Exploring and supporting older women’s chemotherapy decision-making in early-stage breast cancer.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 181-181
Author(s):  
Meghan Sri Karuturi ◽  
Ashley Housten ◽  
Sharon H. Giordano ◽  
Diana Hoover ◽  
Robert Joseph Volk
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Health Literacy ◽  
Adjuvant Chemotherapy ◽  
Shared Decision Making ◽  
Early Stage ◽  
Decision Making Process ◽  
Shared Decision ◽  
Single Item ◽  
Neo Adjuvant Chemotherapy

181 Background: Few studies have focused on the therapeutic decision-making process in older adults with cancer. This study sought to address this gap by exploring older adult breast cancer patients’ (pts) perspectives on neo/adjuvant chemotherapy, thereby identifying informational needs as they navigate the decision-making process. Methods: Women ≥65 years diagnosed with early stage (I-III) breast cancer were recruited from an academic center following their decision on whether to receive neo/adjuvant chemotherapy. Pts took part in individual semi-structured interviews to explore their perspectives, knowledge, and values. They also completed surveys assessing sociodemographics, health literacy/numeracy, and shared decision-making (SDM-Q-9). Interviews were audio-recorded and transcribed, and analyzed using the Sort and Sift, Think and Shift qualitative approach. Quantitative data was summarized using descriptive statistics. Results: 26 pts completed interviews (age range 65-92; 81% non-Hispanic White; 81% ≥ college degree; 70% single). 14 pts elected to undergo chemotherapy and 11 declined. Most pts had adequate health literacy (mean = 4.31; SD = 1.1 on Single Item Literacy Scale) and numeracy (mean = 4.4; SD = 1.0 on Single Item Numeracy Scale). Pts scored high on the shared decision-making questionnaires (SDM-Q-9, mean = 5.3, SD = 0.7). Thematic analysis uncovered several commonalities regardless of the decision. Pts sought information regarding their disease/treatment, but in some instances were confused regarding the objective of chemotherapy. They often chose treatment outside of the physician’s recommendation, and referenced the subjective experience of friends/family members with cancer. Self-perception of health and the side-effects of chemotherapy were also key factors. Pts also placed importance on the maintenance of quality of life throughout the treatment trajectory. Conclusions: Decision-making strategies in older patients were shaped by knowledge, values and the anectodal experience of others. These discussions will subsequently shape the creation of a decision support tool for older pts and physicians to better facilitate the shared-decision making process.

The relationship between health literacy and perceived shared decision making in patients with breast cancer

2019 ◽  
Vol 102 (2) ◽  
pp. 360-366 ◽  
Author(s):  
Hsiu-Nien Shen ◽  
Chia-Chen Lin ◽  
Tammy Hoffmann ◽  
Chia-Yin Tsai ◽  
Wen-Hsuan Hou ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Health Literacy ◽  
Shared Decision Making ◽  
Shared Decision ◽  
The Relationship

“It’s important to me”: A qualitative analysis of shared decision-making and patient preferences in early-stage breast cancer patients.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 227-227
Author(s):  
Valerie Lawhon ◽  
Rebecca England ◽  
Audrey S. Wallace ◽  
Courtney Williams ◽  
Stacey A. Ingram ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Patient Preferences ◽  
Early Stage ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Early Stage Breast Cancer ◽  
Shared Decision ◽  
Treatment Decision Making

227 Background: Shared decision-making (SDM) occurs when both patient and provider are involved in the treatment decision-making process. SDM allows patients to understand the pros and cons of different treatments while also helping them select the one that aligns with their care goals when multiple options are available. This qualitative study sought to understand different factors that influence early-stage breast cancer (EBC) patients’ approach in selecting treatment. Methods: This cross-sectional study included women with stage I-III EBC receiving treatment at the University of Alabama at Birmingham from 2017-2018. To understand SDM preferences, patients completed the Control Preferences Scale and a short demographic questionnaire. To understand patient’s values when choosing treatment, semi-structured interviews were conducted to capture patient preferences for making treatment decisions, including surgery, radiation, or systemic treatments. Interviews were audio-recorded, transcribed, and analyzed using NVivo. Two coders analyzed transcripts using a constant comparative method to identify major themes related to decision-making preferences. Results: Amongst the 33 women, the majority of patients (52%) desired shared responsibility in treatment decisions. 52% of patients were age 75+ and 48% of patients were age 65-74, with an average age of 74 (4.2 SD). 21% of patients were African American and 79% were Caucasian. Interviews revealed 19 recurrent treatment decision-making themes, including effectiveness, disease prognosis, physician and others’ opinions, side effects, logistics, personal responsibilites, ability to accomplish daily activities or larger goals, and spirituality. EBC patient preferences varied widely in regards to treatment decision-making. Conclusions: The variety of themes identified in the analysis indicate that there is a large amount of variability to what preferences are most crucial to patients. Providers should consider individual patient needs and desires rather than using a “one size fits all” approach when making treatment decisions. Findings from this study could aid in future SDM implementations.

The Effect of Previsit Education in Breast Cancer Patients: A Study of a Shared-decision-making Tool

2016 ◽  
Vol 82 (3) ◽  
pp. 259-265 ◽  
Author(s):  
Victoria Serpico ◽  
Amy E. Liepert ◽  
Kenneth Boucher ◽  
Diane L. Fouts ◽  
Layla Anderson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Cancer Biology ◽  
Decision Making Process ◽  
Evidence Based ◽  
Shared Decision ◽  
Group 2 ◽  
New Diagnosis ◽  
Group 1

To enhance shared decision-making for patients with breast cancer, we developed an evidence-based educational breast cancer video (BCV) providing an overview of breast cancer biology, prognostic indicators, and surgical treatment options while introducing health care choice. By providing patients access to a BCV with information necessary to make informed surgical decisions before seeing a surgeon, we aimed to increase patient participation in the decision-making process, while decreasing distress. Patients with a new diagnosis of breast cancer were provided a link to the BCV. Group 1 participated in online pre- and postvideo questionnaires, with the BCV embedded in between. The questionnaires evaluated self-reported baseline knowledge of breast cancer and perceived distress related to the diagnosis. Changes in self-reported responses were analyzed using the Wilcoxon matched pairs test. Group 2 received a survey collecting demographics, decision-making information, and perceptions of the BCV at the time of clinic visit before meeting the surgeon. Group 1 included 69 subjects with 62 per cent reporting improved knowledge and 30 per cent reporting reduced distress in regard to their breast cancer diagnosis. Group 2 included 87 subjects; 94 to 98 per cent felt the BCV provided information and stimulated thoughts and questions to assist in breast cancer treatment decision-making. The BCV was positively received by participants and feasible to implement into clinical practice. Evidence-based media tools improve knowledge and reduce distress in patients with a new diagnosis of breast cancer as well as contributing to the shared decision-making process.

scholarly journals Recurrence of endometrial cancer in a hysterectomised patient treated with tamoxifen for breast cancer: a case report

2020 ◽  
Vol 113 (11) ◽  
pp. 454-456 ◽  
Author(s):  
James Woolas ◽  
Megan Davis ◽  
Siavash Rahimi
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Endometrial Cancer ◽  
Case Report ◽  
Medical History ◽  
Shared Decision Making ◽  
Decision Making Process ◽  
Shared Decision ◽  
Past Medical History ◽  
The Past

Tamoxifen exposure is a recognised risk for primary endometrial cancer. This case serves as a reminder to meticulously check the past medical history and inform patients of the risk-benefit of treatment as part of a shared-decision making process.

scholarly journals Implementation and sustainability factors of two early-stage breast cancer conversation aids in diverse practices

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Danielle Schubbe ◽  
Renata W. Yen ◽  
Catherine H. Saunders ◽  
Glyn Elwyn ◽  
Rachel C. Forcino ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Patient Portal ◽  
Shared Decision ◽  
Structured Interviews ◽  
Sustained Use ◽  
The Future

Abstract Background Conversation aids can facilitate shared decision-making and improve patient-centered outcomes. However, few examples exist of sustained use of conversation aids in routine care due to numerous barriers at clinical and organizational levels. We explored factors that will promote the sustained use of two early-stage breast cancer conversation aids. We examined differences in opinions between the two conversation aids and across socioeconomic strata. Methods We nested this study within a randomized controlled trial that demonstrated the effectiveness of two early-stage breast cancer surgery conversation aids, one text-based and one picture-based. These conversation aids facilitated more shared decision-making and improved the decision process, among other outcomes, across four health systems with socioeconomically diverse patient populations. We conducted semi-structured interviews with a purposive sample of patient participants across conversation aid assignment and socioeconomic status (SES) and collected observations and field notes. We interviewed trial surgeons and other stakeholders. Two independent coders conducted framework analysis using the NOrmalization MeAsure Development through Normalization Process Theory. We also conducted an inductive analysis. We conducted additional sub-analyses based on conversation aid assignment and patient SES. Results We conducted 73 semi-structured interviews with 43 patients, 16 surgeons, and 14 stakeholders like nurses, cancer center directors, and electronic health record (EHR) experts. Patients and surgeons felt the conversation aids should be used in breast cancer care in the future and were open to various methods of giving and receiving the conversation aid (EHR, email, patient portal, before consultation). Patients of higher SES were more likely to note the conversation aids influenced their treatment discussion, while patients of lower SES noted more influence on their decision-making. Intervention surgeons reported using the conversation aids did not lengthen their typical consultation time. Most intervention surgeons felt using the conversation aids enhanced their usual care after using it a few times, and most patients felt it appeared part of their normal routine. Conclusions Key factors that will guide the future sustained implementation of the conversation aids include adapting to existing clinical workflows, flexibility of use, patient characteristics, and communication preferences. Trial registration ClinicalTrials.gov Identifier: NCT03136367, registered on May 2, 2017

Providers’ inability to estimate health literacy among African American (AA) patients (pts) with early prostate cancer (PCa).

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 77-77 ◽  
Author(s):  
William Martin-Doyle ◽  
Kerry L. Kilbridge ◽  
Susan Regan ◽  
Christopher Paul Filson ◽  
Quoc-Dien Trinh ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Literacy ◽  
Shared Decision Making ◽  
Adult Literacy ◽  
Early Stage ◽  
Treatment Options ◽  
Healthcare Providers ◽  
Veterans Administration ◽  
Shared Decision ◽  
Perfect Agreement

77 Background: Providers’ estimates of a pt’s health literacy are important for communication and shared decision making among men with early PCa. We explored differences between providers’ estimates of health literacy and measured health literacy among AA pts in a prospective cohort study at Grady Memorial Hospital and the Atlanta Veterans Administration Hospital. Methods: Providers (n=18) estimated the health literacy of 124 newly diagnosed, early-stage, AA PCa pts after discussions with each pt regarding his PCa treatment options, categorized as ≤Grade (Gr) 3; Gr 4-6; Gr 7-8; and High school. At a subsequent visit, prior to choosing his cancer treatment, each pt’s health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), using the same categories. Domains of numeracy, comprehension of common PCa terms, and anatomic knowledge were assessed using published methods. Concordance between estimated and actual health literacy was evaluated via Cohen’s Kappa coefficient (1.00 = perfect agreement). Results: Despite their discussions with the pts, providers consistently overestimated pts’ health literacy. Agreement between provider estimates and pts’ measured values was consistently low (32.0%-37.6%). These rates were approximately what would be expected by chance. Among the 75 patients with the lowest levels of health literacy, agreement was even lower (12.3%-35.6%). In this group 26.7% of provider assessments were off by ≥2 REALM categories. Conclusions: Healthcare providers are surprisingly ineffective at estimating the health literacy of their pts with early stage PCa. This poor accuracy may diminish providers’ ability to communicate successfully with pts and engage in shared decision making, especially among pts with poor health literacy. [Table: see text]

scholarly journals Implementation and sustainability factors of two early-stage breast cancer conversation aids in diverse practices

2020 ◽  
Author(s):  
Danielle Schubbe ◽  
Renata W. Yen ◽  
Catherine H. Saunders ◽  
Glyn Elwyn ◽  
Rachel C. Forcino ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Patient Portal ◽  
Shared Decision ◽  
Structured Interviews ◽  
Sustained Use ◽  
The Future

Abstract Background Conversation aids can facilitate shared decision making and improve patient-centered outcomes. However, few examples exist of sustained use of conversation aids in routine care due to numerous barriers at clinical and organizational levels. We explored factors that will promote the sustained use of two early-stage breast cancer conversation aids. We examined differences in opinions between the two conversation aids and across socioeconomic strata. Methods We nested this study within a randomized controlled trial that demonstrated the effectiveness of two early-stage breast cancer surgery conversation aids, one text-based and one picture-based. These conversation aids improved shared decision making and the decision process, among other outcomes, across four health systems with socioeconomically diverse patient populations. We conducted semi-structured interviews with a purposive sample of patient participants across conversation aid assignment and socioeconomic status (SES), and collected observations and field-notes. We interviewed trial surgeons and other stakeholders. Two independent coders conducted framework analysis using the NOrmalization MeAsure Development through Normalization Process Theory. We also conducted an inductive analysis and additional sub-analyses based on conversation aid assignment and patient SES. Results We conducted 73 semi-structured interviews with 43 patients, 16 surgeons, and 14 stakeholders like nurses, cancer center directors, and electronic health record (EHR) experts. Patients and surgeons felt the conversation aids should be used in breast cancer care in the future and were open to various methods of giving and receiving the conversation aid (EHR, email, patient portal, before consultation). Patients of higher SES were more likely to note the conversation aids influenced their treatment discussion, while patients of lower SES noted more influence on their decision making. Intervention surgeons reported using the conversation aids did not lengthen their typical consultation time. Most intervention surgeons felt using the conversation aids was similar to their usual care after using it a few times, and most patients felt it appeared part of their normal routine. Conclusions Key factors that will guide the future sustained implementation of the conversation aids include adapting to existing clinical workflows, flexibility of use, patient characteristics and communication preferences.Trial registration ClinicalTrials.gov Identifier: NCT03136367, registered on May 2, 2017, https://clinicaltrials.gov/ct2/show/NCT03136367

What Is the Impact of Shared Decision Making on Treatment and Outcomes for Older Women With Breast Cancer?

2006 ◽  
Vol 24 (30) ◽  
pp. 4908-4913 ◽  
Author(s):  
Jeanne Mandelblatt ◽  
Barbara Kreling ◽  
Melissa Figeuriedo ◽  
Shibao Feng
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Older Women ◽  
Shared Decision Making ◽  
Cancer Care ◽  
Early Stage ◽  
Shared Decision ◽  
Process Of Care ◽  
Short Term ◽  
The Impact

Purpose Shared decision making (SDM) has been recommended as a standard of care, especially when there are treatment alternatives or uncertainty in outcomes. However, we know little about use of SDM in cancer care, and even less is known about SDM in older patients. We describe patient and physician determinants of SDM in older women with breast cancer and evaluate whether SDM is associated with treatment patterns or short-term outcomes of care. Patients and Methods Women age 67 or older treated for early stage breast cancer in 29 sites from five geographic regions comprise the study sample (N = 718). Data were obtained from patients by in-person and telephone interviews. Physician data were collected via survey, and medical records were reviewed to ascertain comorbidity and tumor characteristics. Random effects and logistic regression models were used to assess associations between SDM and other factors. Results Women who were age 67 to 74 years (v 75 or older) were accompanied to consultation and who sought information reported the highest SDM, after considering covariates. While SDM was not associated with surgical treatment, greater SDM was associated with higher odds of having adjuvant treatment, controlling for clinical factors. Greater SDM was also associated with improved short-term satisfaction. Conclusion SDM plays an important role in the process of care for older women with breast cancer. Physicians treating this growing population have a simple, but powerful tool for improving outcomes within their grasp—spending time to engage and involve older women in their breast cancer care.

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