Abstract 5497: Breast cancer treatment decision-making: Are we asking too much of patients

Abstract

Abstract Background. Physicians are mandated to offer treatment choices to breast cancer patients yet not all patients may want the responsibility that entails. Prior studies show that breast cancer patients who are not given enough responsibility for treatment decision-making have poorer treatment knowledge and report worse quality of care. In contrast, few studies explore potential adverse consequences for breast cancer patients who feel they are given too much responsibility for treatment decision-making. Methods. We sought to describe and compare women by degree of responsibility they felt they had for making decisions about their breast cancer treatment. Our sample includes women with early-stage breast cancer treated surgically at 8 NYC hospitals, recruited for an RCT of patient assistance to improve receipt of adjuvant treatment. In multivariable analyses, we explored the association between treatment decision-making responsibility and a) baseline knowledge of benefit of surgical and adjuvant treatments discussed with doctor and b) regret of treatment decisions after 6 months. Results. Of 368 women aged 28-89y enrolled at baseline, 72% reported a “reasonable amount,” 21% “too much,” and 7% “not enough” responsibility for treatment decision-making. The majority in the first group were White (53%), earned >$150,000/year (33%), completed college (53%), had no health literacy problems (50%), and had a great deal of self-efficacy (61%). In contrast, the majority with “not enough” responsibility were Black (42%), earned <$50,000/year (58%), did not finish high school (39%), had health literacy problems (68%), and had low self-efficacy (69%). The majority with “too much” responsibility were Hispanic (68%), earned <$15,000/year (54%), did not finish high school (37%), and had health literacy problems (62%), despite having a great deal of self-efficacy (64%). Only 29% of women had knowledge of treatment benefits and 40% experienced decision regret at 6 months. Multivariable analysis found that women with “too much” vs. a “reasonable amount” of responsibility had less treatment knowledge ([OR] 0.46 [95% CI] 0.21, 0.99; model c=0.7301; p<0.001) and more decision regret at 6 months ([OR] 3.16 [CI] 1.59, 6.29; model c=0.7821; p<0.001). The few women with “not enough” responsibility also had less treatment knowledge, and more decision regret, though results were not statistically significant in this small group ([OR] 0.74 [CI] 0.23, 2.37 and [OR] 3.26 [CI] 0.93, 11.4). Conclusion. Overall, treatment knowledge is low and decision regret common in this group of breast cancer patients. Among women with “too much” responsibility for treatment decisions, low health literacy is common and this has important negative consequences. Physicians must find different ways to communicate with low health literacy patients to enable breast cancer patients to achieve adequate levels of treatment decision responsibility and reduce decision regret. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5497. doi:1538-7445.AM2012-5497