Skip to main content
Log in

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

  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Landis SH, Murray T, Bolden S, Wingo PA: Cancer statistics, 1998. CA Cancer J Clin 48: 6–29, 1998

    Google Scholar 

  2. Yancik R, Ries LA: Cancer in older persons. Magnitude of the problem-how do we apply what we know? Cancer 74: 1995–2003, 1994

    Google Scholar 

  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, 2001

    Google Scholar 

  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, 1994

    Google Scholar 

  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, 2000

    Google Scholar 

  6. Andersen MR, Urban N: Involvement in decision-making and breast cancer survivor quality of life. Ann Behav Med 21: 201–209, 1999

    Google Scholar 

  7. Street RL Jr, Voigt B: Patient participation in deciding breast cancer treatment and subsequent quality of life. Med Decis Making 17: 298–306, 1997

    Google Scholar 

  8. Moyer A, Salovey P: Patient participation in treatment decision making and the psychological consequences of breast cancer surgery. Womens Health 4: 103–116, 1998

    Google Scholar 

  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, 1996

    Google Scholar 

  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, 1997

    Google Scholar 

  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, 1997

    Google Scholar 

  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, 2000

    Google Scholar 

  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, 1995

    Google Scholar 

  14. Beisecker AE: Aging and the desire for information and input in medical decisions: patient consumerism in medical encounters. Gerontologist 28: 330–335, 1988

    Google Scholar 

  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, 1997

    Google Scholar 

  16. Tennstedt SL: Empowering older patients to communicate more effectively in the medical encounter. Clin Geriatr Med 16: 61–70, 2000

    Google Scholar 

  17. Williams MV, Davis T, Parker RM, Weiss BD: The role of health literacy in patient-physician communication. Fam Med 34: 383–389, 2002

    Google Scholar 

  18. Adelman RD, Greene MG, Ory MG: Communication between older patients and their physicians. Clin Geriatr Med 16: 1–24, 2000

    Google Scholar 

  19. Butler RN: Age-ism: another form of bigotry. Gerontologist 9: 243–246, 1969

    Google Scholar 

  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, 1999

    Google Scholar 

  21. Street RL Jr: Information-giving in medical consultations: the influence of patients' communicative styles and personal characteristics. Soc Sci Med 32: 541–548, 1991

    Google Scholar 

  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, 2003

    Google Scholar 

  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, 1995

    Google Scholar 

  24. Maly RC, Leake B, Silliman RA: Health care disparities in older patients with breast carcinoma: informational support from physicians. Cancer 97: 1517–1527, 2003

    Google Scholar 

  25. Feher S, Maly RC: Coping with breast cancer in later life: the role of religious faith. Psychooncology 8: 408–416, 1999

    Google Scholar 

  26. Cronbach LJ: Coefficient alpha and the internal structure of tests. Psychometrika 16: 297–334, 1951

    Google Scholar 

  27. Feinstein AR: Clinimetrics. Yale University Press, New Haven, 1987

    Google Scholar 

  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, 1997

    Google Scholar 

  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, 1998

    Google Scholar 

  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, 1989

    Google Scholar 

  31. Haug MR, Lavin B: Practitioner or patient-who's in charge? J Health Soc Behav 22: 212–229, 1981

    Google Scholar 

  32. Thompson SC, Pitts JS, Schwankovsky L: Preferences for involvement in medical decision-making: situational and demographic influences. Patient Educ Couns 22: 133–140, 1993

    Google Scholar 

  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, 1988

    Google Scholar 

  34. Deber RB, Kraetschmer N, Irvine J: What role do patients wish to play in treatment decision making? Arch Intern Med 156: 1414–1420, 1996

    Google Scholar 

  35. Degner LF, Sloan JA: Decision making during serious illness: what role do patients really want to play? J Clin Epidemiol 45: 941–950, 1992

    Google Scholar 

  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, 1996

    Google Scholar 

  37. Lubben JE: Assessing social networks among elderly populations. Fam Community Health 11: 42–52, 1988

    Google Scholar 

  38. Lupton D: Consumerism, reflexivity and the medical encounter. Soc Sci Med 45: 373–381, 1997

    Google Scholar 

  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, 1999

    Google Scholar 

  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, 2001

    Google Scholar 

  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, 2000

    Google Scholar 

  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, 1999

    Google Scholar 

  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, 1989

    Google Scholar 

  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, 1987

    Google Scholar 

  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, 2002

    Google Scholar 

  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 23-40

    Google Scholar 

  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 131

    Google Scholar 

  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, 2000

    Google Scholar 

  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, 1995

    Google Scholar 

  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, 2000

    Google Scholar 

  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, 2002

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rose C. Maly.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maly, R.C., Umezawa, Y., Leake, B. et al. Determinants of participation in treatment decision-making by older breast cancer patients. Breast Cancer Res Treat 85, 201–209 (2004). https://doi.org/10.1023/B:BREA.0000025408.46234.66

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/B:BREA.0000025408.46234.66

Navigation