How Women Make Decisions About Breast Cancer Surgery
November 22, 2011
Healthcare Prof:
For girls just diagnosed with breast cancer, one of the essential decisions confronting them is no matter whether to have a lumpectomy or mastectomy. A diagnosis of breast cancer will have an effect on one in each and every eight females within the United States, according to the American Cancer Society, causing them to have to decide quickly about treatment.
Most studies investigating how girls make this selection have surveyed girls months and sometimes even years after their decision was created. Lately, however, the publication of a new University at Buffalo study, one of the few to focus on the time period among women’s breast cancer diagnosis and surgery, provides insight into what women are thinking when faced with this decision.
In the study published inside the September issue of Oncology Nursing Forum, girls who had been diagnosed with early-stage breast cancer were interviewed throughout the period just right after surgical consultation and before surgery. Performing the interviews at this time allowed for an in-the-moment snapshot of how ladies arrived at their decisions. These interviews were then transcribed, coded and analyzed to identify themes inside the participants’ thought processes.
“This is among the very few studies to be conducted inside the pretreatment period when ladies were actually engaged within the decision-making process, regardless of whether they had declared a decision or were still contemplating — these thoughts were fresh and appointments with physicians still ongoing,” based on main investigator Robin Lally, PhD, RN, assistant professor of nursing within the UB School of Nursing and adjunct assistant professor at Roswell Park Cancer Institute.
One of the study’s most exciting findings was that when women had been presented with possibilities and felt they had control over their choices they considered this to be a positive prognostic indicator — or an encouraging sign of their future survival. “Women reported gaining confidence in their decision-making role by means of the confidence and support they felt from their surgeon and staff,” Lally stated. “The females in the study valued receiving alternatives, even if they had 1 already in mind, and though they may not have observed themselves as a person who is typically good at making decisions, they drew confidence from the support provided to them by their health care team although making the decision.”
Most usually, women’s surgical therapy decision making has been studied using a structured response format that limits the nature of the answers by providing predetermined choices (several choice or yes/no answers). This structured approach eliminates the context in which decisions are created and limits women’s ability to reveal their thoughts behind how and why they make certain choices.
In contrast, the qualitative analysis method employed by Lally in this study assembles participants who can provide rich insight and expert knowledge on a particular phenomenon so that it can be better understood in a real-world context.
“This analysis provides insight into what ladies newly diagnosed with breast cancer could do, think about and expect even before they see the surgeon in the clinic for the first time,” Lally said.
Specifically, Lally’s analysis showed that ladies felt that info about breast cancer was critical, but that they needed to manage the amount and timing of the details they took in, so that you can prevent themselves from becoming overwhelmed. Much more was not necessarily better. Some ladies preferred to use only the verbal data provided by their care team on which to base their decision and put the breast cancer literature away until just days before their surgery.
Age was not a defining factor in how considerably data females wanted or whether they employed what was provided. Women of all ages employed info that answered their questions and tended to avoid details that upset them emotionally.
Lally identified that many girls already had a plan in mind when they entered the surgeon’s office which they then weighed against the surgeon’s input. Their surgical therapy decisions had been motivated by the desire to: eliminate future inconvenience and worry about cancer balanced by avoiding mastectomy unless medically required; maintain physical function and appearance; and recover rapidly. Most females felt that mastectomy should be reserved only for the worst breast cancers. Older ladies saw advanced age as an advantage — age protected them from worry of recurrence and/or the considerable concern over loss of their breast even though they nonetheless chose lumpectomy.
Women of all ages expressed surprise that their surgeons did not make a definitive recommendation, but that the selection of mastectomy or lumpectomy was ultimately their own. Even women who wanted to make their own decision nonetheless desired a recommendation from the surgeon. When making a option, however, they drew confidence from the surgeons’ support of their decision.
Lally hopes that surgeons and nurses will be inspired by her findings to assess their breast cancer patients’ expectations and understanding regarding their choices as well as the decision-making process at the beginning of every consultation and be aware of the critical role providers play in supporting women’s ability to make this decision.
Breast cancer survivors can also benefit from this research. Lally hopes that, “survivors reading this study may possibly find ‘a little of themselves’ within the women’s narratives and feel comforted in the realization that others also had moments of feeling overwhelmed, uncertain or surprised by the surgical decision-making process — you are not alone.”
Lally at present has a grant under review in collaboration with Roswell Park Cancer Institute’s Breast Center to study the thought processes of African-American girls in response to their breast cancer diagnosis. She intends to use all of her investigation to develop assessment and intervention tools for wellness care professionals to be able to identify girls who may be at danger for ongoing distress beyond this early time period.
Source:
Sara Saldi
University at Buffalo
Filed under: French Village