UNDERSTANDING THE INFLUENCE OF PATIENT NARRATIVES IN A DECISION AID FOR EARLY STAGE BREAST CANCER

Monday, October 25, 2010
Sheraton Hall E/F (Sheraton Centre Toronto Hotel)
Victoria A. Shaffer, PhD, Department of Psychology, Wichita, KS, Lukas Hulsey, BS, Wichita State University, Wichita, KS and Sara Tomek, PhD, University of Alabama, Tuscaloosa, AL

Purpose:    To examine how women are influenced by narratives in a patient decision aid for early stage breast cancer.

Method:    As part of a larger study examining the impact of patient narratives in a decision aid for early stage breast cancer, 100 women viewed a DVD that contained facts about lumpectomy with radiation and mastectomy, statistics about survival and local recurrence rates, and narratives from women who had either a lumpectomy or mastectomy.  The program was approximately one-hour, and the embedded narratives contributed to a quarter of the total program length.  After watching the DVD, participants rated how helpful and influential they perceived the narratives to be.  In addition, participants responded to several questions about their degree of connectedness to the women providing the narratives.  As part of the larger study, we collected demographic information and asked participants to make a hypothetical surgical decision (lumpectomy or mastectomy).

Result:    85% of the participants reported the narratives to be ‘very’ or ‘extremely’ helpful (scale 1-5; M=4.26 SD=0.81); no participants reported the narratives to be unhelpful.  Participants also believed that the narratives were ‘somewhat influential’ in their hypothetical surgical decision (scale 1-5; M=3.10 SD=1.23).  94% of participants reported feeling connected to the patients in the decision aid.  The two major reasons cited for this connection were that the woman appeared strong and confident (70.2%) and the woman reminded me of myself (35.1%).      Participants were more likely report a connection to patients with similar racial/ethnic backgrounds, c2(1) = 4.57, p < .05. 67% of participants felt most connected to a patient of the same race.  Although the majority of participants were most connected to women who had opted for a mastectomy (78.7%), women who reported a preference for lumpectomy (49%) were more likely to report being most connected to a patient who had also chosen a lumpectomy, c2(1) = 17.14, p < .05.  

Conclusion:    Patient narratives presented in a decision aid for early stage breast cancer were perceived to be very helpful and somewhat influential in hypothetical surgical decisions.  Additionally, the vast majority of participants reported feeling some connection to the patients who provided the narratives.  This connection was related to the racial background and surgical choice of the woman providing the narrative.