DECISION MAKING ABOUT BREAST CANCER TREATMENT: PATIENT AND PROVIDER PERSPECTIVES

Purpose: To compare patient and provider perspectives on the most important facts and values involved in breast cancer treatment decisions.

Methods: Breast cancer survivors and providers rated candidate facts and values, in terms of importance to patients’ decisions about surgery, breast reconstruction, and adjuvant therapy. Candidate items were based on focus groups and interviews. Subjects rated each fact or value (from 1 to 4) and selected the three most important.

Results: Respondents included 14 providers and 15 patients for surgery, 18 providers and 21 patients for reconstruction, and 27 providers and 17 patients for adjuvant therapy. Response rates were 70% for providers and 72-85% for patients. Surgery: Patient and provider ratings differed for 3 of 12 facts and 4 of 8 values. 35% of patients versus 87% of providers rated as very/extremely important facts about satisfaction with breast appearance (p=.037). 29% of patients versus 80% of providers rated as extremely important facts about survival (p=.009). 46% of patients versus 7% of providers rated as not important the value of avoiding radiation complications (p=.007). 50% of patients versus 20% of providers rated as not important avoiding hassles of radiation (p=.023). Reconstruction: Patients and providers trended toward disagreement for 2 of 11 facts, and were different for 2 of 9 values. 92% of patients versus 49% of providers rated as very/important the fact that data on complications is limited (p=.051). 100% of patients versus 64% of providers rated as very/extremely important the fact that women who delay reconstruction are as satisfied as women who do not (p=.082). 77% of patients versus 28% of providers rated as very/extremely important the value of avoiding a prosthesis (p=.002). 46% of patients versus 71% of providers rated as very/extremely important the value of looking natural naked (p=.048). Adjuvant therapy: Patient and provider ratings were different for 2 of 13 facts and 4 of 10 values. 100% of patients versus 17% of providers rated as very/extremely important the fact that adjuvant therapy reduces recurrence more than improves survival (p=.026). Values: 87% of patients versus 4% of providers rated preserving fertility as not important (p<.001).

Conclusion: Patients and providers differ over which facts and values are most important to breast cancer treatment decisions. Treatment discussions and decision quality measures should incorporate both perspectives.