Patient and surgeon correlates of shared decision making for surgical breast cancer treatment

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6031-6031
Author(s):  
S. Hawley ◽  
P. Lantz ◽  
B. Salem ◽  
A. Fagerlin ◽  
N. Janz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Surgical Treatment ◽  
Cancer Treatment ◽  
Treatment Decision ◽  
Breast Conserving Surgery ◽  
Breast Cancer Treatment ◽  
Shared Decision ◽  
Treatment Decision Making ◽  
The Right

6031 Background: The choice of surgical breast cancer treatment represents an opportunity for shared decision making (SDM), since both mastectomy and breast conserving surgery are viable options. Yet women vary in their desire for involvement in this decision. Correlates of SDM and/or the level of involvement in breast cancer surgical treatment decision-making are not known. Methods: Breast cancer patients of Detroit and Los Angeles SEER registries were mailed a questionnaire shortly after diagnosis in 2002 (N = 1,800, RR: 77%). Their responses were merged with a surgeon survey (N = 456, RR: 80%) for a dataset of 1,547 patients of 318 surgeons. Surgical treatment decision making was categorized into: 1) surgeon-based; 2) shared; or 3) patient-based. The concordance between a woman’s self-reported actual and desired decisional involvement was categorized as having more, less, or the right amount of involvement. Decision making and concordance were each analyzed as three-level dependent variables using multinomial logistic regression controlling for clustering within surgeons. Independent variables included patient clinical, treatment and demographic factors, surgeon demographic and practice-related factors, and a measure of surgeon-patient communication. Results: 37% of women reported the surgery decision was shared, 25% that it was surgeon-based, and 38% that it was patient-based. Two-thirds experienced the right amount of involvement, while 13% had less and 19% had more. Compared to women who reported a shared decision, those with surgeon-based decision were significantly (p < 0.05) more likely to have male surgeons, and those reporting a patient-based decision were more likely to have received mastectomy vs. breast conserving surgery. Women who were less involved in the surgery decision than they wanted were younger and had less education, while those with more involvement (vs. the right amount) more often had male surgeons. Patient-surgeon communication was associated with decisional involvement. Conclusions: Correlates of SDM and decisional involvement relating to surgical breast cancer treatment differ. Determining patients’ desired role in decision making may as important as achieving a shared decision for evaluating perceived quality of care. No significant financial relationships to disclose.

scholarly journals “Will It Affect Our Chances of Having Children?” and Feeling “Like a Ticking Bomb” —The Fertility Concerns and Fears of Cancer Progression and Recurrence in Cancer Treatment Decision-Making Among Young Women Diagnosed With Gynaecological or Breast Cancer

2021 ◽  
Vol 12 ◽  
Author(s):  
Aleksandra Sobota ◽  
Gozde Ozakinci
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Cancer Treatment ◽  
Cancer Progression ◽  
Cancer Recurrence ◽  
Treatment Decision ◽  
Shared Decision ◽  
Common Sense Model ◽  
Treatment Decision Making ◽  
Decision Making Model

Objective: Cancer treatment decision making process is particularly fraught with challenges for young women because the treatment can affect their reproductive potential. Among many factors affecting the process, fears of cancer progression and recurrence can also be important psychological factors. Our aim is to apply Common-Sense Model and shared decision-making model to explore experiences of treatment decision-making women of reproductive age who were diagnosed with gynaecological or breast cancer and the influence of fertility issues and fears of cancer progression and recurrence.Method: We conducted telephone interviews with 24 women who were diagnosed with gynaecological or breast cancer aged 18–45, who finished active treatment within 5 years prior to study enrolment and had no known evidence of cancer recurrence at the time of participation. They were recruited from three NHS oncology clinics in Scotland and online outlets of cancer charities and support organisations. We analysed the data using Braun and Clarke's thematic analysis method as it allows for both inductive and deductive analyses.Results: We identified five main themes pertaining to treatment-related decision-making experiences and fertility issues and fear of progression and recurrence: Becoming aware of infertility as a potential consequence of cancer treatment; Balancing-prioritising cancer and fertility; Decisions about treatments; Evaluation of treatment decisions; and The consequences of treatments. Sub-themes have also been reported. Different factors such as whether the cancer is breast or gynaecological, physicians' willingness of discussing fertility, influence of others in decision-making, childbearing and relationship status as well as fear of cancer recurrence emerged as important.Conclusion: The importance of physicians directly addressing fertility preservation in the process of treatment decision-making and not treating it as an “add-on” was evident. Satisfaction with treatment decisions depended on both the quality of the process of decision making and its outcome. Fear of recurrence was present in different parts of the adaptation process from illness perceptions to post-treatment evaluation of decisions. Both Common-Sense Model and shared decision-making model were helpful in understanding and explaining young women's experience of treatment decision-making and fertility concerns.

Latina patient perspectives about informed decision making for surgical breast cancer treatment

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6544-6544
Author(s):  
S. Hawley ◽  
N. Janz ◽  
A. Hamilton ◽  
S. J. Katz
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Surgical Treatment ◽  
Cancer Treatment ◽  
Treatment Decision ◽  
Breast Cancer Treatment ◽  
Informed Decision ◽  
Informed Decision Making ◽  
Decisional Satisfaction ◽  
Decisional Regret

6544 Background: Although increasing informed decision making has been identified as a mechanism for reducing disparities in breast cancer treatment outcomes, little is known about these issues from the Latina perspective. Methods: 2,030 women with non- metastatic breast cancer diagnosed from 8/05–5/06 and reported to the Los Angeles County SEER registry were identified and mailed a survey shortly after receipt of surgical treatment. Latina and African American women were over-sampled. Survey data were merged to SEER clinical data. We report results on a 50% respondent sample (N=742) which will be updated based on a final respondent sample of 1,400 patients (projected response rate, 72%). Dependent variables were patient reports of how decisions were made (doctor-based, shared, patient-based); their preferred amount of decisional involvement; and two 5-item scales measuring satisfaction with decision-making and decisional regret. Results: 32% of women were white, 28% African American (AA), 20% Latina-English speaking (L-E), and 20% Latina-Spanish speaking (L- SP). About 28% of women in each ethnic group reported a surgeon-based, 33% a shared, and 38% a patient-based surgical treatment decision. L- SP women reported wanting more involvement in decision making more often than white, AA or L-E women (16% vs. 4%, 5%, 5%, respectively, p<0.001). All minority groups were less likely than white women to have high decisional satisfaction with L-SP women having the lowest satisfaction (w-74%, AA-63%, L-E-56%, L-SP-31%, p<0.001). L-SP women were more likely than white, AA or L-E women to have decisional regret (35% vs. 7%, 15%, 16%, respectively, p<0.001). Multivariate regression showed that Latina ethnicity and low literacy were independently associated with both low decisional satisfaction and high decisional regret (p<0.001). Conclusions: Latina women, especially Spanish speakers, report more dissatisfaction with the breast cancer surgical treatment decision-making process than other racial/ethnic groups. These results highlight the challenges to improving breast cancer treatment informed decision making for Latina women. Future interventions to improve satisfaction with the decision process should be tailored to ethnicity and acculturation. No significant financial relationships to disclose.

Utilization of the 21-gene assay for breast cancer treatment decision-making in Alberta.

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. e12024-e12024
Author(s):  
Gloria Beatriz Roldan Urgoiti ◽  
Kirsten Anna Smerdon ◽  
Hua Yang ◽  
Gilbert Bigras ◽  
Judith Hugh ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Cancer Treatment ◽  
Treatment Decision ◽  
Breast Cancer Treatment ◽  
Treatment Decision Making ◽  
Gene Assay

Primary care provider-reported participation in breast cancer treatment decision making.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 78-78
Author(s):  
Lauren P. Wallner ◽  
Yun Li ◽  
Chandler McLeod ◽  
Archana Radhakrishnan ◽  
Sarah T. Hawley ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Early Stage ◽  
Treatment Decision ◽  
Breast Cancer Treatment ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Treatment Decision Making

78 Background: Surgical treatment decisions for early-stage breast cancer patients are complex and often involve discussions with multiple oncology providers. However, with the increasing adoption of team-based cancer care models, it remains unknown to what extent primary care providers (PCPs) are participating in breast cancer treatment decisions and whether they feel they have enough knowledge to participate in these decisions effectively. Methods: A stratified random sample of PCPs identified by newly diagnosed early-stage breast cancer patients who participated in iCanCare Study (Georgia and Los Angeles SEER registries) were surveyed about their experiences caring for cancer patients (N = 519, 58% current response rate). PCPs were asked how frequently they discussed which surgery a patient should have, how comfortable they were with these discussions, whether they had the necessary knowledge to participate in treatment decision making and their confidence in their ability to help with treatment decision making (5-item likert-type scales). The individual items were then categorized as somewhat/often/always vs. never/rarely for analyses. Results: In this preliminary sample, 62% of PCPs were not comfortable having a discussion about surgery options with a patient newly diagnosed with breast cancer, 41% did not feel that they had the necessary knowledge to participate in treatment decision-making, and 34% were not confident in the ability to help with treatment decision-making. One third (32%) of PCPs reported discussing surgical treatment options with their newly diagnosed breast cancer patients, but 22% of these PCPs also reported that they were not comfortable having these discussions and 16% reported they did not have necessary knowledge to participate in decision-making. Conclusions: A minority of PCPs participate in breast cancer treatment decision-making and there are notable gaps in their self-reported knowledge about decision-making and confidence in their ability to help with these decisions. Efforts to increase PCP knowledge about the specifics of cancer treatments may be warranted, but further research is needed to assess the impact of PCP participation on treatment decision-making outcomes.

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