Australian women's prediagnostic decision-making styles, relating to treatment choices for early breast cancer treatment

Decision-making styles of patients and general population in health care: A scoping review

OBJECTIVE

Decision-making styles form the backbone of effective decision-making and show promise as an important construct that warrants further attention. We investigated what is known about decision-making styles among patients and the general population in a health care setting.

METHODS

We used Arksey and O'Malley's framework and searched PubMed and CINAHL databases using relevant combinations of keywords and subject headings. Articles were limited to those published in English up to February 2020.

RESULTS

Sixteen articles met the inclusion criteria. We found that decision-making styles were described as role preferences or personality, psychological, and cognitive factors that influence decision-making. In the identified studies, the evidence was scarce regarding decision-making styles as the foundation for effective decision-making. Moreover, most studies were vague in the description of decision-making styles, offered little explanation of the concept, and varied substantially in the terminology, numbers, and types of decision-making styles and measurement methods.

CONCLUSIONS

Decision-making styles, as a dynamic process, have received little attention in health care and are rarely addressed in health communication research or investigations of decision-making support. Other frameworks that are not directly related to decision-making styles were used in most analyzed studies.

PRACTICE IMPLICATIONS

Decision-making styles in health care should be reinterpreted as a dynamic process that can be developed or changed.

Breast Cancer Surgery Decision Role Perceptions and Choice of Surgery

BACKGROUND

Retrospective studies have reported that breast cancer patients who perceived more personal responsibility for the surgery decision were more likely to undergo aggressive surgery. We examined this in a prospective study.

METHODS

100 newly diagnosed breast cancer patients identified their decision- making role using the Patient Preference Scale. Chart review captured the initial surgery received. Patient decision role preference, role perception, role concordance, and provider role perception were compared with type of surgery to assess differences between mastectomy and lumpectomy groups and unilateral versus bilateral mastectomy. We compared type of surgery and patient role concordance. Satisfaction with Decision immediately after the visit, Decision Regret and FACT-B quality of life at 2 weeks and 6 months were assessed and compared with type of surgery.

RESULTS

Patient decision role preference (p = 0.49) and perception (p = 0.16) were not associated with type of surgery. Provider perception of patient role was associated with type of surgery, with providers perceiving more passive patient roles in the mastectomy group (p = 0.026). Patient role preference varied significantly by stage of disease (= 0.024), with stage 0 (64%, N = 6) and stage III (60%, N = 6) patients preferring active roles and stage I (60%, N = 25) and stage II (52%, N = 16) patients preferring a collaborative role.

CONCLUSIONS

Patient role preference and perception were not associated with type of surgery, while provider perception of patient role was. Patient role preference varied by stage of disease. Further study is warranted to better understand how disease factors and provider interactions affect decision role preferences and perceptions and surgical choice.

TRIAL REGISTRATION

The study was registered with clinicaltrials.gov (NCT03350854). https://clinicaltrials.gov/ct2/show/NCT03350854 .

Decision-Making Styles and Levels of Involvement Concerning Breast Reconstructive Surgery: An Israeli Study

PURPOSE/OBJECTIVES

To address decision-making styles among breast cancer survivors considering breast reconstruction.
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DESIGN

A primary analysis of a cross-sectional sample among survivors who chose to have breast reconstruction to examine correlations among patient age, decision-making style, and the level of involvement of decision making.
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SETTING

Hadassah Medical Center in Jerusalem, Israel.
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SAMPLE

70 women who had undergone breast reconstruction surgery in the past five years.
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METHODS

Participants completed decision-making style and demographic questionnaires and an assessment of their level of involvement in the decision-making process. 
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MAIN RESEARCH VARIABLES

Level of involvement in decision making, decision-making model between provider and patient, and decision-making styles were examined.
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FINDINGS

No correlation was found between four main decision-making styles and patient age or the extent of patient decision-making involvement and age. A statistically significant correlation was found between the level of involvement in decision making and the decision-making style of the patient.
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CONCLUSIONS

Nurses should assess patient decision-making styles to ensure maximum patient involvement in the decision-making process based on personal desires regardless of age.
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IMPLICATIONS FOR NURSING

Nurses working in breast cancer care must address the decision-making process of patients diagnosed with breast cancer, including the choice to undergo breast reconstruction after mastectomy. Nurses should understand the complex factors that influence a woman's decision-making style to best help with the decision.

Identifying families' shared disease experiences through a qualitative analysis of online twin-to-twin transfusion syndrome stories

Background

Twin-to-twin transfusion syndrome (TTTS) affects 10–20 % of monochorionic diamniotic (MCDA) births and accounts for 50 % of fetal loss in MCDA pregnancies. This exploratory qualitative study identified shared experiences, including potential emotional and psychosocial impacts, of this serious disease.

Methods

Forty-five publicly accessible, online stories posted by families who experienced TTTS were analyzed using grounded theory.

Results

Shared TTTS experiences included a common trajectory: early pregnancy experiences, diagnostic experiences, making decisions, interventions and variable outcomes. Families vacillated between emotional highs such as joy, excitement and relief, and lows including depression, anxiety, anger and grief.

Conclusions

TTTS disease experience can be considered an “emotional roller coaster” exacerbated by TTTS’s unpredictable and quickly changing nature with the potential for emotional and psychosocial effects. Increased TTTS awareness and research about its corresponding impacts can ensure appropriate patient and family support at all phases of the TTTS experience.

Women's decision satisfaction and psychological distress following early breast cancer treatment: a treatment decision support role for nurses

This prospective cross-sectional study investigated Australian women's (n = 104) decision satisfaction with cancer treatment decision for early breast cancer as well as their psychological distress 3-4 months following surgery. Women's satisfaction was surveyed using the Treatment Decision Satisfaction Questionnaire, and the Brief Symptom Inventory-18 was used to measure psychological distress. Women who were living alone, who worked as professionals and who were not involved in the decision-making process by their doctors were less likely to be satisfied with their decision process, outcome and their overall treatment decision. Following treatment, 26.0% of women were distressed; 18.3% experienced anxiety; 19.2% somatization; and 27.9% depression. Women who experienced somatization were more likely to be dissatisfied with the treatment decision (P = 0.003) as were those who reported psychological distress (P = 0.020). Women who were involved in choosing their treatment were more satisfied with their decision. Many women experienced distress following breast cancer treatment and might have required referral for psychological assessment, management and long-term support. Women who experienced distress were more likely to be dissatisfied with the treatment decision (or vice versa).

Patient preferences for shared decisions: a systematic review

OBJECTIVES

Empirical literature on patient decision role preferences regarding treatment and screening was reviewed to summarize patients' role preferences across measures, time and patient population.

METHODS

Five databases were searched from January 1980 to December 2007 (1980-2007 Ovid MEDLINE, Cochrane Database of Systematic Reviews, PsychInfo, Web of Science and PubMed (2005-2007)). Eligible studies measured patient decision role preferences, described measures, presented findings as percentages or mean scores and were published in English from any country. Studies were compared by patient population, time of publication, and measure.

RESULTS

115 studies were eligible. The majority of patients preferred sharing decisions with physicians in 63% of the studies. A time trend appeared. The majority of respondents preferred sharing decision roles in 71% of the studies from 2000 and later, compared to 50% of studies before 2000. Measures themselves, in addition to patient population, influenced the preferred decision roles reported.

CONCLUSION

Findings appear to vary with the measure of preferred decision making used, time of the publication and characteristics of the population.

PRACTICE IMPLICATIONS

The role preference measure itself must be considered when interpreting patient responses to a measure or question about a patient's preference for decision roles.

Elder women's decision-making in breast cancer care: An Israeli study

PURPOSE

Much research has examined women's decision-making behaviour in breast cancer care. Patient age has shaped preferences, values, decision style and participation in treatment decisions. The aim of this study was to test the validity of the Michigan Assessment of Decision Style (MADS) (Pierce, 1995) in an older cohort and provide information on decision styles to identify areas of tailored decision support necessary for Israeli women.

METHODS

This study examined the decision-making styles of older Israeli women receiving routine mammography screening. Fifty two women over 65 years of age, attending a routine mammography screening, were administered a questionnaire containing demographic information and the MADS to determine hypothetical treatment decision-making. The MADS is a 16-item questionnaire assessing decision-making behaviour by characterizing four factors: avoiding, deferring, information-seeking and deliberation.

RESULTS

Age, family history of breast cancer, and having a current mammography were not significantly associated with any of the four MADS factors. Deliberation and Deferring had the highest mean scores, followed closely by Information-Seeking and Avoidance. Correlations among the factors indicate a significant, positive correlation between Deliberation and Information-Seeking and a significant negative correlation between Deliberation and Deferring, consistent with previous studies.

CONCLUSIONS

These findings indicate that older Israeli women's decision style is characterized by information seeking and deliberation reflecting a disposition towards engagement. The findings contribute to clinicians' understanding of women's preferences by countering the traditionally accepted stereotype that older women will employ a passive role when faced with an important health care decision.

Health information seeking behavior

Seeking information about one's health is increasingly documented as a key coping strategy in health-promotive activities and psychosocial adjustment to illness. In this article, the authors critically examine the scientific literature from 1982 to 2006 on the concept of health information-seeking behavior (HISB) to determine its level of maturity and clarify the concept's essential characteristics. A principle-based method of concept analysis provides the framework for exploring the nature of HISB. The authors reviewed approximately 100 published articles and five books reporting on HISB. Although HISB is a popular concept used in various contexts, most HISB definitions provide little insight into the concept's specific meanings. The authors describe the concept's characteristics, contributing to a clearer understanding of HISB, and discuss operationalizations, antecedents, and outcomes of HISB. Such an analysis of HISB might guide further theorizing on this highly relevant concept and assist health care providers in designing optimal informational interventions.

Information needs and decision-making processes in older cancer patients

The paper provides an overview of age-differences in patients' preferences for participation in cancer treatment decision-making and factors that relate to these age-differences. On average, older cancer patients prefer to receive less information about their illness and treatment and assume a less active role in making treatment decisions. They are also less likely to collect and analyze all relevant information in order to make an optimal decision. Observed age-differences are, in part, explained by age-associated cognitive decline. Age-differences are, on average, small to moderate, and most older patients prefer to be well-informed. Nonetheless, only a minority of them wishes to play an active role in decision-making. Given their lower preference for active participation in decision-making, older adults may show less positive psychological effects of active participation, but this question warrants research. Implications for working with older cancer patients are discussed.