Increasing patient involvement in choosing treatment for early breast cancer.
BACKGROUND
This investigation examined factors affecting patient involvement in consultations to decide local treatment for early breast cancer and the effectiveness of two methods of preconsultation education aimed at increasing patient participation in these discussions.


METHODS
Sixty patients with Stage I or II breast cancer (1) were pretested on their knowledge about breast cancer treatment and optimism for the future, (2) were randomly assigned to one of two methods for preconsultation education: interactive multimedia program or brochure, (3) completed knowledge and optimism measures, (4) consulted with a medical oncologist, radiation oncologist, and general surgeon, and (5) completed self-report measures assessing their involvement in the consultations and control over decision-making. The consultations were audiorecorded and analyzed to identify behavioral indicators of patient involvement (question-asking, opinion-giving, and expressing concern) and physician utterances encouraging patient participation.


RESULTS
College-educated patients younger than 65 years of age were more active participants in these consultations than were older, less educated patients. In addition, patients showed more involvement when they interacted with physicians who encouraged and facilitated patient participation. The method of education did not affect patient involvement although patients tended to learn more about breast cancer treatment after using the multimedia program than after reading the brochure.


CONCLUSIONS
Although patients vary in their expressiveness, physicians may be able to increase patient participation in deciding treatment by using patient-centered behavior. Also, preconsultation education appears to be an effective clinical strategy for helping patients gain an accurate understanding of their treatment options before meeting with physicians.
Street
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RL
Institute for Health Care Evaluation, Texas A & M University Health Science Center, College Station, TX 77843-4234, USA.
Voigt
B
B
Geyer
C
C
Manning
T
T
Swanson
G P
GP
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000628:therapy*; D003199:Computer Systems; D003657:Decision Making; D004522:Educational Status; D005260:Female; D013502:General Surgery; D006801:Humans; D008495:Medical Oncology; D008875:Middle Aged; D009367:Neoplasm Staging; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods; D010358:Patient Participation; D010817:Physician-Patient Relations; D018787:Radiation Oncology; D012017:Referral and Consultation; D012647:Self-Assessment; D013637:Tape Recording