Patients' perceived support from physicians and the role of hospital characteristics.

OBJECTIVE Through patient-physician communication, physicians can support breast cancer patients in coping with the diagnosis and treatment of their cancer. Research on the influence of hospital characteristics on patient-reported outcomes suggests that patient-physician communication may be shaped by the hospital environment. The aim of this study is to investigate the relationship between hospital characteristics and breast cancer patients' perceptions of the support provided by physicians. DESIGN Data from two cross-sectional surveys conducted in 2007 were combined and hierarchical logistic regression models were calculated. SETTING Newly diagnosed breast cancer patients treated in breast center hospitals in North Rhine-Westphalia and at least one key person from these hospitals were surveyed. PARTICIPANTS Data from 3285 newly diagnosed breast cancer patients and 172 key persons from 87 breast center hospitals were used. MAIN OUTCOME MEASURE The patients' perceptions of support from physicians were measured with three items from the Cologne Patient Questionnaire. Physician support was studied in relation to patient characteristics as well as hospital structure and processes. RESULTS The multilevel model showed that breast cancer patients perceived themselves as receiving less support from the physician when there were problems within the hospitals' organization of care, independent of patient characteristics. CONCLUSION This study provides preliminary evidence that the quality of patient-physician communication depends not only on the patient or physician but also on hospital organization. Further studies should be conducted to determine the extent to which interventions for improving quality at the hospital level can modify physician communication performance.