The relationship between breast cancer treatment choice & decisional difficulty

Abstract

A study of 200 Wichita women was conducted to see if the addition of testimonials to a video decision aid would affect their treatment choice for breast cancer. Participants were asked to imagine that they had just been diagnosed with breast cancer. They then viewed a video decision aid explaining their treatment options and potential outcomes. After the video, participants indicated their treatment preference on a six-point Likert scale ranging from “extremely likely to choose lumpectomy with radiation” to “extremely likely to choose mastectomy”. Additionally, participants rated four measures of decisional difficulty: confidence in decision, difficulty of decision, how overwhelmed participants felt, and their likelihood of changing their mind. Despite the fact that survival rates are the same for both mastectomy and lumpectomy, women who chose mastectomy were more confident in their decision and less likely to change their mind. Women who preferred mastectomy over lumpectomy reported less difficulty in making their decision and also found the overall process less overwhelming. A potential explanation for this is that mastectomy may be psychologically more reassuring than lumpectomy. This interpretation is consistent with previous research showing that patients sometimes prefer more extreme treatments for cancer to the detriment of their health (Fagerlin, Zikmund-Fisher & Ubel, 2005).