Factors associated with patient involvement in surgical treatment decision making for breast cancer

Abstract

Objective To evaluate factors associated with women's reported level of involvement in breast cancer surgical treatment decision making, and the factors associated with the match between actual and preferred involvement in this decision. Methods Survey data from breast cancer patients in Detroit and Los Angeles was merged with surgeon data for an analytic dataset of 1101 patients and 277 surgeons. Decisional involvement and the match between actual and preferred amount of involvement were analyzed as three-level dependent variables using multinomial logistic regression controlling for clustering within surgeons. Independent variables included patient demographic and clinical factors, surgeon demographic and practice factors, cancer program designation, and two measures of patient–surgeon communication. Results We found variation in women's actual decisional involvement and match between actual and preferred involvement. Women with a surgeon-based or patient-based (versus shared) decision were significantly ( p ≤ 0.05) younger. Women who had too little decisional involvement (versus the right amount) were younger, while women with too much involvement had less education. Patient–surgeon communication variables were significantly associated with both involvement and match, and higher surgeon volume as associated with too little involvement. Conclusion Patient factors and patient–surgeon communication influence women's perception of their involvement in breast cancer surgical treatment decision making. Practice implications Decision tools are needed across surgeons and practice settings to elicit patients’ preferences for involvement in treatment decisions for breast cancer.