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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
Article

Abstract

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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References

  1. 1.
    Landis SH, Murray T, Bolden S, Wingo PA: Cancer statistics, 1998. CA Cancer J Clin 48: 6–29, 1998Google Scholar
  2. 2.
    Yancik R, Ries LA: Cancer in older persons. Magnitude of the problem-how do we apply what we know? Cancer 74: 1995–2003, 1994Google Scholar
  3. 3.
    Institute of Medicine (U.S.). Committee on the National Quality Report on Health Care Delivery. In: Hurtado MP, Swift EK, Corrigan JM (eds) Envisioning the National Health Care Quality Report. National Academy Press, Washington, DC, 2001Google Scholar
  4. 4.
    Nayfield SG, Bongiovanni GC, Alciati MH, Fischer RA, Bergner L: Statutory requirements for disclosure of breast cancer treatment alternatives. J Natl Cancer Inst 86: 1202–1208, 1994Google Scholar
  5. 5.
    Siminoff LA, Zhang A, Saunders Sturm CM, Colabianchi N: Referral of breast cancer patients to medical oncologists after initial surgical management. Med Care 38: 696–704, 2000Google Scholar
  6. 6.
    Andersen MR, Urban N: Involvement in decision-making and breast cancer survivor quality of life. Ann Behav Med 21: 201–209, 1999Google Scholar
  7. 7.
    Street RL Jr, Voigt B: Patient participation in deciding breast cancer treatment and subsequent quality of life. Med Decis Making 17: 298–306, 1997Google Scholar
  8. 8.
    Moyer A, Salovey P: Patient participation in treatment decision making and the psychological consequences of breast cancer surgery. Womens Health 4: 103–116, 1998Google Scholar
  9. 9.
    Sandison AJ, Gold DM, Wright P, Jones PA: Breast conservation or mastectomy: treatment choice of women aged 70 years and older. Br J Surg 83: 994–996, 1996Google Scholar
  10. 10.
    Degner LF, Kristjanson LJ, Bowman D, Sloan JA, Carriere KC, O'Neil J, Bilodeau B, Watson P, Mueller B: Information needs and decisional preferences in women with breast cancer. JAMA 277: 1485–1492, 1997Google Scholar
  11. 11.
    Petrisek AC, Laliberte LL, Allen SM, Mor V: The treatment decision-making process: age differences in a sample of women recently diagnosed with nonrecurrent, early-stage breast cancer. Gerontologist 37: 598–608, 1997Google Scholar
  12. 12.
    Wallberg B, Michelson H, Nystedt M, Bolund C, Degner LF, Wilking N: Information needs and preferences for participation in treatment decisions among Swedish breast cancer patients. Acta Oncol 39: 467–476, 2000Google Scholar
  13. 13.
    Street RL Jr, Voigt B, Geyer C Jr, Manning T, Swanson GP: Increasing patient involvement in choosing treatment for early breast cancer. Cancer 76: 2275–2285, 1995Google Scholar
  14. 14.
    Beisecker AE: Aging and the desire for information and input in medical decisions: patient consumerism in medical encounters. Gerontologist 28: 330–335, 1988Google Scholar
  15. 15.
    Charles C, Gafni A, Whelan T: Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med 44: 681–692, 1997Google Scholar
  16. 16.
    Tennstedt SL: Empowering older patients to communicate more effectively in the medical encounter. Clin Geriatr Med 16: 61–70, 2000Google Scholar
  17. 17.
    Williams MV, Davis T, Parker RM, Weiss BD: The role of health literacy in patient-physician communication. Fam Med 34: 383–389, 2002Google Scholar
  18. 18.
    Adelman RD, Greene MG, Ory MG: Communication between older patients and their physicians. Clin Geriatr Med 16: 1–24, 2000Google Scholar
  19. 19.
    Butler RN: Age-ism: another form of bigotry. Gerontologist 9: 243–246, 1969Google Scholar
  20. 20.
    Krupat E, Irish JT, Kasten LE, Freund KM, Burns RB, Moskowitz MA, McKinlay JB: Patient assertiveness and physician decision-making among older breast cancer patients. Soc Sci Med 49: 449–457, 1999Google Scholar
  21. 21.
    Street RL Jr: Information-giving in medical consultations: the influence of patients' communicative styles and personal characteristics. Soc Sci Med 32: 541–548, 1991Google Scholar
  22. 22.
    Street RL Jr, Krupat E, Bell RA, Kravitz RL, Haidet P: Beliefs about control in the physician-patient relationship: effect on communication in medical encounters. J Gen Intern Med 18: 609–616, 2003Google Scholar
  23. 23.
    Kaplan SH, Gandek B, Greenfield S, Rogers W, Ware JE: Patient and visit characteristics related to physicians' participatory decision-making style. Results from the Medical Outcomes Study. Med Care 33: 1176–1187, 1995Google Scholar
  24. 24.
    Maly RC, Leake B, Silliman RA: Health care disparities in older patients with breast carcinoma: informational support from physicians. Cancer 97: 1517–1527, 2003Google Scholar
  25. 25.
    Feher S, Maly RC: Coping with breast cancer in later life: the role of religious faith. Psychooncology 8: 408–416, 1999Google Scholar
  26. 26.
    Cronbach LJ: Coefficient alpha and the internal structure of tests. Psychometrika 16: 297–334, 1951Google Scholar
  27. 27.
    Feinstein AR: Clinimetrics. Yale University Press, New Haven, 1987Google Scholar
  28. 28.
    Smitt MC, Heltzel M: Women's use of resources in decision-making for early-stage breast cancer: results of a community-based survey. Ann Surg Oncol 4: 564–569, 1997Google Scholar
  29. 29.
    Maly RC, Frank JC, Marshall GN, DiMatteo MR, Reuben DB: Perceived efficacy in patient-physician interactions (PEPPI): validation of an instrument in older persons. J Am Geriatr Soc 46: 889–894, 1998Google Scholar
  30. 30.
    Ende J, Kazis L, Ash A, Moskowitz MA: Measuring patients' desire for autonomy: decision making and information-seeking preferences among medical patients. J Gen Intern Med 4: 23–30, 1989Google Scholar
  31. 31.
    Haug MR, Lavin B: Practitioner or patient-who's in charge? J Health Soc Behav 22: 212–229, 1981Google Scholar
  32. 32.
    Thompson SC, Pitts JS, Schwankovsky L: Preferences for involvement in medical decision-making: situational and demographic influences. Patient Educ Couns 22: 133–140, 1993Google Scholar
  33. 33.
    Blanchard CG, Labrecque MS, Ruckdeschel JC, Blanchard EB: Information and decision-making preferences of hospitalized adult cancer patients. Soc Sci Med 27: 1139–1145, 1988Google Scholar
  34. 34.
    Deber RB, Kraetschmer N, Irvine J: What role do patients wish to play in treatment decision making? Arch Intern Med 156: 1414–1420, 1996Google Scholar
  35. 35.
    Degner LF, Sloan JA: Decision making during serious illness: what role do patients really want to play? J Clin Epidemiol 45: 941–950, 1992Google Scholar
  36. 36.
    Katz JN, Chang LC, Sangha O, Fossel AH, Bates DW: Can comorbidity be measured by questionnaire rather than medical record review? Med Care 34: 73–84, 1996Google Scholar
  37. 37.
    Lubben JE: Assessing social networks among elderly populations. Fam Community Health 11: 42–52, 1988Google Scholar
  38. 38.
    Lupton D: Consumerism, reflexivity and the medical encounter. Soc Sci Med 45: 373–381, 1997Google Scholar
  39. 39.
    Lobb EA, Butow PN, Kenny DT, Tattersall MH: Communicating prognosis in early breast cancer: do women understand the language used? Med J Aust 171: 290–294, 1999Google Scholar
  40. 40.
    Oliver MN, Goodwin MA, Gotler RS, Gregory PM, Stange KC: Time use in clinical encounters: are African-American patients treated differently? J Natl Med Assoc 93: 380–385, 2001Google Scholar
  41. 41.
    Doescher MP, Saver BG, Franks P, Fiscella K: Racial and ethnic disparities in perceptions of physician style and trust. Arch Fam Med 9: 1156–1163, 2000Google Scholar
  42. 42.
    Cooper-Patrick L, Gallo JJ, Gonzales JJ, Vu HT, Powe NR, Nelson C, Ford DE: Race, gender, and partnership in the patient-physician relationship. JAMA 282: 583–589, 1999Google Scholar
  43. 43.
    Diehr P, Yergan J, Chu J, Feigl P, Glaefke G, Moe R, Bergner M, Rodenbaugh J: Treatment modality and quality differences for black and white breast-cancer patients treated in community hospitals. Med Care 27: 942–958, 1989Google Scholar
  44. 44.
    McWhorter WP, Mayer WJ: Black/white differences in type of initial breast cancer treatment and implications for survival. Am J Public Health 77: 1515–1517, 1987Google Scholar
  45. 45.
    Matthews AK, Sellergren SA, Manfredi C, Williams M: Factors influencing medical information seeking among African American cancer patients. J Health Commun 7: 205–219, 2002Google Scholar
  46. 46.
    Brown R, Kulik J: Flashbulb memories. In: Neisser U (ed) Memory Observed: Remembering in Natural Contexts. Freeman and Co, San Francisco, CA, 1982, pp 23-40Google Scholar
  47. 47.
    Andersen R: Methodology and social policy issues. In: Andersen R, Kasper J, Frankel MR, Associates: Total Survey Error: Applications to Improve Health Surveys. Jossey Bass, San Francisco, CA, 1979, p 131Google Scholar
  48. 48.
    Legler J, Potosky AL, Gilliland FD, Eley JW, Stanford JL: Validation study of retrospective recall of disease-targeted function: results from the prostate cancer outcomes study. Med Care 38: 847–857, 2000Google Scholar
  49. 49.
    Makoul G, Arntson P, Schofield T: Health promotion in primary care: physician patient communication and decision making about prescription medications. Soc Sci Med 41: 1241–1254, 1995Google Scholar
  50. 50.
    Stewart M, Brown JB, Donner A, McWhinney IR, Oates J, Weston WW, Jordan J: The impact of patient-centered care on outcomes. J Fam Pract 49: 796–804, 2000Google Scholar
  51. 51.
    Liang W, Burnett CB, Rowland JH, Meropol NJ, Eggert L, Hwang YT, Silliman RA, Weeks JC, Mandelblatt JS: Communication between physicians and older women with localized breast cancer: implications for treatment and patient satisfaction. J Clin Oncol 20: 1008–1016, 2002Google Scholar

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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