title: Understanding older women's decision making and coping in the context of breast cancer treatment.
abstract: BACKGROUND
  Primary endocrine therapy (PET) is a recognised alternative to surgery followed by endocrine therapy for a subset of older, frailer women with breast cancer. Choice of treatment is preference-sensitive and may require decision support. Older patients are often conceptualised as passive decision-makers. The present study used the Coping in Deliberation (CODE) framework to gain insight into decision making and coping processes in a group of older women who have faced breast cancer treatment decisions, and to inform the development of a decision support intervention (DSI).
  
  
  METHODS
  Semi-structured interviews were carried out with older women who had been offered a choice of PET or surgery from five UK hospital clinics. Women's information and support needs, their breast cancer diagnosis and treatment decisions were explored. A secondary analysis of these interviews was conducted using the CODE framework to examine women's appraisals of health threat and coping throughout the deliberation process.
  
  
  RESULTS
  Interviews with 35 women aged 75-98 years were analysed. Appraisals of breast cancer and treatment options were sometimes only partial, with most women forming a preference for treatment relatively quickly. However, a number of considerations which women made throughout the deliberation process were identified, including: past experiences of cancer and its treatment; scope for choice; risks, benefits and consequences of treatment; instincts about treatment choice; and healthcare professionals' recommendations. Women also described various strategies to cope with breast cancer and their treatment decisions. These included seeking information, obtaining practical and emotional support from healthcare professionals, friends and relatives, and relying on personal faith. Based on these findings, key questions were identified that women may ask during deliberation.
  
  
  CONCLUSIONS
  Many older women with breast cancer may be considered involved rather than passive decision-makers, and may benefit from DSIs designed to support decision making and coping within and beyond the clinic setting.
authors.affiliation: Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK. LiffordKJ@cardiff.ac.uk.
authors.forename: Kate J
authors.initials: KJ
authors.lastname: Lifford
authors.affiliation: Institute of Palliative Care, Policy and Rehabilitation, Kings College London, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK.
authors.forename: Jana
authors.initials: J
authors.lastname: Witt
authors.affiliation: Centre for Health and Social Care Research, Sheffield Hallam University, 32 Collegiate Crescent, Sheffield, S10 2BP, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Burton
authors.affiliation: Centre for Health and Social Care Research, Sheffield Hallam University, 32 Collegiate Crescent, Sheffield, S10 2BP, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Collins
authors.affiliation: Academic Unit of Surgical Oncology, University of Sheffield Medical School, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2RX, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Caldon
authors.affiliation: Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
authors.forename: Adrian
authors.initials: A
authors.lastname: Edwards
authors.affiliation: Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9PX, UK.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Reed
authors.affiliation: Academic Unit of Surgical Oncology, University of Sheffield Medical School, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2RX, UK.
authors.forename: Lynda
authors.initials: L
authors.lastname: Wyld
authors.affiliation: Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Brain
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000523:psychology* / Q000628:therapy*; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D057240:Patient Preference / Q000523:psychology*