Breast Cancer Treatment, part 3

Breast Cancer Treatment, part 3

Breast Cancer Treatment

DISCUSSION

Data from this study indicates that although breast
cancer patients want an active role in the decision-making
process and desire information regarding treatment options,
they also expect a physician’s recommendation and,
when provided, will follow this recommendation 93.8%
of the time. This is consistent with the research of Strull
et a]. [9], which indicated that patients seek information
not to control their treatment outcome, but rather to reduce
their anxiety and fear of the unknown. In this study, 76%
of patients had specific fears about facing breast cancer,
yet only 55% of these patients actually discussed these
fears with a physician. Thus information seelung by patients
may be an indirect attempt to resolve their fears
surrounding their diagnosis, treatment, and outcome,
without engaging in an emotional discussion of their concerns
with their physicians. Physicians need to encourage
patients to voice their fears, thus allowing them to be
addressed with appropriate information and counseling.

Additionally, common patient concerns should be routinely
addressed with each patient diagnosed with breast
cancer. A useful way to elicit patient fears is to ask, “Have
you ever known anyone with breast cancer and what was
the outcome?’ Through this question, open communication
can be facilitated and anxiety reduction may occur.
Another question the physician might ask the patient is,
“Are there specific aspects of your care or treatment
options which you would like more information about?”
Hack et al. [S] found that this patient initiated desire for
knowledge enhances patient recall of information.

In our study, 74% of the patients wanted a physician
recommendation, a figure that is in close agreement with
the finding of Degner and Sloan [lo] that 59% of newly
diagnosed cancer patients wanted their physicians to make
a treatment decision. Based on these results, we suggest
that physicians ask, “Would you like me to recommend
a treatment plan to assist in your decision making?’

In spite of the intuitive appeal of the monitor vs. blunter
personality type, the data did not support the notion that
a majority of patients fall clearly into one category or
the other. Most patients used both monitor and blunter
coping mechanisms. Among the clearly identifiable monitors
and blunters, there was no significant difference in
their desire for a physician’s recommendation. Additionally,
both monitors and blunters were equally likely to
have specific fears about facing breast cancer and the
monitors were no more likely to discuss these fears with
their physicians. Consequently, in this analysis, patient
coping styles had no significant effect on decision
making.

A limitation of this study stems from the data collection
procedure. Although a majority of subjects were surveyed
soon after their breast cancer diagnosis and initial surgery,
27% (21/76) were surveyed between 3 and 6 months later,
thus introducing the possibility of inaccurate recall of the
interaction with their surgeons. In addition, administration
of the MBSS during the period of emotional crisis surrounding
the cancer diagnosis may not have provided the
most valid representation of subjects’ typical or noncrisis
coping mechanism. For instance, in the study by Degner
and Sloan [l0], they showed that decision-malung preferences
were highly dependent on health status. Of the
general public surveyed, while healthy, 64% said they
would want to select their own treatment, whereas 59%
of patients being treated for cancer stated they wanted the
doctor to make treatment decisions on their behalf [l0].

The observation that older women harbored fewer speprevious
studies showing that older individuals have dealt with
more life crises and therefore are better equipped
to cope with breast cancer [ll]. Contrary to our expectations,
the younger women were more likely to want a
physician’s recommendation, perhaps related to their being
more fearful and consequently wanting more direction.

Thus age is a predictor of patient preferences in
decision making, although it should be considered along
with other patient-specific variables in the decision-making
process. Clinically, we suggest that younger women
often desire more physician direction than clinicians
might normally assume, whereas older women are more
comfortable making treatment choices themselves.

CONCLUSIONS

Today’s consumer-oriented health care movement has
fostered the consensus that all patients desire choice and
that the traditional model of physician-patient interaction
should be abandoned. This research shows that although
the majority of patients seeking care at a cancer center
desire an active role in the decision-making process, many
also want a physician’s recommendation. Finally, most
patients need education from their physicians and use this
education to lessen anxiety about facing breast cancer.

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