SUPPLEMENT Differences in Oncologist Communication Across Age Groups and Contributions to Adjuvant Decision Outcomes Mary M. Step, PhD, à Laura A. Siminoff, PhD, w and Julia H. Rose, PhD, MA à z §k The objective of this study was to assess potential age- related differences in oncologist communication during con- versations about adjuvant therapy decisions and subsequent patient decision outcomes. Communication was observed between a cross-section of female patients aged 40 to 80 with early-stage breast cancer (n 5 180) and their oncologists (n 5 36) in 14 academic and community oncology practices in two states. Sources of data included audio recordings of visits, followed by post-visit patient interviews. Communica- tion during the visit was assessed using the Siminoff Com- munication Content and Affect Program. Patient outcome measures included self-reported satisfaction with decision, decision conflict, and decision regret. Results showed that oncologists were significantly more fluent and more direct with older than middle-aged patients and trended toward expressing their own treatment preferences more with older patients. Satisfaction with treatment decisions was highest for women in their 50s and 60s. Decision conflict was signifi- cantly associated with more discussion of oncologist treat- ment preferences and prognosis. Decision regret was significantly associated with patient age and education. Older adults considering adjuvant therapy may find that oncolo- gists’ communication accommodations to perceived deficien- cies in older adult cognition or communication challenge their decision-making involvement. Oncologists should care- fully assess patient decision-making preferences and be mind- ful of accommodating their speech to age-related stereotypes. J Am Geriatr Soc 57:S279–S282, 2009. Key words: breast cancer; physician–patient communi- cation; decision-making; communication accommodation P atient participation in medical decision-making can vary considerably between patient age groups. For ex- ample, older adults are often passive, spend less time with physicians, and are less likely to have their decision pref- erences assessed. 1–3 These age differences in communica- tion are important to know, because older adults’ treatment preferences may not be in concordance with the clinician’s recommendation, resulting in inappropriate treatment, low decision satisfaction, and poor treatment adherence. 4,5 The purpose of this study was to explore patterns in oncologist communication related to patient age that may contribute to variation in decision-making outcomes. Although health decisions are negotiated between pa- tients, caregivers, and clinicians, the clinician sets the agenda for discussion, manages topics, interprets data, and provides support. Clinicians also project an impression of who they are as individuals and professionals through their communication. These impressions create a sense of rela- tionship that is important to patients and attenuated in the face of serious illness. 6,7 Older patients in particular value the positive affect that accompanies supportive relational communication but risk experiencing patronizing commu- nication. 8 Consequently, it is important to explore the dy- namics of decision-making and affect for older patients. Adjuvant therapy decision-making after breast cancer surgery features communication that entails careful assess- ment of the patient’s disease characteristics, care goals, and overall ability to tolerate treatment. Decision-making can be a significant source of stress for older patients, who may change their preferences after experiencing the burden of treatment. This study aimed to assess the contributions of clinician task and relational communication behaviors to cancer patients’ decision outcomes, with an eye toward identifying age-related differences in clinician talk. Older patients were also expected to value positive clinician re- lational communication and for this to positively influence their decision outcomes. Research question (RQ)1: Is there a difference in instrumental or relational communication directed toward middle-aged and older patients with breast cancer? A version of this study was presented at the ‘‘Geriatric Oncology and Primary Care: Promoting Partnerships in Practice and Research Conference,’’ April 3 to 4, 2008, Case Comprehensive Cancer Center of Case Western Reserve University, Cleveland, Ohio. Address correspondence to Mary M. Step, Department of Family Medicine, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106. E-mail: mms8@case.edu DOI: 10.1111/j.1532-5415.2009.02512.x From the à Departments of Family Medicine, w Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, Virginia; and z Geriatrics and Palliative Care, § Bioethics, and k Biostatistics and Epidemiology, School of Medicine, Case Western Reserve University, Cleveland, Ohio. JAGS 57:S279–S282, 2009 r 2009, Copyright the Authors Journal compilation r 2009, The American Geriatrics Society 0002-8614/09/$15.00