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Rivers AS, Sanford K. A special kind of stress: Assessing feelings of decisional distress for breast cancer treatment decisions. PATIENT EDUCATION AND COUNSELING 2021; 104:3038-3044. [PMID: 33941423 DOI: 10.1016/j.pec.2021.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/19/2021] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Women with breast cancer need to make difficult treatment decisions and may experience decisional distress (worry, anxiety, and thought intrusion) associated with these decisions. This study investigated ways that decisional distress was both associated with and distinct from other variables regarding decisional process and life functioning, and it investigated the validity of a decisional distress scale. METHODS A total of 263 women previously or currently diagnosed with breast cancer reported on initial treatment decisions regarding surgery, chemotherapy, or radiation, or decisions involving oral endocrine therapy (either currently or retrospectively). Participants completed online measures of decisional distress, alliance and confusion in patient-practitioner relationships, positive and negative interactions in close relationships, financial and general distress, and decision satisfaction. RESULTS Decisional distress demonstrated a unidimensional factor structure invariant across treatment context groups, a wide range of meaningful variation, significant correlations with all hypothesized variables (especially patient confusion), but also key distinctions from other variables. CONCLUSION Decisional distress is a meaningful construct that can be assessed with precision, and important for understanding medical decision-making processes and patient quality of life. PRACTICE IMPLICATIONS Assessing decisional distress is crucial for evaluating treatment decision outcomes. One key to reducing decisional distress may involve reducing patient confusion.
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Affiliation(s)
| | - Keith Sanford
- Department of Psychology and Neuroscience, Baylor University, Waco, USA
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Aminaie N, Lehto R, Negarandeh R. Iranian Women’s Decision Making: Preferred Roles, Experienced Involvement, and Decisional Conflict When Undergoing Surgery for Early-Stage Breast Cancer. Clin J Oncol Nurs 2019; 23:529-536. [DOI: 10.1188/19.cjon.529-536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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McCrate F, Dicks E, Powell E, Chafe J, Roome R, Simmonds C, Etchegary H. Surgical treatment choices for breast cancer in Newfoundland and Labrador: a retrospective cohort study. Can J Surg 2019; 61:377-384. [PMID: 30265635 DOI: 10.1503/cjs.015217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Mastectomy is often chosen by women for treatment of breast cancer, even when breast-conserving surgery (BCS) is an option. Newfoundland and Labrador has a high mastectomy rate. We documented the number of breast cancers over a given period in the province and their related surgical treatments, and explored the impact of several variables on surgical choice. METHODS A retrospective cohort design linked diagnosis data from the Newfoundland and Labrador tumour registry to surgery data from the Canadian Institute for Health Information Discharge Abstract Database. Data were extracted for all women aged 19 years or more in whom breast cancer was diagnosed in 2009-2014. RESULTS A total of 2346 cases of breast cancer with a linked surgical procedure were included. Most operations (1605 [68.4%]) were mastectomy procedures, with the remainder being BCS. Logistic regression analysis revealed that women were 1.82 times (95% confidence interval [CI] 1.64-2.02) more likely to have mastectomy for each unit of stage increase from 0 to IV and 1.15 times (95% CI 1.11-1.21) more likely for each unit of driving time increase. CONCLUSION Tumour stage and driving time to a radiation facility significantly predicted Newfoundland and Labrador women's surgical treatment choices for breast cancer. Notably, mastectomy was the favoured choice across all age groups, tumour stages and geographical regions of the province. We hope that these results will galvanize efforts to better understand local surgical practices and assist in improving the quality of surgical care of women with breast cancer.
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Affiliation(s)
- Farah McCrate
- From the Cancer Care Program, Eastern Regional Health Authority, St. John's, Nfld. (McCrate, Powell); the Faculty of Medicine, Memorial University, St. John's, Nfld. (Dicks, Etchegary)); the Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Nfld. (Chafe); patient/community representative, St. John's, Nfld. (Roome); and the Health Research Unit, Faculty of Medicine, St. John's, Nfld. (Simmonds)
| | - Elizabeth Dicks
- From the Cancer Care Program, Eastern Regional Health Authority, St. John's, Nfld. (McCrate, Powell); the Faculty of Medicine, Memorial University, St. John's, Nfld. (Dicks, Etchegary)); the Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Nfld. (Chafe); patient/community representative, St. John's, Nfld. (Roome); and the Health Research Unit, Faculty of Medicine, St. John's, Nfld. (Simmonds)
| | - Erin Powell
- From the Cancer Care Program, Eastern Regional Health Authority, St. John's, Nfld. (McCrate, Powell); the Faculty of Medicine, Memorial University, St. John's, Nfld. (Dicks, Etchegary)); the Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Nfld. (Chafe); patient/community representative, St. John's, Nfld. (Roome); and the Health Research Unit, Faculty of Medicine, St. John's, Nfld. (Simmonds)
| | - Joanne Chafe
- From the Cancer Care Program, Eastern Regional Health Authority, St. John's, Nfld. (McCrate, Powell); the Faculty of Medicine, Memorial University, St. John's, Nfld. (Dicks, Etchegary)); the Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Nfld. (Chafe); patient/community representative, St. John's, Nfld. (Roome); and the Health Research Unit, Faculty of Medicine, St. John's, Nfld. (Simmonds)
| | - Rebecca Roome
- From the Cancer Care Program, Eastern Regional Health Authority, St. John's, Nfld. (McCrate, Powell); the Faculty of Medicine, Memorial University, St. John's, Nfld. (Dicks, Etchegary)); the Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Nfld. (Chafe); patient/community representative, St. John's, Nfld. (Roome); and the Health Research Unit, Faculty of Medicine, St. John's, Nfld. (Simmonds)
| | - Charlene Simmonds
- From the Cancer Care Program, Eastern Regional Health Authority, St. John's, Nfld. (McCrate, Powell); the Faculty of Medicine, Memorial University, St. John's, Nfld. (Dicks, Etchegary)); the Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Nfld. (Chafe); patient/community representative, St. John's, Nfld. (Roome); and the Health Research Unit, Faculty of Medicine, St. John's, Nfld. (Simmonds)
| | - Holly Etchegary
- From the Cancer Care Program, Eastern Regional Health Authority, St. John's, Nfld. (McCrate, Powell); the Faculty of Medicine, Memorial University, St. John's, Nfld. (Dicks, Etchegary)); the Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, Nfld. (Chafe); patient/community representative, St. John's, Nfld. (Roome); and the Health Research Unit, Faculty of Medicine, St. John's, Nfld. (Simmonds)
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Dicks E, Roome R, Chafe J, Powell E, McCrate F, Simmonds C, Etchegary H. Factors influencing surgical treatment decisions for breast cancer: a qualitative exploration of surgeon and patient perspectives. ACTA ACUST UNITED AC 2019; 26:e216-e225. [PMID: 31043830 DOI: 10.3747/co.26.4305] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background The rate of mastectomy is much higher in Newfoundland and Labrador than in any other province in Canada, even for women diagnosed at an early stage. In this paper, we present qualitative data from women who have made a decision for surgical treatment and from breast surgeons in an effort to better explicate factors influencing breast cancer (bca) surgical decision-making. Methods The study's descriptive, qualitative design involved holding interviews with breast surgeons and holding focus groups and interviews with women who were offered the choice of breast-conserving surgery (bcs) or mastectomy (mt). Results Participants included 35 women and 13 surgeons. High interest in mt and increasing requests for prophylactic contralateral mt were evident. A host of factors-clinical, demographic, psychosocial, education-related, and cultural-influenced the decisions. A key factor for women was fear of recurrence and a need to "just get rid of it," but the experiences of others also influenced the decisions. Life stage and family considerations also factored prominently into women's decisions. Conclusions Women with early-stage bca more often chose mt and often demanded prophylactic removal of the healthy breast. Findings highlight the importance of ensuring that women at average risk are appropriately counselled about the low likelihood of a subsequent contralateral bca and the lack of survival benefit associated with prophylactic contralateral mt. Findings also revealed other areas of presurgical discussion that might help women think through their personal circumstances and values so as to encourage informed surgical decisions.
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Affiliation(s)
- E Dicks
- Faculty of Medicine, Memorial University, St. John's, NL
| | - R Roome
- Patient partner, Eastern Regional Health Authority, St. John's, NL
| | - J Chafe
- Centre for Nursing Studies, Eastern Regional Health Authority, St. John's, NL
| | - E Powell
- Cancer Care Program, Eastern Regional Health Authority, St. John's, NL
| | - F McCrate
- Cancer Care Program, Eastern Regional Health Authority, St. John's, NL
| | - C Simmonds
- Faculty of Medicine, Memorial University, St. John's, NL
| | - H Etchegary
- Faculty of Medicine, Memorial University, St. John's, NL
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Mulkins AL, McKenzie E, Balneaves LG, Salamonsen A, Verhoef MJ. From the conventional to the alternative: exploring patients' pathways of cancer treatment and care. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2016; 13:51-64. [PMID: 26259233 DOI: 10.1515/jcim-2014-0070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 07/23/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Complementary and alternative medicine (CAM) use is widespread and on the increase among cancer patients. Most research to date has involved a cross-sectional snapshot of CAM use rather than an exploration into the longitudinal, nonlinear treatment trajectories that cancer patients develop. Our aim is to explore and describe different treatment and decision-making pathways that individuals develop after receipt of a diagnosis of either breast, colorectal, or prostate cancer. METHODS The study was part of a larger mixed-methods pilot project to explore the feasibility of conducting a five-year international study to assess cancer patients' treatment pathways, including health care use and the perceived impact of different patterns of use on health outcomes over the course of one year. The results presented in this paper are based on the analysis of personal interviews that were conducted over the course of 12 months with 30 participants. RESULTS Five pathways emerged from the data: passive conventional, self-directed conventional, cautious integrative, aggressive integrative, and aggressive alternative. Factors that shaped each pathway included health beliefs, decision-making role, illness characteristics, and the patient-practitioner relationship. CONCLUSIONS The results of this examination of the longitudinal treatment and decision-making trajectory provide important information to support health care professionals in their quest for individualized, targeted support at each stage of the patient pathway.
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Resnicow K, Abrahamse P, Tocco RS, Hawley S, Griggs J, Janz N, Fagerlin A, Wilson A, Ward KC, Gabram SGA, Katz S. Development and psychometric properties of a brief measure of subjective decision quality for breast cancer treatment. BMC Med Inform Decis Mak 2014; 14:110. [PMID: 25476986 PMCID: PMC4272518 DOI: 10.1186/s12911-014-0110-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 11/10/2014] [Indexed: 01/05/2023] Open
Abstract
Background Breast cancer patients face several preference-sensitive treatment decisions. Feelings such as regret or having had inadequate information about these decisions can significantly alter patient perceptions of recovery and recurrence. Numerous objective measures of decision quality (e.g., knowledge assessments, values concordance measures) have been developed; there are far fewer measures of subjective decision quality and little consensus regarding how the construct should be assessed. The current study explores the psychometric properties of a new subjective quality decision measure for breast cancer treatment that could be used for other preference sensitive decisions. Methods 320 women aged 20–79 diagnosed with AJCC stage 0 – III breast cancer were surveyed at two cancer specialty centers. Decision quality was assessed with single items representing six dimensions: regret, satisfaction, and fit as well as perceived adequacy of information, time, and involvement. Women rated decision quality for their overall treatment experience and surgery, chemotherapy, and radiation decisions separately. Principle components was used to explore factor structure. After scales were formed, internal consistency was computed using Cronbach’s alpha. The association of each of the four final scales with patient characteristics scores was examined by Pearson correlation. Results For overall breast cancer treatment as well as surgery, chemotherapy, and radiation decisions, the six items yielded a single factor solution. Factor loadings of the six decision items were all above .45 across the overall and treatment-specific scales, with the exception of “Right for You” for chemotherapy and radiation. Internal consistency was 0.77, 0.85, 0.82, and 0.78 for the overall, surgery, chemotherapy, and radiation decision quality scales, respectively. Conclusions Our measure of subjective appraisal of breast cancer treatment decisions includes 5 related elements; regret and satisfaction as well as perceived adequacy of information, time, and involvement. Future research is needed to establish norms for the measure as is further psychometric testing, particularly to examine how it is associated with outcomes such as quality of life, psychological coping and objective decision quality.
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Affiliation(s)
- Ken Resnicow
- University of Michigan, School of Public Health, 109 Observatory Street, Ann Arbor, MI, 48109-2029, USA.
| | - Paul Abrahamse
- University of Michigan, School of Medicine, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - Rachel S Tocco
- University of Michigan, School of Medicine, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - Sarah Hawley
- University of Michigan, School of Medicine, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA. .,Veterans Administration, Ann Arbor Center for Clinical Management Research, 2800 Plymouth Road, Building 16, Rm. 421 W, Ann Arbor, MI, 48109-2800, USA.
| | - Jennifer Griggs
- University of Michigan, School of Medicine, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - Nancy Janz
- University of Michigan, School of Public Health, 109 Observatory Street, Ann Arbor, MI, 48109-2029, USA.
| | - Angela Fagerlin
- University of Michigan, School of Medicine, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA. .,Veterans Administration, Ann Arbor Center for Clinical Management Research, 2800 Plymouth Road, Building 16, Rm. 421 W, Ann Arbor, MI, 48109-2800, USA.
| | - Adrienne Wilson
- University of Michigan, School of Public Health, 109 Observatory Street, Ann Arbor, MI, 48109-2029, USA.
| | - Kevin C Ward
- Emory University, Rollins School of Public Health, 1518 Clifton Road, NE, Atlanta, GA, 30322, USA.
| | - Sheryl G A Gabram
- Department of Surgery, Emory University School of Medicine, Winship Cancer Institute of Emory University, 69 Jesse Hill Jr. Dr. SE, Room 303, Atlanta, GA, 30303, USA.
| | - Steven Katz
- University of Michigan, School of Medicine, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
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Sivell S, Elwyn G, Edwards A, Manstead ASR. Factors influencing the surgery intentions and choices of women with early breast cancer: the predictive utility of an extended theory of planned behaviour. BMC Med Inform Decis Mak 2013; 13:92. [PMID: 23962230 PMCID: PMC3849725 DOI: 10.1186/1472-6947-13-92] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 08/06/2013] [Indexed: 11/25/2022] Open
Abstract
Background Women diagnosed with early breast cancer (stage I or II) can be offered the choice between mastectomy or breast conservation surgery with radiotherapy due to equivalence in survival rates. A wide variation in the surgical management of breast cancer and a lack of theoretically guided research on this issue highlight the need for further research into the factors influencing women’s choices. An extended Theory of Planned Behaviour (TPB) could provide a basis to understand and predict women’s surgery choices. The aims of this study were to understand and predict the surgery intentions and choices of women newly diagnosed with early breast cancer, examining the predictive utility of an extended TPB. Methods Sixty-two women recruited from three UK breast clinics participated in the study; 48 women, newly diagnosed with early breast cancer, completed online questionnaires both before their surgery and after accessing an online decision support intervention (BresDex). Questionnaires assessed views about breast cancer and the available treatment options using items designed to measure constructs of an extended TPB (i.e., attitudes, subjective norms, perceived behavioural control, and anticipated regret), and women’s intentions to choose mastectomy or BCS. Objective data were collected on women’s choice of surgery via the clinical breast teams. Multiple and logistic regression analyses examined predictors of surgery intentions and subsequent choice of surgery. Results The extended TPB accounted for 69.9% of the variance in intentions (p <.001); attitudes and subjective norms were significant predictors. Including additional variables revealed anticipated regret to be a more important predictor than subjective norms. Surgery intentions significantly predicted surgery choices (p <.01). Conclusions These findings demonstrate the utility of an extended TPB in predicting and understanding women’s surgery intentions and choices for early breast cancer. Understanding these factors should help to identify key components of interventions to support women while considering their surgery options.
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Affiliation(s)
- Stephanie Sivell
- Marie Curie Palliative Care Research Centre, Wales Cancer Trials Unit, Cardiff University School of Medicine, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
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Weber KM, Solomon DH, Meyer BJF. A qualitative study of breast cancer treatment decisions: evidence for five decision-making styles. HEALTH COMMUNICATION 2013; 28:408-421. [PMID: 23421433 DOI: 10.1080/10410236.2012.713775] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Being diagnosed with breast cancer requires that women make a number of decisions about their medical treatments. To gain insight into the variety of forces that shape a woman's breast cancer treatment decisions, we conducted semistructured interviews with 44 breast cancer survivors. Through an interpretive analysis, we identified five treatment decision-making styles: (a) medical expert, (b) self-efficacy, (c) relationship embedded, (d) inhibition, and (e) constellation of information, which are differentiated by two dimensions: (a) low versus high information needs and (b) self versus other preferences.
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Affiliation(s)
- Kirsten M Weber
- Department of Communication and Dramatic Arts, Central Michigan University, Pleasant, MI 48858, USA.
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Sivell S, Edwards A, Manstead ASR, Reed MWR, Caldon L, Collins K, Clements A, Elwyn G. Increasing readiness to decide and strengthening behavioral intentions: evaluating the impact of a web-based patient decision aid for breast cancer treatment options (BresDex: www.bresdex.com). PATIENT EDUCATION AND COUNSELING 2012; 88:209-217. [PMID: 22541508 DOI: 10.1016/j.pec.2012.03.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 01/18/2012] [Accepted: 03/27/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To undertake a quantitative evaluation of a theory-based, interactive online decision aid (BresDex) to support women choosing surgery for early breast cancer (Stage I and II), based on observations of its use in practice. METHODS Observational cohort study. Website log-files collected data on the use of BresDex. Online questionnaires assessed knowledge about breast cancer and treatment options, degree to which women were deliberating about their options, and surgery intentions, pre- and post-BresDex. RESULTS Readiness to make a decision significantly increased after using BresDex (p<.001), although there was no significant improvement in knowledge. Participants that were 'less ready' to make a decision before using BresDex, spent a longer time using BresDex (p<.05). Significant associations between surgery intentions and choices were observed (p<.001), with the majority of participants going on to have BCS. Greater length of time spent on BresDex was associated with stronger intentions to have BCS (p<.05). CONCLUSION The use of BresDex appears to facilitate readiness to make a decision for surgery, helping to strengthen surgery intentions. PRACTICE IMPLICATIONS BresDex may prove a useful adjunct to the support provided by the clinical team for women facing surgery for early breast cancer.
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Affiliation(s)
- Stephanie Sivell
- Marie Curie Palliative Care Research Centre, Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK.
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Sivell S, Marsh W, Edwards A, Manstead ASR, Clements A, Elwyn G. Theory-based design and field-testing of an intervention to support women choosing surgery for breast cancer: BresDex. PATIENT EDUCATION AND COUNSELING 2012; 86:179-188. [PMID: 21571485 DOI: 10.1016/j.pec.2011.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 03/07/2011] [Accepted: 04/08/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Design and undertake usability and field-testing evaluation of a theory-guided decision aid (BresDex) in supporting women choosing surgery for early breast cancer. METHODS An extended Theory of Planned Behavior (TPB) and the Common Sense Model of Illness Representations (CSM) guided the design of BresDex. BresDex was evaluated and refined across 3 cycles by interviewing 6 women without personal history of breast cancer, 8 women with personal history of breast cancer who had completed treatment and 11 women newly diagnosed with breast cancer. Participants were interviewed for views on content, presentation (usability) and perceived usefulness towards deciding on treatment (utility). Framework analysis was used, guided by the extended TPB and the CSM. RESULTS BresDex was positively received in content and presentation (usability). It appeared an effective support to decision-making and useful source for further information, particularly in clarifying attitudes, social norms and perceived behavioral control, and presenting consequences of decisions (utility). CONCLUSION This study illustrates the potential benefit of the extended TPB and CSM in designing a decision aid to support women choosing breast cancer surgery. PRACTICE IMPLICATIONS BresDex could provide decision-making support and serve as an additional source of information, to complement the care received from the clinical team.
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Affiliation(s)
- Stephanie Sivell
- Marie Curie Palliative Care Research Group, Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK.
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Sivell S, Edwards A, Elwyn G, Manstead ASR. Understanding surgery choices for breast cancer: how might the Theory of Planned Behaviour and the Common Sense Model contribute to decision support interventions? Health Expect 2011; 14 Suppl 1:6-19. [PMID: 20579123 PMCID: PMC5057170 DOI: 10.1111/j.1369-7625.2009.00558.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe the evidence about factors influencing breast cancer patients' surgery choices and the implications for designing decision support in reference to an extended Theory of Planned Behaviour (TPB) and the Common Sense Model of Illness Representations (CSM). BACKGROUND A wide range of factors are known to influence the surgery choices of women diagnosed with early breast cancer facing the choice of mastectomy or breast conservation surgery with radiotherapy. However, research does not always reflect the complexities of decision making and is often atheoretical. A theoretical approach, as provided by the CSM and the TPB, could help to identify and tailor support by focusing on patients' representations of their breast cancer and predicting surgery choices. DESIGN Literature search and narrative synthesis of data. SYNTHESIS Twenty-six studies reported women's surgery choices to be influenced by perceived clinical outcomes of surgery, appearance and body image, treatment concerns, involvement in decision making and preferences of clinicians. These factors can be mapped onto the key constructs of both the TPB and CSM and used to inform the design and development of decision support interventions to ensure accurate information is provided in areas most important to patients. CONCLUSIONS The TPB and CSM have the potential to inform the design of decision support for breast cancer patients, with accurate and clear information that avoids leading patients to make decisions they may come to regret. Further research is needed examining how the components of the extended TPB and CSM account for patients' surgery choices.
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Affiliation(s)
- Stephanie Sivell
- Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, Wales, UK.
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Crighton MH, Lingler JH, Happ MB. Fit and misfit. Res Gerontol Nurs 2011; 4:27-35. [PMID: 21210575 DOI: 10.3928/19404921-20101201-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 10/27/2010] [Indexed: 11/20/2022]
Abstract
This article presents an interpretive case analysis of an older adult's experience with treatment decision making for acute myeloid leukemia. Interview and observational data were compared and contrasted with key constructs in behavioral decision theory to analyze theoretical utility and fit. Decision making involved a complex interplay among the patient, treating clinicians, and family members. While some constructs of decision theory, such as trade-offs, avoidance-avoidance, and the certainty effect, showed utility for decision making in geriatric oncology, this case demonstrated that individual preferences for treatment may be expressed in quality of life preferences rather than a specific treatment decision. The Cage, a major theme in this case, represented the trap of two undesirable choices in treatment decision making, as well as the imprisoning consequence of aggressive medical treatment for advanced cancer. Further decision making research is needed to develop practice-level theory that can more effectively support and guide treatment decision making in geriatric oncology.
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Affiliation(s)
- Margaret H Crighton
- Department of acute and Tertiary Care, Department of Health and Community System, University of Pittsburg School of Nursing, Pittsburg, PA 15261, USA.
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Sheppard VB, Williams KP, Harrison TM, Jennings Y, Lucas W, Stephen J, Robinson D, Mandelblatt JS, Taylor KL. Development of decision-support intervention for Black women with breast cancer. Psychooncology 2010; 19:62-70. [PMID: 19267384 PMCID: PMC3136087 DOI: 10.1002/pon.1530] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Adjuvant therapy improves breast cancer survival but is underutilized by Black women. Few interventions have addressed this problem. This preliminary report describes the process we used to develop a decision-support intervention for Black women eligible for adjuvant therapy. Aims were to use qualitative methods to describe factors that influence Black women's adjuvant therapy decisions, use these formative data to develop messages for a treatment decision-support intervention, and pilot test the acceptability and utility of the intervention with community members and newly diagnosed women. METHODS Thirty-four in-depth interviews were conducted with breast cancer patients in active treatment, survivors and cancer providers to gather qualitative data. Participant ages ranged from 38 to 69 years. A cultural framework was used to analyze the data and to inform intervention messages. Most women relied on their providers for treatment recommendations. Several women reported problems communicating with providers and felt unprepared to ask questions and discuss adjuvant treatment options. Other factors related to treatment experiences were: spiritual coping, collectivism and sharing breast cancer experiences with other Black survivors. RESULTS Using these formative data, we developed an intervention that is survivor-based and includes an in-person session which incorporates sharing personal stories, communication skills training and decision support. Intervention materials were reviewed by community members, researchers/clinicians and patients newly diagnosed with breast cancer. CONCLUSION Patients reported satisfaction with the intervention and felt better prepared to talk with providers. The intervention will be tested in a randomized trial to enhance decision support and increase use of indicated adjuvant treatment.
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Affiliation(s)
- Vanessa B. Sheppard
- Georgetown University, Cancer Control Program, 3300 Whitehaven St., NW, Suite 4100, Washington, DC 20007, 202-687-7036 (phone), 202-687-0305 (fax)
| | - Karen Patricia Williams
- Michigan State University, Obstetrics Gynecology & Reproductive Biology, 224D W Fee Hall, East Lansing, MI 48824-1315, 517-432-4790 (phone)
| | - Toni Michelle Harrison
- Georgetown University, Cancer Control Program, 3300 Whitehaven St., NW, Suite 4100, Washington, DC 20007, 202-687-7036 (phone), 202-687-0305 (fax)
| | - Yvonne Jennings
- Georgetown University, Cancer Control Program, 3300 Whitehaven St., NW, Suite 4100, Washington, DC 20007, 202-687-7036 (phone), 202-687-0305 (fax)
| | - Wanda Lucas
- Georgetown University, Cancer Control Program, 3300 Whitehaven St., NW, Suite 4100, Washington, DC 20007, 202-687-7036 (phone), 202-687-0305 (fax)
| | - Juleen Stephen
- Virginia Polytechnic Institute and State University, Department of Health Promotion, 206 War Memorial Hall, Blacksburg, VA 24061, 540-231-5029 (phone)
| | - Dana Robinson
- Sisters from the Heart, Washington, D.C., 5100 Auth Way, Suitland, MD 20747, 202-564-8018
| | - Jeanne S. Mandelblatt
- Georgetown University, Cancer Control Program, 3300 Whitehaven St., NW, Suite 4100, Washington, DC 20007, 202-687-7036 (phone), 202-687-0305 (fax)
| | - Kathryn L. Taylor
- Georgetown University, Cancer Control Program, 3300 Whitehaven St., NW, Suite 4100, Washington, DC 20007, 202-687-7036 (phone), 202-687-0305 (fax)
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Halkett GKB, Arbon P, Scutter SD, Borg M. The phenomenon of making decisions during the experience of early breast cancer. Eur J Cancer Care (Engl) 2007; 16:322-30. [PMID: 17587355 DOI: 10.1111/j.1365-2354.2007.00778.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Breast cancer patients are faced with many decisions about their treatment, relationships and lives. The aims of this study were: to provide an understanding of the phenomenon of making decisions during the experience of early breast cancer, and to describe the types of decisions these patients are typically faced with. Previous research has focused largely on describing the different ways patients behave when making choices about treatment. However, few studies provide an understanding of the range of decisions women are likely to face, or describe what the experience of making these decisions is like. Hermeneutic phenomenology was used to inform the research. In-depth interviews were conducted with 18 breast cancer patients who had completed treatment. This study provides an understanding of the broad range of decisions with which women may be faced, and presents a new interpretation of what the experience of making decisions is like for women diagnosed with breast cancer. Five existential themes were found to be representative of the experience of making decisions: being challenged, getting ready, surviving, sharing the challenge and interrogating the future. Health professionals can use the understandings presented to improve their therapeutic relationships with patients and further assist women as they work through their experience of breast cancer.
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Affiliation(s)
- G K B Halkett
- Western Australian Centre for Cancer and Palliative Care, Curtin University of Technology, Health Research Campus, Perth, Western Australia, Australia.
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