Treatment decision-making in breast cancer: the patient–doctor relationship

A diagnosis of breast cancer, whether the disease is early or advanced, can be devastating. With this in mind, constructive patient–physician relationships are essential to minimizing disease-related stress and anxiety, as patients undergo treatment and learn to cope with their diagnosis. Good communication skills are vital, and achieve measurable benefits, yet doctors receive very little training in communication. Patients may find it difficult to process large amounts of information, may not understand medical terminology, and can become confused or scared during discussions. They may need time to absorb information, and discuss it with friends and family, before treatment decisions are made. Patient awareness of treatment options is greater than ever, largely because of media exposure and the internet. Consequently, patients’ expectations and desire to be involved in treatment choice are increasing, although some patients still prefer to leave decision-making to their doctor. Information about potential side-effects and other treatment burdens is vital, if patients are to make truly informed choices. Knowing in advance what side effects may be encountered, and how to manage them, can also help to improve adherence to treatment, which is necessary for patients to gain the maximum benefit. Side effects that patients find most problematic often differ from those that most concern doctors. Individual patients have different needs and expectations that must be respected, but ensuring that they understand their diagnosis, and the expected benefits and potential risks of treatment, is the key to establishing a good therapeutic relationship and providing the best possible care.