Breast Cancer Research and Treatment

, Volume 85, Issue 3, pp 201–209 | Cite as

Determinants of participation in treatment decision-making by older breast cancer patients

  • Rose C. Maly
  • Yoshiko Umezawa
  • Barbara Leake
  • Rebecca A. Silliman


Purpose. To identify the impact of patient age and patient-physician communication on older breast cancer patients' participation in treatment decision-making.

Methods. We conducted a cross-sectional survey of breast cancer patients aged 55 years or older (n= 222) in Los Angeles County. Patients received a breast cancer diagnosis between 1998 and 2000, and were interviewed on average 7.1 months (SD = 2.9) from diagnosis. All patient-physician communication variables were measured by patient self-report. Patient participation in treatment decision-making was defined by (1) questioning the surgeon about treatment, and (2) perception of self as the final decision-maker.

Results. In multiple logistic regression analyses, surgeons' specific solicitation of patients' input about treatment preferences had positive relationships with both dimensions of patient participation in decision-making, that is, questioning the surgeon (adjusted odds ratio [OR] = 2.09, 95% confidence interval [CI] = 1.05–4.16) and perceiving oneself to be the final decision-maker (OR = 2.38, CI = 1.08–5.28), controlling for patients' sociodemographic and case-mix characteristics and social support. Greater emotional support from surgeons was negatively associated with patient perception of being the final decision-maker. Physicians' information-giving and patient age were not associated with the participation measures. However, greater patient-perceived self-efficacy in patient—physician interactions was related to participation.

Conclusion. In breast cancer patients aged 55 years and older, surgeons' solicitation of patients' treatment preferences was a powerful independent predictor of patient participation in treatment decision-making, as was patient's self-efficacy in interacting with physicians. Increasing both physicians' and patients' partnership-building skills might enhance the quality of treatment decision-making and treatment outcomes in this burgeoning patient population.

breast neoplasms medical decision-making older patients patient-centered care patient participation patient-physician interaction physician communication physician-patient relations treatment decision-making 


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Copyright information

© Kluwer Academic Publishers 2004

Authors and Affiliations

  • Rose C. Maly
    • 1
  • Yoshiko Umezawa
    • 2
  • Barbara Leake
    • 1
    • 3
  • Rebecca A. Silliman
    • 4
    • 5
  1. 1.Department of Family MedicineDavid Geffen School of Medicine at UCLALos AngelesUSA
  2. 2.Department of Community Health SciencesUCLA School of Public HealthLos AngelesUSA
  3. 3.UCLA School of NursingLos AngelesUSA
  4. 4.Geriatrics Section, Department of MedicineBoston University School of MedicineBostonUSA
  5. 5.Department of EpidemiologyBoston University School of Public HealthBostonUSA

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