TY - JOUR
T1 - Deciding on breast cancer risk reduction
T2 - The role of counseling in individual decision-making – A qualitative study
AU - Blakeslee, Sarah B.
AU - McCaskill-Stevens, Worta
AU - Parker, Patricia A.
AU - Gunn, Christine M.
AU - Bandos, Hanna
AU - Bevers, Therese B.
AU - Battaglia, Tracy A.
AU - Fagerlin, Angela
AU - Müller-Nordhorn, Jacqueline
AU - Holmberg, Christine
N1 - Publisher Copyright:
© 2017 Elsevier B.V.
PY - 2017/12
Y1 - 2017/12
N2 - 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.
AB - 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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U2 - 10.1016/j.pec.2017.06.033
DO - 10.1016/j.pec.2017.06.033
M3 - Article
C2 - 28734560
AN - SCOPUS:85024858739
SN - 0738-3991
VL - 100
SP - 2346
EP - 2354
JO - Patient Education and Counseling
JF - Patient Education and Counseling
IS - 12
ER -