Breast cancer prevention: patient decision making and risk communication in the high risk setting.
The purpose of this study was to investigate prevention decision making among women at high risk for breast cancer, including patient preferences for preventive interventions, patient understanding of disease risk, and patient preferences for risk communication methods, and the corresponding physician understanding of these factors. A prospective interview and survey study was conducted of consecutive new patients seen at a cancer risk and prevention clinic and their physicians. One hundred and forty-six of 217 eligible patients participated and completed all components of the study (67%), and they were seen by a four physicians. Women's preferences for prevention intervention varied widely across women but were stable across time. Physicians were very often unable to predict their patients' preferences for prevention efforts. Patients overestimated their risk of disease, and physicians overestimated the decrease in perceived risk resulting from counseling (p < 0.001). As risk stratification for breast cancer improves, and prevention options become more tolerable, it becomes increasingly important to appropriately counsel women considering such options. This study provides insight into the decision making process of women at high risk for breast cancer and highlights the importance of addressing patient preferences for interventions and risk perception during risk assessment and counseling consultations.
Ozanne
Elissa M
EM
Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA. elissa@mgh-ita.org
Wittenberg
Eve
E
Garber
Judy E
JE
Weeks
Jane C
JC
D000328:Adult; D000367:Age Factors; D000368:Aged; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000235:genetics* / Q000517:prevention & control* / Q000628:therapy; D003142:Communication; D003657:Decision Making; D005260:Female; D005817:Genetic Counseling; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D006801:Humans; D008875:Middle Aged; D057240:Patient Preference; D010817:Physician-Patient Relations; D011322:Primary Prevention / Q000379:methods* / Q000639:trends; D012042:Registries; D018570:Risk Assessment; D012309:Risk-Taking; D011795:Surveys and Questionnaires; D055815:Young Adult