Despite the high proportions of older women living with breast cancer, we know relatively little about their treatment decision-making and the barriers to recommended surveillance. Research reveals an age bias in the medical treatment of older women with breast cancer and those who do not receive appropriate treatment and surveillance experience higher rates of recurrence and poorer prognoses. Yet research has failed to explicate the reasons why older women with breast cancer are receiving suboptimal treatment and surveillance. Thus we have a limited understanding of treatment and post-treatment surveillance decision- making among older breast cancer patients. In particular, we have not adequately explored the role of older women's informal support networks in their decision-making. The goal of this pilot study is to gain a better understanding of the influence of elderly women's support network on treatment choices and screening practices. Specifically, we propose: 1) To identify factors associated with older women's primary therapy decision-making processes, 2) To identify factors associated with older women's cancer surveillance decision-making and adherence, 3) To ascertain how women's primary support person influence decision-making processes and choices, and 4) To determine the relative influence of various support person (e.g., spouses, adult children, and peers) on women's primary treatment and surveillance decisions. In-depth, open-ended interviews will be conducted with 30 women aged 70 years and older receiving treatment in Rhode Island. Our sample will be stratified such that 15 will be women who are newly diagnosed (i.e. < 12 months) and 15 will be women who have been living with breast cancer for > 1 and equal to or <5 years. Women who were recently diagnosed will have better recall of their treatment decision making process, whereas survivors can describe their surveillance decision making and behavior. We will also interview the person who respondents identify as their primary support person (PSP) (i.e., the person with whom the patient discusses her cancer and treatment). The results of this pilot study are intended to inform a larger project in which we extend our study beyond a dyadic analysis. By including others in women's informal networks we can gain a better understanding of the environment in which medical decisions are made. Building on our knowledge of PSPs respective roles and potential needs, we can then determine the feasibility of an intervention aimed at improving older women's involvement in their medical care. Interventions that incorporate members of patients' informal support network move toward a more holistic approach to patient care.
| Ciambrone, Desiree (2006) Treatment decision-making among older women with breast cancer. J Women Aging 18:31-47 |
