Health literacy and patient participation in multidisciplinary tumor conferences in breast cancer care: a multilevel modeling approach

Abstract

Background Decisions made in multidisciplinary tumor conferences (MTC) that consider patient preferences result in better patient outcomes. Furthermore, it has been shown that in some breast cancer centers in Germany, patients participate in MTCs and that participation is associated with sociodemographic and breast cancer center-related factors. Health literacy (HL) has been shown to be predictive for individual health behavior and is an important prerequisite for patient participation in healthcare. However, so far nothing is known about the association between HL and MTC patient participation. To close this gap in research, we analyzed which patient characteristics affect participation in MTCs and whether participation varies between breast cancer centers. Methods In a prospective, multicenter cohort study, newly diagnosed breast cancer patients were surveyed directly after surgery (T1) as well as 10 weeks (T2) and 40 weeks (T3) after surgery. After descriptive analysis, t-tests were conducted, correlations for independent variables were run, and logistic multilevel regression analysis was applied to estimate the association between patient participation in MTCs at T1 and HL (HLS-EU-Q16 [1]), sociodemographic and disease-related characteristics ( n = 863 patients) and the variation between breast cancer centers ( n = 43 centers). Results Descriptive results show that 6.8% of breast cancer patients took part in a MTC. The logistic multilevel regression model revealed that patients with an inadequately HL are less likely to participate in MTCs (OR = 0.31, 95%-CI = 0.1–0.9, Pseudo-R 2 = 0.06), and participation is dependent on the breast cancer center (ICC = 0.161). Conclusions These findings are the first to show significant differences in HL and patient participation in MTCs in a large sample of breast cancer patients. In future research on patient participation in MTCs and HL, questions concerning the organization, communication and decision-making in MTCs with and without patient participation have to be addressed, and patient and provider perspectives must be equally considered. Trial registration Database Health Services Research, VfD_PIAT_12_001630 , registered prospectively on 01.03.2012.

Patient participation in multidisciplinary tumor conferences: Providers' perceptions of patients' need satisfaction and emotional experiences

“…According to the accreditation criteria of the Medical Council Westphalia‐Lippe, Germany, patients should be allowed to participate in an MTC during the discussion of their own case if they desire. However, only about 5%‐7% of breast cancer patients in Germany actually make use of this offer 25,29,34 . At the moment, little is known about patient participation in MTCs and its effect on patients' needs and emotions.…”

“…However, only about 5%-7% of breast cancer patients in Germany actually make use of this offer. 25,29,34 At the moment, little is known about patient participation in MTCs and its effect on patients' needs and emotions. Own prior research focused on the patient perspective concerning patient participation in an MTC and provided first indications of a mixed picture of positive and negative cognitive and emotional experiences of breast cancer patients.…”

<p>Patient Participation in Multidisciplinary Tumor Conferences from the Providers’ Perspective: Is It Feasible in Routine Cancer Care?</p>

“…Furthermore, our results expand the findings from previous international research concerning the reasons for differences in MTCpp between cancer centers. Previous German studies have shown significant differences in the frequency of MTCpp between breast cancer centers 31,33 but could not explain them. We were able to explain potential reasons for these differences by studying the providers' experienced external factors, attitudes and goals concerning the feasibility of MTCpp.…”

“…Previous studies have shown that in Germany, participation is a rare but constant reality in healthcare, with 5–7% of breast cancer patients participating in MTCs, regardless of the certification program. 31–33 The results of these studies also suggest that MTCpp varies by patient characteristics and between the breast cancer centers themselves. 31 , 33 So far, no explanations for the variation between organizations as well as the feasibility of MTCpp from the providers’ perspective exist.…”

“… 31–33 The results of these studies also suggest that MTCpp varies by patient characteristics and between the breast cancer centers themselves. 31 , 33 So far, no explanations for the variation between organizations as well as the feasibility of MTCpp from the providers’ perspective exist.…”