Preferred and Perceived Participation of Younger and Older Patients in Decision Making About Treatment for Early Breast Cancer: A Prospective Study

• Published in: Clinical breast cancer Vol. 18; no. 2; pp. e245 - e253
• Main Authors: Hamelinck, Victoria C., Bastiaannet, Esther, Pieterse, Arwen H., van de Velde, Cornelis J.H., Liefers, Gerrit-Jan, Stiggelbout, Anne M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2018
• Subjects: Adjuvant therapy; Adult; Age Factors; Aged; Antineoplastic Agents - therapeutic use; Breast Neoplasms - psychology; Breast Neoplasms - therapy; Chemotherapy, Adjuvant - methods; Clinical Decision-Making - methods; Female; Geriatric oncology; Humans; Mastectomy - methods; Middle Aged; Patient involvement; Patient Participation - psychology; Patient Participation - statistics & numerical data; Patient Preference - psychology; Patient Preference - statistics & numerical data; Perception; Prospective Studies; Referral and Consultation - statistics & numerical data; Retrospective Studies; Shared decision making; Surgery; Shared decision making; Patient involvement; Surgery; Adjuvant therapy; Geriatric oncology
• ISSN: 1526-8209; 1938-0666
• DOI: 10.1016/j.clbc.2017.11.013

Older patients are believed to prefer a more passive role in decision making. This prospective study surveyed younger and older patients undergoing treatment for early breast cancer. Older patients most frequently preferred to decide with their clinician, although they often felt they had a passive role. It is important to elicit the preferred role of all patients, regardless of their age. Older patients are believed to prefer a more passive role in treatment decision making, but studies reporting this relation were conducted over a decade ago or were retrospective. We prospectively compared younger (40-64 years) versus older (≥ 65 years) breast cancer patients' preferences for decision-making roles and their perceived actual roles. A prospective multicenter study was conducted in Leiden, The Hague, and Tilburg over a 2-year period. Early-stage breast cancer patients were surveyed about their preferred and perceived decision-making roles (active, shared, or passive) concerning surgery type (breast-conserving vs. mastectomy) (n = 74), adjuvant chemotherapy (aCT, n = 43), and adjuvant hormonal therapy (aHT, n = 39). For all decisions, both age groups most frequently preferred a shared role before consultation, except for decisions about aHT, for which younger patients more commonly preferred an active role. The proportion of patients favoring an active or passive role in each decision was lower for the older than the younger patients, but none of the differences was significant. Regarding perceived actual roles, both groups most frequently reported an active role in the surgical decision after consultation. In deciding about both aCT and aHT, a larger proportion of older patients perceived having had a passive role compared to younger patients, and a greater proportion of younger patients perceived having been active. Again, differences were not statistically significant. Most older patients preferred to decide together with their clinician, but preferences varied widely. Older patients more often than younger patients perceived they had not been involved in decisions about systemic therapy. Clinicians should invite all patients to participate in decision making and elicit their preferred role.