Sarah B Blakeslee1, Worta McCaskill-Stevens2, Patricia A Parker3, Christine M Gunn4, Hanna Bandos5, Therese B Bevers6, Tracy A Battaglia7, Angela Fagerlin8, Jacqueline Müller-Nordhorn9, Christine Holmberg10. 1. Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Public Health. Electronic address: sarah.blakeslee@charite.de. 2. National Cancer Institute, Division of Cancer Prevention, 9609 Medical Center Drive, Bethesda, MD 20892, United States. Electronic address: mccaskiw@mail.nih.gov. 3. The University of Texas MD Anderson Cancer Center, 1155 Pressler Street, P.O. Box 301439, Unit Number: 1322, Houston, TX 77230-1439, United States. Electronic address: parkerp@mskcc.org. 4. Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave, Boston, MA 02118, United States. 5. NRG Oncology, Pittsburgh, United States; The University of Pittsburgh, 201 North Craig St., Suite 350, Pittsburgh, PA 15213, United States. Electronic address: BandosH@NRGOncology.org. 6. The University of Texas MD Anderson Cancer Center, 1155 Pressler Street, P.O. Box 301439, Unit Number: 1322, Houston, TX 77230-1439, United States. Electronic address: tbevers@mdanderson.org. 7. Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Ave, Boston, MA 02118, United States. Electronic address: Tracy.Battaglia@bmc.org. 8. Salt Lake City VA Center for Informatics Decision Enhancement and Surveillance (IDEAS); Department of Population Health Sciences, University of Utah. Electronic address: angie.fagerlin@hsc.utah.edu. 9. Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Public Health. Electronic address: Jacqueline.mueller-nordhorn@charite.de. 10. Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Public Health. Electronic address: christine.holmberg@charite.de.
Abstract
OBJECTIVES: The presentation of risks and benefits in clinical practice is common particularly in situations in which treatment recommendations involve trade-offs. The treatment of breast cancer risk with selective estrogen receptor modulators (SERMs) is such a decision. We investigated the influence of health care provider (HCP) counseling on women's decision-making. METHODS: Thirty breast cancer risk counseling sessions were recorded from April 2012-August 2013 at a comprehensive cancer center and at a safety-net, community hospital in the US. Participating women and HCPs were interviewed. A cross-case synthesis was used for analysis. RESULTS: Of 30 participants 21 received a SERM-recommendation, 11 decided to take SERMs. Counseling impacted decision-making, but did not determine it. Three categories emerged: 1.) ability to change the decision anytime, 2.) perceptions on medications, and 3.) proximity of cancer. CONCLUSION: Decision-making under conditions of a risk diagnosis such as increased breast cancer risk is a continuous process in which risk information is transformed into practical and experiential considerations. PRACTICE IMPLICATIONS: Individuals' health care decision-making is only marginally dependent on the interactions in the clinic. Accepting patients' experiences and beliefs in their own right and letting them guide the discussion may be important for a satisfying decision-making process.
OBJECTIVES: The presentation of risks and benefits in clinical practice is common particularly in situations in which treatment recommendations involve trade-offs. The treatment of breast cancer risk with selective estrogen receptor modulators (SERMs) is such a decision. We investigated the influence of health care provider (HCP) counseling on women's decision-making. METHODS: Thirty breast cancer risk counseling sessions were recorded from April 2012-August 2013 at a comprehensive cancer center and at a safety-net, community hospital in the US. Participating women and HCPs were interviewed. A cross-case synthesis was used for analysis. RESULTS: Of 30 participants 21 received a SERM-recommendation, 11 decided to take SERMs. Counseling impacted decision-making, but did not determine it. Three categories emerged: 1.) ability to change the decision anytime, 2.) perceptions on medications, and 3.) proximity of cancer. CONCLUSION: Decision-making under conditions of a risk diagnosis such as increased breast cancer risk is a continuous process in which risk information is transformed into practical and experiential considerations. PRACTICE IMPLICATIONS: Individuals' health care decision-making is only marginally dependent on the interactions in the clinic. Accepting patients' experiences and beliefs in their own right and letting them guide the discussion may be important for a satisfying decision-making process.
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