THE ASSOCIATION BETWEEN DECISION STYLES AND APPRAISAL OF TREATMENT DECISION-MAKING: RESULTS OF THE ICANCARE STUDY

Purpose: Despite documented variation in decision-making approaches (i.e. “decision styles,”) limited work has evaluated the association between decision styles and key decision outcomes, such as decision satisfaction or decision quality. Specifically, to date no research has examined the association between women’s decision-making styles and their decision appraisal in the context of breast cancer surgery. Consequently, the objective of this study was to examine the association between three decision-making styles and surgical decision quality and satisfaction among women with breast cancer.

Method: Newly diagnosed breast cancer patients in the Georgia and Los Angeles SEER registries were surveyed approximately 6 months post-diagnosis. A validated 5-item decision satisfaction scale adapted for breast cancer surgery was used to assess women’s satisfaction with their surgical decision-making process. Items were combined into a composite decision satisfaction score (scale: 0-5). A 3-item subjective measure of decision quality was used (Resnicow et al, 2014) that assessed respondents’ satisfaction with the information, involvement and time to make their surgical decision. These items were summed into a composite decision quality score (scale: 0-5). Decision style was assessed with three measures: 1) degree to which decisions are typically motivated by anticipatory regret, 2) rational vs. intuitive decision style, and 3) degree of deliberative decision-making. Multivariable linear regression was used to examine the adjusted differences in decision satisfaction and decision quality by the three participant-reported decision style items. Models adjusted for sociodemograhpic and clinical factors, including type of surgery received.

Result: Among the 2,020 women in the sample, decision-making was appraised positively: the mean decision satisfaction score was 4.4 (SD:0.81) and the mean decision quality score was 4.5 (SD:0.84) out of 5. In the adjusted regression models, greater orientation towards anticipatory regret was significantly associated with worse appraisal of decision-making (P<0.001 for decision satisfaction and decision quality). Conversely, more deliberation was significantly associated with positive appraisal of decision-making (P<0.001 for decision satisfaction and P=0.029 for decision quality) Rational/intuitive decision style was not significantly associated with either decision-making outcome.

Conclusion: Decision quality and satisfaction were high in our sample overall. Greater deliberation in decision--making was associated with better appraisal of both decision quality and satisfaction. Identification of women who typically make decisions based on anticipatory regret may assist clinicians in supporting their breast cancer surgical decision-making process.