Treatment decision making and adjustment to breast cancer: A longitudinal study.

Abstract

This study monitored women (N = 76) with breast cancer from diagnosis through 1 year, and tested constructs from subjective expected utility theory with regard to their ability to predict patients' choice of surgical treatment as well as psychological distress and well-being over time. Women's positive expectancies for the consequences of treatment generally were maintained in favorable perceptions of outcome in several realms (i.e., physician agreement, likelihood of cancer cure or recurrence, self-evaluation, likelihood of additional treatment, partner support for option, attractiveness to partner). Assessed before the surgical decision-making appointment, women's expectancies for consequences of the treatment options, along with age, correctly classified 94% of the sample with regard to election of mastectomy versus breast-conserving procedures. Calculated from the point of decision making to 3 months later, expectancy disconfirmations and value discrepancies concerning particular treatment consequences predicted psychological adjustment 3 months and 1 year after diagnosis.

Is self‐efficacy a predictor of short‐term post‐surgical adjustment among Chinese women with breast cancer?

“…Most women in this study experienced some psychological morbidity at follow-up. E-OI exacerbated psychological morbidity at 1-month post-surgery, consistent with reports of E-OI predicting psychological morbidity at 3 months post-surgery [19]. So, if the breast surgical outcome turns out to be incongruent with their expectations, Chinese women are, like their Caucasian counterparts, likely to experience greater psychological distress.…”

“…a worse outcome than expected), while a negative discrepancy score indicates an impact less than that anticipated (i.e. a better outcome than expected) [19]. Possible total discrepancy scores ranged from À48 to +48.…”

“…We modified the Breast Cancer Decision-Making Questionnaire (BCDMQ) [19], by measuring the expectations and the perceived consequences of surgical outcome to incorporate Chinese women's concerns about surgical outcome. The modified BCDMQ [21] is a 12 item measure of the impact of surgical outcome on appearance, social relationship, regaining and retaining normalcy, perceived husband's support, and the possibility of having additional treatment.…”

“…Women's dissatisfaction with the expected consequences of the chosen treatment predicts subsequent psychological distress. In the only prospective study reported, discrepancies between expected and perceived outcomes of the elected surgery (expectancy discomfirmation) explained 16% and 14% of the variance in the level of psychological distress experienced by women with breast cancer at 3 months and 12 months post-surgery, respectively [19]. Women reporting greater expectancy disconfirmation regarding the consequences of the elected surgery for breast cancer experienced more psychological distress.…”

Chemotherapy for advanced breast cancer: what influences oncologists’ decision-making?

“…It also enabled the separate examination of the perceived effectiveness (expectancy) and perceived value (utility) associated with each of the goals. This theory has been applied previously to investigate health-related decision-making, including patient decisions regarding treatment for breast cancer (Stanton et al, 1998).…”