CONFIDENCE IN THE ABILITY TO COMMUNICATE WITH PHYSICIANS AMONG LOW-INCOME PATIENTS WITH PROSTATE CANCER SALLY L. MALISKI, LORNA KWAN, TRACEY KRUPSKI, ARLENE FINK, JAMES R. ORECKLIN, AND MARK S. LITWIN ABSTRACT Objectives. To describe the confidence of low-income patients with prostate cancer in interacting with physicians. Men with prostate cancer need to communicate easily with their physicians when facing treat- ment decisions and symptom management; however, little is known about whether low-income men are confident in these interactions. Methods. We used validated instruments to measure self-efficacy in patient-physician interactions, emo- tional well-being, symptom distress, satisfaction with care, and health-related quality of life among low- income men receiving prostate cancer treatment through a statewide public assistance program. We abstracted clinical variables from medical records. We dichotomized self-efficacy scores empirically on the basis of the sample distribution and conducted univariate and multivariate analyses. Results. The self-efficacy scores were skewed toward the high scores, with 77% in the high range. Those (23%) with low self-efficacy were more likely to have poor emotional well-being, symptom distress, role limitations—emotional, low social function, and poor urinary, sexual, and bowel outcomes. In multivariate analysis, low-income men were more likely to have low self-efficacy if they were less satisfied with their care, did not have confidence in their provider, or had more symptom distress. Conclusions. Among low-income patients with prostate cancer, low self-efficacy for interacting with physi- cians was best predicted by diminished overall satisfaction with care, low confidence in providers, and worse symptom distress. Men with low self-efficacy fared worse over a range of psychosocial outcomes and both general and disease-specific health-related quality of life. UROLOGY 64: 329–334, 2004. © 2004 Elsevier Inc. F eeling confident in the ability to communicate with physicians to gain knowledge, under- stand options and potential complications, and comfortably voice concerns effectively is particu- larly important for men with early-stage prostate cancer as they face treatment decisions and manage treatment side effects and disease symptoms. The feeling of confidence in one’s ability is captured by the concept of self-efficacy. Specifically, patient self-efficacy in patient-physician interactions 1 is defined as the patient’s confidence in his ability to interact with physicians. Self-efficacy can influ- ence, and be influenced by, information ex- changed, trust, satisfaction with care, and under- standing of instructions and treatments and has been shown to affect patient outcomes and well- being. 2–4 Self-efficacy may be either a predictor of patient perception of an encounter with the physi- cian or an outcome of the encounter. 5 Thus, self- efficacy for patient-physician interactions is criti- cal to consider in understanding communication between patients and physicians. Research has demonstrated that low-income in- dividuals have lower self-esteem, a lower sense of mastery, and lower self-efficacy for obtaining pros- tate cancer screening. 6 –11 These findings suggest This study was supported by the California Department of Health Services Cancer Detection Section. From the Department of Urology and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, David Gef- fen School of Medicine, and Department of Health Services, Uni- versity of California, Los Angeles, School of Public Health, Los Angeles, California Reprint requests: Sally L. Maliski, Ph.D., R.N., Department of Urology, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, David Geffen School of Medicine, Box 956900, Los Angeles, CA 90095-6900 Submitted: December 8, 2003, accepted (with revisions): March 23, 2004 ADULT UROLOGY © 2004 ELSEVIER INC. 0090-4295/04/$30.00 ALL RIGHTS RESERVED doi:10.1016/j.urology.2004.03.042 329