title: Young breast cancer patients' involvement in treatment decisions: the major role played by decision-making about surgery.
abstract: OBJECTIVE
  The objective of this study is to investigate young breast cancer patients' preferred and actual involvement in decision-making about surgery, chemotherapy, and adjuvant endocrine therapy (AET).
  
  
  METHODS
  A total of 442 women aged 18-40 years at the time of the diagnosis participated in the region-wide ELIPPSE40 cohort study (southeastern France). Logistic regression analyses were performed on various factors possibly affecting patients' preferred and perceived involvement in the decisions about their cancer treatment.
  
  
  RESULTS
  The women's mean age was 36.8 years at enrollment. Preference for a fully passive role in decision-making was stated by 20.7% of them. It was favored by regular breast surveillance (p = 0.04) and positive experience of being informed about cancer diagnosis (p = 0.02). Patients' preferences were independently associated with their reported involvement in decision-making about surgery (p = 0.01). A fully passive role in decision-making about chemotherapy and AET was more likely to be reported by patients who perceived their involvement in decision-making about surgery as having been fully passive (adjusted odds ratio = 4.8, CI95% [2.7-8.7], and adjusted odds ratio = 9.8, CI95% [3.3-29.2], respectively). This study shows a significant relationship between the use of antidepressants and involvement in decision-making about surgery, and confirms the relationship between impaired quality of life (in the psychological domain) and a fully passive role in decisions about cancer treatment.
  
  
  CONCLUSIONS
  Patients' involvement in decision-making about chemotherapy and AET was strongly influenced by their experience of decision-making about surgery, regardless of their tumor stage and history of breast or ovarian cancer. When decisions are being made about surgery, special attention should be paid to facilitating breast cancer patients' involvement in the decision-making.
authors.affiliation: INSERM, UMR912 'Economics and Social Sciences Applied to Health & Analysis of Medical Information' (SESSTIM), Marseille, France; Aix-Marseille University, UMR_S912, IRD, Marseille, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Seror
authors.forename: Sébastien
authors.initials: S
authors.lastname: Cortaredona
authors.forename: Anne-Deborah
authors.initials: AD
authors.lastname: Bouhnik
authors.forename: Mégane
authors.initials: M
authors.lastname: Meresse
authors.forename: Camille
authors.initials: C
authors.lastname: Cluze
authors.forename: Patrice
authors.initials: P
authors.lastname: Viens
authors.forename: Dominique
authors.initials: D
authors.lastname: Rey
authors.forename: Patrick
authors.initials: P
authors.lastname: Peretti-Watel
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000523:psychology / Q000601:surgery*; D003657:Decision Making; D003863:Depression / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008408:Mastectomy / Q000523:psychology; D010358:Patient Participation; D057240:Patient Preference; D017060:Patient Satisfaction; D010465:Perception; D010817:Physician-Patient Relations; D011788:Quality of Life; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: breast cancer; cohort study; decision-making; oncology; patients; treatments