Effects of decisional conflict, decision regret and self-stigma on quality of life for breast cancer survivors: A cross-sectional, multisite study in China.

Abstract

To examine the differences in decisional conflict, decision regret, self-stigma and quality of life among breast cancer survivors who chose different surgeries, as well as the effects of decisional conflict, decision regret and self-stigma on quality of life. Observational study. Paper and online surveys were used to collect data from March to September 2020. The Chinese version of the Decisional Conflict Scale, Decision Regret Scale, Self-Stigma Form and Functional Assessment of Cancer Treatment-B were used to measure the corresponding health outcomes for breast cancer survivors who chose different surgeries from three university-affiliated hospitals. One-way analysis of variance, Pearson's correlation coefficient and hierarchical multiple regression analysis were used for data analysis. Among the 448 participants, only 21% chose breast conservative surgery, while 79% chose mastectomy with or without reconstruction. Women who chose mastectomy with reconstruction reported higher decisional conflict (p=.028) and more decision regret (p=.013) than women who chose breast conservative surgery; women who chose mastectomy without reconstruction indicated higher decisional conflict (p=.015), more decision regret (p < .001), and higher self-stigma (p=.034) than women who chose breast conservative surgery. Decisional conflict (r=-.430), decision regret (r=-.495), and self-stigma (r=-.561) were negatively correlated with quality of life. After controlling for sociodemographic and clinical variables, decisional conflict and decision regret explained 19.7% and self-stigma explained 12.9% of the variance in quality of life. Decisional conflict, decision regret and self-stigma vary according to different breast surgeries and are greatly associated with the quality of life of breast cancer survivors. Future studies are warranted to investigate the decision-making process and the underlying reasons for surgical choices. Decision support strategies pre-surgery are needed to inform women about the risks and benefits of surgery options. Moreover, psychosocial support post-surgery is warranted to relieve women's self-stigma, thus improving their quality of life.