Cancer

Background Little is known about how the individual decision styles and values of breast cancer patients at the time of treatment decision making are associated with consideration of different treatment options, specifically with consideration of contralateral prophylactic mastectomy (CPM). Methods We identified newly diagnosed patients with early-stage breast cancer treated in 2013–14, identified through SEER registries of Los Angeles & Georgia, and surveyed them about 7 months after surgery (N=2578, RR=71%). The primary outcome was consideration of CPM (strong vs. less strong). We assessed the association between patients’ values and decision styles and strong consideration using multivariable logistic regression. Results About one quarter (25%) of women reported strong/very strong consideration of CPM, and another 29% considered it moderately/weakly. Decision styles, including “rational-intuitive” approach to decision making, varied. The factors most valued by women at the time of treatment decision making were: avoiding worry about recurrence (82%), and reducing the need for more surgery (73%). In multivariable analysis, patients who preferred to make their own decisions, those who valued avoiding worry about recurrence, and who valued avoiding radiation significantly (P<0.05) more often strongly considered CPM, while those reported being more “logical” and who valued keeping their breast less often did so. Conclusions Many patients considered CPM, and consideration was associated with both decision style and values. The variability in decision style and values observed in this study suggests that formally evaluating these characteristics at or prior to the initial treatment encounter could provide an opportunity for improving patient clinician discussions.

28810062

PMC5907487

CDC Public Access