||
| Northeast/Midwest | 714 (13) | 1090 (13) | 68.4% | <0.001 | 572 (12) | 59.8% | <0.001 |
| South | 1778 (33) | 2861 (35) | 70.9% | 1636 (34) | 62.0% | ||
| West | 2823 (53) | 4240 (52) | 65.5% | 2617 (54) | 51.1% | ||
| Income in last year | |||||||
| < $20,000 | 1415 (27) | 2122 (26) | 63.9% | <0.001 | 1266 (26) | 53.6% | 0.12 |
| $20,000–$40,000 | 1409 (27) | 2156 (26) | 68.1% | 1286 (27) | 58.3% | ||
| $40,000–$60,000 | 824 (16) | 1302 (16) | 70.4% | 760 (16) | 55.1% | ||
| > $60,000 | 1211 (23) | 1960 (24) | 72.9% | 1132 (23) | 56.2% | ||
| Unknown | 456 (9) | 651 (8) | 381 (8) | 54.9% | |||
| Integrated health system | |||||||
| No | 3492 (66) | 5419 (66) | 68.0% | 0.55 | 3197 (66) | 55.8% | 0.97 |
| Yes | 1823 (34) | 2772 (34) | 67.2% | 1628 (34) | 55.8% | ||
| Number of self-reported comorbid conditions | |||||||
| 0 | 2392 (45) | 3836 (47) | 67.5% | 0.17 | 2193 (45) | 57.8% | 0.08 |
| 1 | 1781 (34) | 2684 (33) | 67.1% | 1606 (33) | 54.7% | ||
| 2 | 760 (14) | 1138 (14) | 67.8% | 686 (14) | 53.8% | ||
| 3+ | 380 (7) | 533 (7) | 72.6% | 340 (7) | 52.7% | ||
| Not ascertained | 2 (0) | 0 (0) | 0 (0) | ||||
| Pre-diagnosis health status (quartile) | |||||||
| 1 | 1304 (25) | 2046 (25) | 68.0% | <0.001 | 1161 (24) | 52.8% | <0.001 |
| 2 | 1341 (25) | 2060 (25) | 63.0% | 1222 (25) | 51.3% | ||
| 3 | 1177 (22) | 1841 (23) | 67.7% | 1075 (22) | 55.7% | ||
| 4 | 1386 (26) | 2100 (26) | 72.4% | 1274 (26) | 63.1% | ||
| Not ascertained | 107 (2) | 144 (2) | 93 (2) | ||||
| CES-D short form | |||||||
| <6 | 4266 (80) | 6474 (79) | 69.8% | <0.001 | 3881 (80) | 58.6% | <0.001 |
| ≥6 | 813 (15) | 1358 (17) | 60.3% | 738 (15) | 43.4% | ||
| Not ascertained | 236 (4) | 359 (4) | 206 (4) |
*
P for test of combined significance of the levels of each independent variable for prediction of the outcome, using bivariable logistic regression analysis. For the perceived quality outcome, we used a robust standard error estimate to account for repeated measures among individual patients.
†
Patients only reported quality of care corresponding to a treatment decision if they received the treatment under consideration for that decision.
‡
Ratings of physician communication were analyzed when the decision role for a treatment corresponded to the most common type of treatment decision for patients with the same stage and cancer type. There were no clinical subgroups for whom the most common decision type was radiation therapy.