title: The information and decision support needs of older women (>75 yrs) facing treatment choices for breast cancer: a qualitative study.
abstract: OBJECTIVE
  Primary Endocrine Therapy (PET) is a good alternative to surgery for breast cancer in older frailer women. Overall survival rates are equivalent although rates of local control are inferior. There is little research regarding the decision support needs of older patients faced with this choice. This qualitative study aimed to explore these among older breast cancer patients offered a choice of treatment, as the basis to develop an appropriate decision support tool.
  
  
  METHODS
  Semi-structured interviews were undertaken with older women (>75 years) with breast cancer who had been offered a choice of PET or surgery at diagnosis. Women's involvement in their treatment decision and support for the process were explored and analysed using framework analysis.
  
  
  RESULTS
  Thirty-three interviews were undertaken (median age 82, range 75-95 years, 22 PET, 11 surgery). Most women, regardless of treatment choice, wanted tailored information about the different treatment options, their impact on independence, the practicalities of treatment and the risk of recurrence and spread. Surgery was the treatment of choice in women wanting optimal disease control; those choosing PET felt that they were 'too old' for surgery and wanted minimal disruption.
  
  
  CONCLUSIONS
  Older women described making active treatment decisions. However, some knowledge was inaccurate. Women wanted information and decision support from their clinicians along with a specific tailored information booklet to support this process.
authors.affiliation: Sheffield Hallam, University Centre for Health and Social Care Research Montgomery House, Sheffield, South Yorkshire, United Kingdom.
authors.forename: Maria
authors.initials: M
authors.lastname: Burton
authors.affiliation: Sheffield Hallam, University Centre for Health and Social Care Research Montgomery House, Sheffield, South Yorkshire, United Kingdom.
authors.forename: Karen Anna
authors.initials: KA
authors.lastname: Collins
authors.affiliation: Cardiff University, Institute of Primary Care and Public Health, School of Medicine, Cardiff, United Kingdom.
authors.forename: Kate Joanna
authors.initials: KJ
authors.lastname: Lifford
authors.affiliation: Cardiff University, Institute of Primary Care and Public Health, School of Medicine, Cardiff, United Kingdom.
authors.forename: Kate
authors.initials: K
authors.lastname: Brain
authors.affiliation: University of Sheffield, Royal Hallamshire Hospital, Sheffield, United Kingdom.
authors.forename: Lynda
authors.initials: L
authors.lastname: Wyld
authors.affiliation: University of Sheffield, Sheffield, United Kingdom.
authors.forename: L
authors.initials: L
authors.lastname: Caldon
authors.affiliation: North Trent Cancer Network Consumer Research Panel, Sheffield, United Kingdom.
authors.forename: Jacqui
authors.initials: J
authors.lastname: Gath
authors.affiliation: North Trent Cancer Network Consumer Research Panel, Sheffield, United Kingdom.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Revell
authors.affiliation: University of Sheffield, Academic Surgical Oncology Unit, Sheffield, United Kingdom.
authors.forename: Malcolm William
authors.initials: MW
authors.lastname: Reed
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000517:prevention & control / Q000523:psychology* / Q000628:therapy*; D002755:Choice Behavior; D003661:Decision Support Techniques; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D033181:Information Dissemination; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D036301:Qualitative Research
keywords: cancer; elderly; information needs; oncology; treatment options