Decision-support networks of women newly diagnosed with breast cancer

• Authors: Lauren P. Wallner, University of Michigan; Yun Li, University of Michigan; M. Chandler McLeod, University of Michigan; Ann S. Hamilton, University of Southern California; Kevin Ward, Emory University; Christine M. Veenstra, University of Michigan; Lawrence C. An, University of Michigan; Nancy K. Janz, University of Michigan; Steven J. Katz, University of Michigan; Sarah T. Hawley, University of Michigan
• Journal Title: Cancer
• Volume: Volume 123, Number 20
• Publisher: Wiley: 12 months | 2017-10-15, Pages 3895-3903
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1002/cncr.30848
• Subjects: Health Sciences, Oncology; Health Sciences, Epidemiology; Health Sciences, Health Care Management
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; breast cancer; breast cancer study; caregivers; decision-support networks; family; informal decision support; treatment decision making; CONTRALATERAL PROPHYLACTIC MASTECTOMY; SIGNIFICANT OTHERS; FAMILY; CARE; DETERMINANTS; INVOLVEMENT; PARTICIPATION; PERSPECTIVES; EXPERIENCES

Abstract

BACKGROUND: Little is known about the size and characteristics of the decision-support networks of women newly diagnosed with breast cancer and whether their involvement improves breast cancer treatment decisions. METHODS: A population-based sample of patients newly diagnosed with breast cancer in 2014 and 2015, as reported to the Georgia and Los Angeles Surveillance, Epidemiology, and End Results registries, were surveyed approximately 7 months after diagnosis (N = 2502; response rate, 68%). Network size was estimated by asking women to list up to 3 of the most important decision-support persons (DSPs) who helped them with locoregional therapy decisions. Decision deliberation was measured using 4 items assessing the degree to which patients thought through the decision, with higher scores reflecting more deliberative breast cancer treatment decisions. The size of the network (range, 0-3 or more) was compared across patient-level characteristics, and adjusted mean deliberation scores were estimated across levels of network size using multivariable linear regression. RESULTS: Of the 2502 women included in this analysis, 51% reported having 3 or more DSPs, 20% reported 2, 18% reported 1, and 11% reported not having any DSPs. Married/partnered women, those younger than 45 years, and black women all were more likely to report larger network sizes (all P <.001). Larger support networks were associated with more deliberative surgical treatment decisions (P <.001). CONCLUSIONS: Most women engaged multiple DSPs in their treatment decision making, and involving more DSPs was associated with more deliberative treatment decisions. Future initiatives to improve treatment decision making among women with breast cancer should acknowledge and engage informal DSPs. Cancer 2017;123:3895-903. © 2017 American Cancer Society.