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PURPOSE: The purpose of this secondary investigation was to examine the impact of the type of treatment received and the perceived role in treatment decision making in predicting distress and cancer-specific quality of life in patients newly diagnosed with breast or prostate cancer.METHOD: Participants included 1057 newly diagnosed breast and prostate cancer patients from four Canadian cancer centers who partook in a randomized controlled trial examining the utility of providing patients with an audio-recording of their treatment planning consultation. A MANCOVA was performed to predict distress and cancer-specific quality of life at 12 weeks post-consultation based on control variables (patient age, education, residence, tumor size (breast sample), gleason score (prostate sample), and receipt of an initial treatment consultation recording), predictor variables (treatment type--chemotherapy, hormone therapy, radiation therapy; decisional role--active, collaborative, passive), and interactions between these predictors.RESULTS: Women who received chemotherapy and reported having played a more passive role in treatment decision making had significantly greater distress and lower cancer-specific quality of life at 12-week post-consultation. There were no statistically significant predictors of these outcomes identified for men with prostate cancer.CONCLUSION: Receipt of chemotherapy places women with breast cancer at risk for distress and reduced quality of life, but only for the subset of women who report playing a passive role in treatment decision making. Prospective, longitudinal studies are needed to confirm the present findings and to explicate the antecedents, composition, and consequences of the 'passive' decisional role during the treatment phase of the cancer trajectory.

Objective: The purpose of this investigation was to explicate the content of primary adjuvanttreatment consultations in breast oncology and examine the predictive relationships betweenpatient and oncologist consultation factors and patient satisfaction with communication.Methods: The recorded consultations of 172 newly diagnosed breast cancer patients fromfour Canadian cancer centers were randomly drawn from a larger subset of 481 recordings andexamined by three coders using the Medical Interaction Process System (MIPS); a system thatcategorizes the content and mode of each distinct utterance. The MIPS findings, independentobserver ratings of patient and oncologist affective behavior, and derived consultation ratios ofpatient centeredness, patient directedness, and psychosocial focus, were used to predict patientsatisfaction with communication post-consultation and at 12-weeks post-consultation.Results: Biomedical content categories were predominant in the consultations, accounting for88% of all utterances, followed by administrative (6%) and psychosocial (6%) utterances.Post-consultation satisfaction with communication was significantly higher for older patients,those with smaller primary tumors and those with longer consultations. Smaller tumor, lack ofpatient assertiveness during the treatment consultation and having the consultation with aradiation rather than medical oncologist were significantly predictive of greater satisfaction at12-weeks post-consultation.Conclusions: Adjuvant treatment consultations are characterized by a high degree of informationgivingby the physician, a predominance of biomedical discussion and relatively minimal timeaddressing patients’ psychosocial concerns. Controlled trials are needed to further identify andaddress the contextual features of these consultations that enhance patient satisfaction.