Breast Cancer Treatment Decision-Making: Are We Asking Too Much of Patients?

Abstract

OBJECTIVE: Physicians are mandated to offer treatment choices to patients, yet not all patients may want the responsibility that entails. We evaluated predisposing factors for, and long-term consequences of, too much and not enough perceived decision-making responsibility among breast cancer patients. DESIGN: Longitudinal assessment, with measurements collected just after surgical treatment (baseline) and 6-month follow-up. PARTICIPANTS: Women with early-stage breast cancer treated surgically at eight NYC hospitals, recruited for a randomized controlled trial of patient assistance to improve receipt of adjuvant treatment. MEASUREMENTS: Using logistic regression, we explored multivariable-adjusted associations between perceived treatment decision-making responsibility and a) baseline knowledge of treatment benefit and b) 6-month decision regret. RESULTS: Of 368 women aged 28-89 years, 72 % reported a "reasonable amount", 21 % "too much", and 7 % "not enough" responsibility for treatment decisionmaking at baseline. Health literacy problems were most common among those with "not enough" (68 %) and "too much" responsibility (62 %). Only 29 % of women had knowledge of treatment benefits; 40 % experienced 6-month decision regret. In multivariable analysis, women reporting "too much" vs. Findings were similar for women reporting "not enough" responsibility, though not statistically significant. CONCLUSION: Too much perceived responsibility for breast cancer treatment decisions was associated with poor baseline treatment knowledge and 6-month decision regret. Health literacy problems were common, suggesting that health care professionals find alternative ways to communicate with low health literacy patients, enabling them to assume the desired amount of decision-making responsibility, thereby reducing decision regret.

Association of Breast Cancer Knowledge With Receipt of Guideline-Recommended Breast Cancer Treatment

“…20 The lack of association for grade and treatment was also not surprising; providers may not emphasize grade during treatment discussions as much as they may highlight subtype and stage. Although our observations are provocative and consistent with other work describing associations for understanding general treatment rationales and benefits of therapy with receipt of care, 5,6,8,28,29 broader interpretation of our results is limited by a lack of detailed information on treatment discussions, information on trastuzumab, patient preferences, and if/how information was conveyed to patients. In addition to the potential importance of individualized tumor information, others have suggested that the ways recurrence and survival risks are presented may also impact receipt of chemotherapy.…”

Primary Breast Cancer Decision-making Among Chinese American Women

“…Regret may also relate to the individual's sense of responsibility in the decision-making process (Zeelenberg, van Dijk, & Manstead, 2000). Livaudais, Franco, Fei, and Bickell (2013) examined factors associated with perceived decision-making responsibility in a sample of 368 women with early-stage breast cancer across eight New York City hospitals. The sample consisted of 52% non-White women with breast cancer, and the perceived level of decisional responsibility differed significantly by race/ethnicity, income, education, health literacy, and trust and communication with the physician.…”

Readiness to engage in treatment decision-making during initial surgical oncology consultation for early stage breast cancer

“…It has been posited that imposing "choice" on patients may be as detrimental as imposing treatment decisions [44] , with many studies indicating that a sizeable minority of women prefer to engage in physician-based treatment decision-making [43,46,47] . Further, individual role preferences in treatment decision-making are dynamic and may change between treatment decisions across survivorship [48] .…”