“I Made All Decisions Myself”: Breast Cancer Treatment Decision-Making by Receivers and Decliners

Kim, Eunjung; Jang, Sou Hyun; Andersen, M. Robyn; Standish, Leanna J.

doi:10.4103/2347-5625.311952

Cited by 8 publications

(6 citation statements)

References 26 publications

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“…Qualitative studies have indicated that older patients with metastatic cancer or advanced chronic conditions forgo clinician recommendations because of diagnosis denial and fear of treatment adverse effects . Patient-clinician communication, shared decision-making, and trust can affect patients’ treatment decisions . Other factors, including lack of health care access and advanced disease, also are associated with treatment declination, consistent with our observations in this study.…”

Section: Discussionsupporting

confidence: 76%

Declination of Treatment, Racial and Ethnic Disparity, and Overall Survival in US Patients With Breast Cancer

Freeman,

Li,

Fisher

et al. 2024

JAMA Netw Open

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ImportanceDeclining treatment negatively affects health outcomes among patients with cancer. Limited research has investigated national trends of and factors associated with treatment declination or its association with overall survival (OS) among patients with breast cancer.ObjectivesTo examine trends and racial and ethnic disparities in treatment declination and racial and ethnic OS differences stratified by treatment decision in US patients with breast cancer.Design, Setting, and ParticipantsThis retrospective cross-sectional study used data for patients with breast cancer from the 2004 to 2020 National Cancer Database. Four treatment modalities were assessed: chemotherapy, hormone therapy (HT), radiotherapy, and surgery. The chemotherapy cohort included patients with stage I to IV disease. The HT cohort included patients with stage I to IV hormone receptor–positive disease. The radiotherapy and surgery cohorts included patients with stage I to III disease. Data were analyzed from March to November 2023.ExposureRace and ethnicity and other sociodemographic and clinicopathologic characteristics.Main Outcomes and MeasuresTreatment decision, categorized as received or declined, was modeled using logistic regression. OS was modeled using Cox regression. Models were controlled for year of initial diagnosis, age, sex, health insurance, median household income, facility type, Charlson-Deyo comorbidity score, histology, American Joint Committee on Cancer stage, molecular subtype, and tumor grade.ResultsThe study included 2 837 446 patients (mean [SD] age, 61.6 [13.4] years; 99.1% female), with 1.7% American Indian, Alaska Native, or other patients; 3.5% Asian or Pacific Islander patients; 11.2% Black patients; 5.6% Hispanic patients; and 78.0% White patients. Of 1 296 488 patients who were offered chemotherapy, 124 721 (9.6%) declined; 99 276 of 1 635 916 patients (6.1%) declined radiotherapy; 94 363 of 1 893 339 patients (5.0%) declined HT; and 15 846 of 2 590 963 patients (0.6%) declined surgery. Compared with White patients, American Indian, Alaska Native, or other patients (adjusted odds ratio [AOR], 1.47; 95% CI, 1.26-1.72), Asian or Pacific Islander patients (AOR, 1.29; 95% CI, 1.15-1.44), and Black patients (AOR, 2.01; 95% CI, 1.89-2.14) were more likely to decline surgery; American Indian, Alaska Native, or other patients (AOR, 1.13; 95% CI, 1.05-1.21) and Asian or Pacific Islander patients (AOR, 1.21; 95% CI, 1.16-1.27) were more likely to decline chemotherapy; and Black patients were more likely to decline radiotherapy (AOR, 1.05; 95% CI, 1.02-1.08). Asian or Pacific Islander patients (AOR, 0.81; 95% CI, 0.77-0.85), Black patients (AOR, 0.86; 95% CI, 0.83-0.89), and Hispanic patients (AOR, 0.66; 95% CI, 0.63-0.69) were less likely to decline HT. Furthermore, Black patients who declined chemotherapy had a higher mortality risk than White patients (adjusted hazard ratio [AHR], 1.07; 95% CI, 1.02-1.13), while there were no OS differences between Black and White patients who declined HT (AHR, 1.05; 95% CI, 0.97-1.13) or radiotherapy (AHR, 0.98; 95% CI, 0.92-1.04).Conclusions and RelevanceThis cross-sectional study highlights racial and ethnic disparities in treatment declination and OS, suggesting the need for equity-focused interventions, such as patient education on treatment benefits and improved patient-clinician communication and shared decision-making, to reduce disparities and improve patient survival.

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Section: Discussionsupporting

confidence: 76%

Declination of Treatment, Racial and Ethnic Disparity, and Overall Survival in US Patients With Breast Cancer

Freeman,

Li,

Fisher

et al. 2024

JAMA Netw Open

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“…However, only a few studies have focused on the patients' decision to refuse chemotherapy. Interviews of women with BC revealed that they refused to receive chemotherapy because of their acquaintances' or relatives' experience with chemotherapy or the prospected impact of the same and the risk of recurrence, side effects, and reduced QOL; they were satisfied with their decision to refuse chemotherapy (Kim et al, 2021;Karuturi et al, 2022). These studies indicated the factors that influenced the refusal of chemotherapy, but they did not indicate when factors associated with job loss (Takahashi et al, 2018;Tsuchiya et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Time-Related Characteristics of Medical and Psychosocial Decisions in Japanese Women with Breast Cancer: Results of a Web-Based Open-Ended Response

Yamauchi,

Nakashima,

Nakao

2023

Asian Pac J Cancer Prev

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Background: This study aimed to articulate chronological characteristics of decisions made by Japanese women with breast cancer (BC) since their diagnosis. Methods: Open-ended questions were asked using an Internet-based cross-sectional survey method. Qualitative content analysis was performed on 1,158 free descriptive responses obtained from 549 participants, which were categorized according to the content of decisions. Furthermore, 994 text data from 433 respondents to the quantitative questions were categorized according to the decisions’ timing and examined in relation to medical and sociodemographic factors. Results: Whereas more than 60% of medical decisions, except chemotherapy, were made before initial treatment, approximately more than one-third of sociopsychological decisions were made only after the initial treatment. In decisions regarding medical care, only surgical decisions showed an association between timing and the participants’ decision-making style. Meanwhile, in decisions regarding sociopsychological matters, socioeconomic status at the time of diagnosis, such as marital and employment status, along with the perceived importance of what was to be determined, were associated with the timing of decision-making related to employment, attitudes toward life with BC, family matters and financial affairs. Conclusion: Women make various decisions depending on the amount of time since the diagnosis of BC. Generally, medical decisions are made prior to initial treatment, while these temporal characteristics are not observed for decisions relating to sociopsychological matters. Furthermore, socioeconomic status influences the timing of decision-making regarding sociopsychological matters. This finding can illustrate the manner in which to go through life with BC, and thus, help women who are unexpectedly diagnosed with BC to be more prepared.

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“…The doctor seemed to communicate matters related to the treatment rather than the psychology of the patient. Kim et al (2021) reported that some participants admitted that they felt disappointed with a certain doctor's attitude that did not really care and was too pushy. Moreover, family members also played a significant role in influencing some of the women to undergo conventional treatment, which is consistent with a study by Al-Bahri et al (2019), Kim et al (2021), andWang et al (2020).…”

Section: Discussionmentioning

confidence: 99%

Women and Family Members’ Views Regarding Early Decisions about Breast Cancer Treatment: A Qualitative Study

Wan Mamat,

Jarrett,

Hairulisa@Mohd Hairi

et al. 2023

Nurs. Med. J. Nursing

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Background: Conventional or hospital treatment such as surgery, chemotherapy, or radiotherapy is widely recommended by health care providers for treating breast cancer. Early decision in conventional treatment is a complex phenomenon that requires careful consideration of the medical condition, available information, potential risk, financial, job, and involvement of family members. However, there is an inadequate understanding of early decisions about conventional treatment in Malaysia. Purpose: This study aimed to explore the early decisions about breast cancer treatment among women and their family members.Methods: This study employed a qualitative, narrative approach. Purposive and snowball sampling were applied, and 28 participants were recruited for this study. The participants took part in in-depth, face-to-face, and audio-recorded one-time interviews. All interviews were subsequently transcribed verbatim and analysed using narrative analysis.Results: This study identified two themes regarding early decisions about breast cancer treatment: (1) women and family members who accepted immediate conventional treatment, and (2) women and family members who refused immediate conventional treatment. This study discovered that some women and family members agreed to undergo conventional treatment immediately due to following doctors’ advice, influence by other patients with breast cancer, personal attitude, and appropriate knowledge concerning breast cancer. Meanwhile, other women refused it due to fear, not ready to undergo treatment, influenced by other people and socio-culture template. The unique finding in this study is the presence of specific socio-cultural templates related to breast cancer.Conclusion: This study highlights that health care providers can assist women who decline breast cancer treatment by offering education about conventional treatment options. This can be achieved by providing accurate information about the treatment, addressing treatment-related fears, providing emotional support, and encouraging open communication regarding the reasons for refusing conventional treatment.

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“I Made All Decisions Myself”: Breast Cancer Treatment Decision-Making by Receivers and Decliners

Cited by 8 publications

References 26 publications

Declination of Treatment, Racial and Ethnic Disparity, and Overall Survival in US Patients With Breast Cancer

Declination of Treatment, Racial and Ethnic Disparity, and Overall Survival in US Patients With Breast Cancer

Time-Related Characteristics of Medical and Psychosocial Decisions in Japanese Women with Breast Cancer: Results of a Web-Based Open-Ended Response

Women and Family Members’ Views Regarding Early Decisions about Breast Cancer Treatment: A Qualitative Study

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