THE ASSOCIATION BETWEEN INVOLVEMENT OF SIGNIFICANT OTHERS IN BREAST CANCER TREATMENT DECISIONS AND THEIR LONG-TERM DISTRESS

Purpose: Significant others (SOs) often participate in women’s breast cancer treatment decisions, yet the impact of this involvement on SOs over time is unknown. The objective of this study was to explore the association between SO decisional involvement at diagnosis and their breast cancer-related distress four years later.

Method: SOs completed mailed surveys four years following their partners’ breast cancer diagnosis. Decisional involvement at diagnosis was assessed by asking the SO to reflect about the treatment decision-making process and respond: 1) how much did you participate in discussions about treatment with your partner and her doctor? (5-point response scale), and 2) would you have liked doctors to talk to you more than they did about your concerns? (yes/no.) Breast cancer-related distress at four years was assessed via SO responses to five items related to: 1) frequency of worry, 2) level of fear, 3) overall concern, 4) perceived likelihood of recurrence, and 5) worry about family members getting breast cancer. Responses were summed to create a composite distress score (scale: 0-20; Cronbach’s alpha = 0.88). Multiple linear regression was used to examine the association between SO decisional involvement at diagnosis and breast cancer-related distress four years later. To better understand the role of clinicians in this association, the model was stratified by SO-reported receipt of emotional support by healthcare providers at diagnosis.

Result: Mean distress among the 510 SOs in the sample was generally low (6.6 out of 20; SD=4.8). Forty-two percent (n=209) participated in treatment decisions “a lot” and 43% (n=212) wished doctors had addressed their concerns more. Compared to SOs who participated in treatment decisions “not at all,” those who participated “a lot” reported significantly higher breast cancer-related distress at four years (Est.= 3.7, p<0.001). SOs who wished doctors had spoken more to them about their concerns at diagnosis also had significantly higher breast cancer-related distress four years later (Est.= 1.08, p=0.031). In the stratified analysis, there was no significant association between decisional involvement and distress among SOs who reported receiving emotional support from providers.

Conclusion: In addition to addressing their concerns during treatment decision-making, ongoing provider monitoring of SOs’ breast cancer-related psychosocial needs is warranted. Emotional support from providers may help mitigate potential distress among SOs with high decisional involvement at diagnosis.