Purpose: To examine decision making about breast cancer surgery among low educated, Latina patients and determine factors associated with decision regret.
Methods: A cross-sectional mailed survey of adult females with stage I or II breast cancer within last 2 years. Eligible patients of Hispanic or Spanish descent were identified through the California Cancer Registry. The Breast Cancer Surgery Decision Quality Instrument assessed knowledge, goals, and involvement. A total knowledge score, concordance score (indicating percentage who received treatments that matched their goals) and involvement score were calculated (range 0-100%, higher scores are better). The Short Acculturation Scale for Hispanics was used (1 to 5, higher scores indicate more acculturation). T-tests and Chi-Square tests examined differences and a logistic regression model examined factors (including treatment, age, education, acculturation, knowledge, involvement and concordance) associated with regret.
Results: The sample included 113/274 (41%) patients, mean age 56, and 20% with college degree or more. Patients had moderate knowledge scores (mean 49% SD 15.8%). More lumpectomy patients knew that there is no difference in survival between treatments (72.1% vs. 46.2%, p=0.004) compared to mastectomy patients. Mastectomy patients knew that having a lumpectomy results in a higher chance of needing another operation (55.8% vs. 37.7%, p=0.04) and a higher chance of local recurrence (48.1% vs. 26.2%, p=0.01) compared to lumpectomy patients. Many patients received treatments that matched their goals (concordance score of 73.5%). Mean involvement scores were (67.5% SD 29.4%). Overall 61% of patients would definitely have the same surgery again, indicating no decision regret. Knowledge scores were not associated with regret, but involvement scores were (mean score 78% versus 53% for no regret versus some regret, p=0.006). Patients who received care that matched their goals were also more likely to have no regret (68.7% versus 40%, p=0.008). A multivariate logistic regression model found that total involvement score and having treatment that was concordant with patients’ goals were the only factors significantly associated with having no decision regret.
Conclusions: This sample of Latina patients had fairly limited knowledge, although they reported significant involvement in decision making and a good concordance score, indicating the majority received treatment that matched their goals. Increasing involvement and concordance are worth exploring as ways to reduce decision regret for Latina women with early stage breast cancer.
See more of: The 34th Annual Meeting of the Society for Medical Decision Making