title: The balance of clinician and patient input into treatment decision-making in older women with operable breast cancer.
abstract: OBJECTIVE
  Primary endocrine therapy (PET) is an alternative to surgery for oestrogen receptor positive operable breast cancer in some older women. However the decision to offer PET involves complex trade-offs and is influenced by both patient choice and healthcare professional (HCP) preference. This study aimed to compare the views of patients and HCPs about this decision and explore decision-making (DM) preferences and whether these are taken into account during consultations.
  
  
  METHODS
  This multicentre, UK, mixed methods study had three components: (a) questionnaires to older women undergoing counseling about breast cancer treatment options which assessed their DM preferences and realities; (b) qualitative interviews with older women with operable breast cancer offered a choice of either surgery or PET and (c) qualitative interviews with HCPs (both of which focused on DM preferences in this setting).
  
  
  RESULTS
  Thirty-three patients and 34 HCPs were interviewed. A range of opinions about patient involvement in DM were identified. Patients indicated varying preferences for DM involvement which were variably taken into account by HCPs. These qualitative findings were broadly supported by the questionnaire results. Most patients (536/729; 73.5%) achieved their preferred DM style; however, the remainder felt that their DM preferences had not been taken into consideration.
  
  
  CONCLUSIONS
  These results suggest that whilst many older women achieve their desired level of DM engagement, some do not, raising the possibility that they may be making choices which are not concordant with their treatment preferences.
authors.affiliation: Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK.
authors.forename: Jenna L
authors.initials: JL
authors.lastname: Morgan
authors.affiliation: Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Burton
authors.affiliation: Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Collins
authors.affiliation: Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Kate J
authors.initials: KJ
authors.lastname: Lifford
authors.affiliation: University of Leicester, Department of Cardiovascular Sciences, Robert Kilpatrick Clinical Sciences Building, Leicester, UK.
authors.forename: Thompson G
authors.initials: TG
authors.lastname: Robinson
authors.affiliation: School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby, UK.
authors.forename: Kwok-Leung
authors.initials: KL
authors.lastname: Cheung
authors.affiliation: Department of Surgery, University of Liverpool, St Helens Teaching Hospital, Marshalls Cross Road, St Helens, UK.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Audisio
authors.affiliation: Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK.
authors.forename: Malcolm W
authors.initials: MW
authors.lastname: Reed
authors.affiliation: Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK.
authors.forename: Lynda
authors.initials: L
authors.lastname: Wyld
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology* / Q000601:surgery; D002755:Choice Behavior; D003657:Decision Making; D005260:Female; D006801:Humans; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology*; D057240:Patient Preference / Q000523:psychology*; D010817:Physician-Patient Relations; D011379:Prognosis; D011795:Surveys and Questionnaires