Factors associated with patient involvement in surgical treatment decision making for breast cancer.
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 < or = 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.


CONCLUSIONS
Patient factors and patient-surgeon communication influence women's perception of their involvement in breast cancer surgical treatment decision making.


CONCLUSIONS
Decision tools are needed across surgeons and practice settings to elicit patients' preferences for involvement in treatment decisions for breast cancer.
Hawley
Sarah T
ST
Division of General Medicine, Department of Internal Medicine, University of Michigan, United States. sarahawl@med.umich.edu
Lantz
Paula M
PM
Janz
Nancy K
NK
Salem
Barbara
B
Morrow
Monica
M
Schwartz
Kendra
K
Liu
Lihua
L
Katz
Steven J
SJ
D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology / Q000601:surgery; D003142:Communication; D003299:Cooperative Behavior; D003657:Decision Making; D003661:Decision Support Techniques; D004522:Educational Status; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D016015:Logistic Models; D015141:Los Angeles; D008408:Mastectomy / Q000379:methods / Q000523:psychology*; D008824:Michigan; D008875:Middle Aged; D010353:Patient Education as Topic; D010358:Patient Participation / Q000379:methods / Q000523:psychology*; D010819:Physician's Role / Q000523:psychology*; D010817:Physician-Patient Relations; D018714:Radiotherapy, Adjuvant / Q000523:psychology; D018426:SEER Program; D014930:Women / Q000193:education / Q000523:psychology*