Breast Cancer Treatment

Breast Cancer Patients’ Personality Style, Age, and Treatment Decision Making

Background: Previous studies have shown that whereas nearly all cancer
patients want information, far fewer wish to make treatment decisions.
Although breast cancer patients who were given a choice of lumpectomy
versus mastectomy and were encouraged to make the decision were believed
to do better psychologically, a 1994 study refuted this. Some authors
suggest that patient personality style is an important consideration in
decisional preference.

Methods: Newly diagnosed breast cancer patients (n = 76) were surveyed
within 6 months of surgery. They answered seven questions about patient
and physician roles in the decision-making process. Additionally, they
completed the Miller Behavioral Style Scale (MBSS), which categorizes
“monitors,” or information seekers, and “blunters,” or information avoiders.
Chi-square analyses were used to explore the relationship of personality
style and age to treatment decision-making preferences.

Results: Although 80% of women wanted a role in decision making, 74%
wanted their surgeons to make a recommendation and when given, 94%
followed the recommended treatment plan. Monitors and blunters were
equally likely to want physician recommendations. Younger women, particularly
those under age 40, were more likely to want a physician’s recommendation.
Of those women who had specific fears about their cancer
(76%), only half of them revealed such fears to their doctors.
Conclusions: The notion that health care consumers, particularly younger
ones, desire an independent choice of treatment was contradicted in this
study, Physicians are encouraged to provide information and to probe
regarding the fears of breast cancer patients in order to reduce anxiety
while recognizing that treatment recommendations are desired by most
women.

INTRODUCTION

Data from clinical trials have shown that 80-90% of
women can be offered the choice of either mastectomy
or breast preservation with radiation therapy. Earlier studies
of women randomized into treatment groups showed
that those in the lumpectomy group had more psychological
distress [1]. These studies concluded that a woman’s
psychological well-being was not related to the type of
surgery but instead concerned whether she had been allowed
to choose the surgery type herself. Fallowfield and colleagues
[2], who noted that most cancer patients want
information about their disease but did not wish to make
treatment decisions, followed women for 3 years after
surgery and found no evidence that women offered a
treatment choice had fewer psychological problems.
Schain [3] proposed that physician-patient communication
about breast cancer should be tailored to the patient’s
desire for, and ability to handle, information. This proposal
drew upon the work of Miller et al. [4], who identified
two coping responses of patients seeking information.
“Monitors,” or information seekers, seemed to benefit
psychologically from data presented to them. “Blunters,”
or information avoiders, would rather not be told all the
information relevant to their diagnosis, care, and treatment
[4]. A study by Hack et al. [5] lends empirical
support to Schain’s proposal as some of their passive
patients, presumably blunters, indicated that pressure to
assume a more active role in treatment decision making
was anxiety provoking. Hack and colleagues [5] suggested
that physicians should respect patient preferences
regarding information and participation in decision making.
They further cautioned that patient preferences may
shift depending upon the severity of the illness. Roberts
et al. [6] advocated interactive physician-patient communication
in the decision-making process with the physician
attempting to elicit, understand, and respond to the
individual patient’s specific fears and concerns about
breast cancer.
Other studies have focused on decision-making preferences
and involvement in care among patients with different
types of cancer. Cassileth [7] found that 25% of patients,
particularly younger patients, wanted active
involvement in decision making. Similarly, Blanchard et
al. [8] reported that 92% of hospitalized oncology patients
wanted all information to be given to them, whereas 69%
wanted to participate in treatment decisions. Those
who wanted the physician to make decisions tended to
be older, sicker, married males, leading Blanchard and
colleagues [8] to observe that these men may have been
comfortable allowing their wives to act as brokers in the
health care system. In contrast to these findings regarding
age-related differences, Hack et al. [5] studied breast
cancer patients and found that the relationship between
age and preference for decisional control was not significant.
Additionally, the relationship between treatment role
preference (active vs. passive) was not related to illness
severity or treatment procedure.
This study addressed the following research questions:
(1 ) do breast cancer patients want an active role in choosing
their treatment plan and what role do they want their
physician to assume? (2) do monitors and blunders differ
in their desired patient and physician roles in decision
making? (3) is age a predictor of patient preferences in
decision making? (4) do patients reveal specific fears
about breast cancer to their physicians?