Understanding older women's decision making and coping in the context of breast cancer treatment

Lifford, Kate ORCID: https://orcid.org/0000-0002-9782-2080, Witt, Jana, Burton, Maria, Collins, Karen, Caldon, Lisa, Edwards, Adrian G. ORCID: https://orcid.org/0000-0002-6228-4446, Reed, Malcolm, Wyld, Lynda and Brain, Katherine Emma ORCID: https://orcid.org/0000-0001-9296-9748 2015. Understanding older women's decision making and coping in the context of breast cancer treatment. BMC Medical Informatics and Decision Making 15 (1) 10.1186/s12911-015-0167-1

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Abstract

BACKGROUND: Primary endocrine therapy (PET) is a recognised alternative to surgery followed by endocrine therapy for a subset of older, frailer women with breast cancer. Choice of treatment is preference-sensitive and may require decision support. Older patients are often conceptualised as passive decision-makers. The present study used the Coping in Deliberation (CODE) framework to gain insight into decision making and coping processes in a group of older women who have faced breast cancer treatment decisions, and to inform the development of a decision support intervention (DSI). METHODS: Semi-structured interviews were carried out with older women who had been offered a choice of PET or surgery from five UK hospital clinics. Women's information and support needs, their breast cancer diagnosis and treatment decisions were explored. A secondary analysis of these interviews was conducted using the CODE framework to examine women's appraisals of health threat and coping throughout the deliberation process. RESULTS: Interviews with 35 women aged 75-98 years were analysed. Appraisals of breast cancer and treatment options were sometimes only partial, with most women forming a preference for treatment relatively quickly. However, a number of considerations which women made throughout the deliberation process were identified, including: past experiences of cancer and its treatment; scope for choice; risks, benefits and consequences of treatment; instincts about treatment choice; and healthcare professionals' recommendations. Women also described various strategies to cope with breast cancer and their treatment decisions. These included seeking information, obtaining practical and emotional support from healthcare professionals, friends and relatives, and relying on personal faith. Based on these findings, key questions were identified that women may ask during deliberation. CONCLUSIONS: Many older women with breast cancer may be considered involved rather than passive decision-makers, and may benefit from DSIs designed to support decision making and coping within and beyond the clinic setting.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Subjects:	R Medicine > R Medicine (General) R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
Uncontrolled Keywords:	Breast cancer treatment, Old age, Decision making, Coping, Deliberation
Publisher:	Biomed Central Ltd
ISSN:	1472-6947
Date of Acceptance:	25 May 2015
Last Modified:	21 Jun 2023 01:16
URI:	https://orca.cardiff.ac.uk/id/eprint/86270

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