title: What influences healthcare professionals' treatment preferences for older women with operable breast cancer? An application of the discrete choice experiment.
abstract: BACKGROUND
  Primary endocrine therapy (PET) is used variably in the UK as an alternative to surgery for older women with operable breast cancer. Guidelines state that only patients with "significant comorbidity" or "reduced life expectancy" should be treated this way and age should not be a factor.
  
  
  METHODS
  A Discrete Choice Experiment (DCE) was used to determine the impact of key variables (patient age, comorbidity, cognition, functional status, cancer stage, cancer biology) on healthcare professionals' (HCP) treatment preferences for operable breast cancer among older women. Multinomial logistic regression was used to identify associations.
  
  
  RESULTS
  40% (258/641) of questionnaires were returned. Five variables (age, co-morbidity, cognition, functional status and cancer size) independently demonstrated a significant association with treatment preference (p < 0.05). Functional status was omitted from the multivariable model due to collinearity, with all other variables correlating with a preference for operative treatment over no preference (p < 0.05). Only co-morbidity, cognition and cancer size correlated with a preference for PET over no preference (p < 0.05).
  
  
  CONCLUSIONS
  The majority of respondents selected treatment in accordance with current guidelines, however in some scenarios, opinion was divided, and age did appear to be an independent factor that HCPs considered when making a treatment decision in this population.
authors.affiliation: Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK. Electronic address: j.morgan@sheffield.ac.uk.
authors.forename: J L
authors.initials: JL
authors.lastname: Morgan
authors.affiliation: School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Walters
authors.affiliation: Centre for Health and Social Care Research, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BA, UK.
authors.forename: K
authors.initials: K
authors.lastname: Collins
authors.affiliation: Department of Cardiovascular Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, P.O. Box 65, Leicester, LE2 7LX, UK.
authors.forename: T G
authors.initials: TG
authors.lastname: Robinson
authors.affiliation: School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby, DE22 3DT, UK.
authors.forename: K-L
authors.initials: KL
authors.lastname: Cheung
authors.affiliation: Department of Surgery, University of Liverpool, St Helens Teaching Hospital, Marshalls Cross Road, St Helens, WA9 3DA, UK.
authors.forename: R
authors.initials: R
authors.lastname: Audisio
authors.affiliation: Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9PX, UK.
authors.forename: M W
authors.initials: MW
authors.lastname: Reed
authors.affiliation: Academic Unit of Surgical Oncology, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
authors.forename: L
authors.initials: L
authors.lastname: Wyld
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D002755:Choice Behavior; D000066491:Clinical Decision-Making; D003071:Cognition; D060825:Cognitive Dysfunction / Q000150:complications; D015897:Comorbidity; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D047368:Tumor Burden
keywords: Breast cancer; Discrete choice experiment; Older; Primary endocrine therapy; Surgery