Objective: We evaluated pathways linking physicians' decision-making style with cancer survivors' health-related quality of life (HRQOL).
Methods: We analyzed survey data from 623 survivors diagnosed with leukemia, colorectal, or bladder cancer in Northern California, 2-5 years prior to the study. Of these, 395 reported making a medical decision in the past 12 months and were asked about their physician's decision-making style. We evaluated the association of physician style with proximal communication outcomes (trust and participation self-efficacy), intermediate cognitive outcomes (perceived control and uncertainty), and distal health outcomes (physical and mental HRQOL).
Results: Overall, 54% of survivors reported a sub-optimal decision-making style for their physician. With the exception of physical health, physician style was associated with all proximal, intermediate, and distal outcomes (p< or =0.01). We identified two significant pathways by which a participatory physician style may be associated with survivors' mental health: (1) by increasing survivors' participation self-efficacy and thereby enhancing their perceptions of personal control (p<0.01); (2) by enhancing survivors' level of trust and thereby reducing their perceptions of uncertainty (p<0.05).
Conclusion: A participatory physician style may improve survivors' mental health by a complex two-step mechanism of improving survivors' proximal communication and intermediate cognitive outcomes.
Practice implications: Physicians who adopt a participatory decision-making style are likely to facilitate patient empowerment and enhance patients' HRQOL.