Abstract
BackgroundPrimary 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).MethodsSemi-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.ResultsInterviews 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.ConclusionsMany 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.
Highlights
Primary endocrine therapy (PET) is a recognised alternative to surgery followed by endocrine therapy for a subset of older, frailer women with breast cancer
Primary endocrine therapy (PET; hormonal therapy) can be just as effective as surgery followed by endocrine therapy for a subset of
The present findings provide a unique insight into older women’s appraisals about their breast cancer treatment decision and coping strategies, and the basis for a theoretically grounded decision support intervention (DSI) for these women
Summary
Primary endocrine therapy (PET) is a recognised alternative to surgery followed by endocrine therapy for a subset of older, frailer women with breast cancer. The extent to which older women with breast cancer are involved with and cope with treatment choices, and the potential need or value of decision support interventions, is not well described. Should the cancer escape control with PET, a change of management is necessary This can be surgery or alternative lines of PET. Older women are being asked to gamble whether they will die of something else before the breast cancer escapes control by the PET and whether they are prepared to risk this to avoid surgery. It is a complex and potentially difficult decision
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