Decision-making in older women with breast cancer: a mixed methods study

Abstract

Background and aims In the United Kingdom one third of all breast cancers are diagnosed in women aged 70 or over. Older women with breast cancer are less likely to be offered or receive standard treatment. Aim The overarching aim of this study was to establish the information needs and decision-making preferences of older women diagnosed with primary, operable, oestrogen receptor positive breast cancer and faced with a choice of surgery or primary endocrine therapy (PET). Research design and methods This exploratory, sequential mixed methods study comprised a critical review of the literature, qualitative interviews and a quantitative questionnaire. The findings were interpreted and integrated in line with the mixed method ethos. Key Findings The findings are underpinned by varied and complex internal and external influences. It is accepted that with increasing age cognitive functioning is compromised and poor health literacy is common. Although, the views of HCPs influenced treatment decisions, contrary to previously reported studies older women in this study wanted active involvement in the decision-making process and demonstrated confidence when making treatment choices. In terms of the content and format of information, unsurprisingly women preferred tailored information delivered face to face by the specialist HCP. In terms of written information women wanted brevity and simplicity. Visual displays of numeric data were unpopular and were found to be confusing for most women. Conclusions and recommendations Information and decision support needs varied among this group of women. Understanding how older women define ' involvement in treatment decision-making' would enhance the development of appropriate decision support. Further work is required in the development of data collection tools, particularly questionnaires, appropriate for an older, frail population.