This research utilizes retrospective, self-report data collected from a nonprobability sample of women recently diagnosed with nonrecurrent, early-stage breast cancer to better understand how the treatment decision-making process varies with patient age. Three important areas--context, decision-making style, and influencing factors--are examined using bivariate and multivariate analyses. Findings indicate that although patients recalled similar contextual attributes, they reported attitudes, behavior, and considerations that differed by age. Older women were less likely than their younger counterparts to have desired participation in therapy selection, sought out medical information, or considered the possibility of recurrence when making treatment decisions.

Since 1989, the Medicare hospice benefit has been available to terminally ill individuals residing in nursing homes. We first describe the evolution and nature of hospice care for nursing home residents. We then utilize recent On-line Survey and Certification of Automated Records data on a national sample of Medicare/Medicaid certified nursing homes, merged with hospice Provider of Service and Area Resource File information, to examine the distribution of hospice beneficiaries in nursing homes. Bivariate analyses provide descriptive comparisons of homes with 0%, 0.1-4.9%, and 5%+ residents on the hospice benefit. Multinomial logistic regression reveals the influence of organizational, market, and environmental factors on the proportion of beneficiaries in nursing homes. Results indicate that significant numbers of homes have hospice patients and that these institutions may have strong incentives to convert residents to the Medicare hospice benefit.

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AB S T R A C T Communication between physicians and patients is considered to be a core component in the provision and receipt of appropriate medical care. However, previous research indicates that doctor-patient relationships can be problematic, with negative consequences for patients including higher levels of anxiety, distrust of medical providers, dissatisfaction with healthcare and lower quality of life. This research utilizes data collected from a series of focus groups involving 19 women with breast cancer aged 50 and under to examine the nature of problems that may arise in communication between physicians and younger patients concerning the detection, diagnosis and treatment of this life-threatening disease. Conducted according to the general principals of grounded theory generation, this analysis identi ed four central themes: (1) women's realization of medical uncertainty, (2) their rejection of physician paternalism, (3) women's desire for information, and(4) their preference for a greater role in decision making. Qualitative data are presented in the context of social in uences and cohort experiences that help to explain these dif culties. The results suggest that communication problems may be a consequence of incongruity between medical practice and patient expectations. Medical uncertainty regarding breast cancer in pre-menopause can lead to recognition of physician fallibility and rejection of expert authority. Socialized in an era of increasing patient autonomy and medical consumerism, results indicate that this cohort of women tends to prefer an active partner to passive patient role in the diagnostic and treatment decisionmaking process.