Choice empowers breast cancer patients

U. BUFFALO (US)—Women who are diagnosed with breast cancer consider being able to make their own decision about treatment an encouraging sign of future survival, a new study finds.

Researchers at the University at Buffalo conducted a study of women between the time of breast cancer diagnosis and surgery, offering an in-the-moment snapshot of how women arrived at their decisions. A diagnosis of breast cancer will affect one in every eight women in the United States, according to the American Cancer Society, causing them to have to decide quickly about treatment.

“This is one of the very few studies to be conducted in the pretreatment period when women were actually engaged in the decision-making process, whether they had declared a decision or were still contemplating, says Robin Lally, assistant professor of nursing at the University at Buffalo School of Nursing and adjunct assistant professor at Roswell Park Cancer Institute. “These thoughts were fresh and appointments with physicians still ongoing.”

In the study published in the September issue of Oncology Nursing Forum, women who were diagnosed with early-stage breast cancer were interviewed during the period just after surgical consultation and before surgery. The interviews were then transcribed, coded, and analyzed to identify themes in the participants’ thought processes.

When women were presented with options as to treatment, they saw it as a positive prognostic indicator, Lally says. “Women reported gaining confidence in their decision-making role through the confidence and support they felt from their surgeon and staff.

“The women in the study valued receiving options, even if they had one already in mind, and though they may not have seen themselves as a person who is typically good at making decisions, they drew confidence from the support provided to them by their health care team while making the decision.”

Previous surgical treatment studies have for the most part used a structured response format that limits the nature of the answers by providing predetermined choices (multiple choice or yes/no answers), eliminating the context in which decisions are made and limiting women’s ability to reveal their thoughts behind how and why they make certain choices.

In contrast, the qualitative research approach used by Lally assembles participants who can provide insight and expert knowledge on a particular phenomenon so that it can be better understood in a real-world context.

“This research provides insight into what women newly diagnosed with breast cancer may do, think about, and expect even before they see the surgeon at the clinic for the first time,” Lally explains.

Specifically, Lally’s research showed that women felt that information about breast cancer was important, but that they needed to manage the amount and timing of the information they took in, in order to prevent themselves from becoming overwhelmed.

More was not necessarily better. Some women preferred to use only the verbal information provided by their care team on which to base their decision and put the breast cancer literature away until just days before their surgery.

Age was not a defining factor in how much information women wanted or whether they used what was provided. Women of all ages used information that answered their questions and tended to avoid information that upset them emotionally.

Lally found that many women already had a plan in mind when they entered the surgeon’s office which they then weighed against the surgeon’s input. Their surgical treatment decisions were motivated by the desire to: eliminate future inconvenience and worry about cancer balanced by avoiding mastectomy unless medically required; maintain physical function and appearance; and recover rapidly.

Most women felt that mastectomy should be reserved only for the worst breast cancers. Older women saw advanced age as an advantage—age protected them from worry of recurrence and/or the significant concern over loss of their breast although they still chose lumpectomy.

Women of all ages expressed surprise that their surgeons did not make a definitive recommendation, but that the choice of mastectomy or lumpectomy was ultimately their own. Even women who wanted to make their own decision still desired a recommendation from the surgeon. When making a choice, however, they drew confidence from the surgeons’ support of their decision.

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