PRIMARY CARE PROVIDER PARTICIPATION IN BREAST CANCER TREATMENT DECISIONS: RESULTS FROM THE ICANCARE STUDY

Purpose: With recent initiatives promoting collaborative breast cancer care which incorporates the primary care physician (PCPs), it remains unknown whether or not PCPs are participating in breast cancer treatment decisions and if their participation results in higher quality decisions. 

Method: A weighted random sample of newly diagnosed breast cancer patients in the Georgia and Los Angeles SEER registries were surveyed approximately 6 months after diagnosis (N=2054; 68% current response rate).  Women were asked how much their PCP participated in breast cancer treatment decisions, using a 5-point likert scale, categorized as not at all/a little bit vs. somewhat/quite a bit/a lot. A previously developed and validated decision satisfaction scale was used that averaged patient responses to 5 questions about satisfaction, information, participation and time spent with the decision. A decision deliberation scale was created by averaging 4 questions (not at all-very much) including weighing pros/cons, talking with others, thinking though and spending time thinking about the decision. Decision satisfaction and deliberation were evaluated on continuous scales and also categorized as low vs. high, with scores >4 indicating high satisfaction/deliberation. Patient factors (age, race, education, comorbidities) associated with PCP participation and the association of PCP participation with decision satisfaction and deliberation were estimated using logistic regression.

Result: 34% reported that their PCP was involved in their surgical breast cancer treatment decision. Women who reported PCP participation in the treatment decision were more likely to be Latina (OR: 2.57, 95%CI: 1.98, 3.32) Asian (OR: 2.68, 1.92, 3.742) or Black (OR: 1.79, 1.39, 2.30) vs. White, were less educated (< high school) (OR: 3.20, 95% CI: 2.37, 4.33), were older than 65 (OR: 1.68, 95%CI: 1.38, 2.04), and had 2 or more comorbidities (OR: 2.08, 95%CI: 1.58, 2.75). After adjustment for age, race, education, comorbidities and treatment, PCP involvement was not associated with overall decision satisfaction (adjusted p: 0.64), or decision deliberation (adjusted p: 0.80).

Conclusion: In this population-based sample, PCPs were involved in women’s breast cancer treatment decisions, particularly among women who are at risk of poor outcomes following treatment. However, PCP participation did not contribute to overall appraisal of decision-making. Efforts need to be made to ensure PCP’s understand the details of breast cancer treatment options in order to help women make more informed treatment decisions.