FCCC LOGO Faculty Publications
Fagerlin A , Lakhani I , Lantz PM , Janz NK , Morrow M , Schwartz K , Deapen D , Salem B , Liu LH , Katz SJ
An informed decision? Breast cancer patients and their knowledge about treatment
Patient Education and Counseling. 2006 Dec;64(1-3) :303-312
PMID: ISI:000243012600037   
Back to previous list
Abstract
Objective: Although involving women in breast cancer treatment decisions is advocated, there is little understanding of whether women have the information they need to make informed decisions. The objective of the current study was to evaluate women's knowledge of survival and recurrence rates for mastectomy and breast conserving surgery (BCS) and the factors associated with this knowledge. Methods: We used a population-based sample of women diagnosed with breast cancer in metropolitan Los Angeles and Detroit between December 2001 and January 2003. All women with ductal carcinoma in situ and a random sample of women with invasive disease were selected (N = 2382), of which 1844 participated (77.4%). All participants were mailed surveys. The main outcome measures were knowledge of survival and recurrence rates by surgical treatment type. Results: Only 16% of women knew that recurrence rates were different for mastectomy and BCS, and 48% knew that the survival rates were equivalent across treatment. Knowledge about survival and recurrence was improved by exposure to the Internet and health pamphlets (p < 0.01). Women who had a female (versus male) surgeon, and/or a surgeon who explained both treatments (rather than just one treatment) demonstrated higher survival knowledge (p < 0.01). The majority of women had inadequate knowledge with which to make informed decisions about breast cancer surgical treatment. Conclusion: Previous explanations for poor knowledge, such as irrelevance of knowledge to decision making and lack of access to information, were not shown to be plausible explanations for the low levels of knowledge observed in this sample. Practice implications: These results suggest a need for fundamental changes in patient education to ensure that women are able to make informed decisions about their breast cancer treatment. These changes may include an increase in the use of decision aids and in decreasing the speed at which treatment decisions are made. Published by Elsevier Ireland Ltd.
Notes
ISI Document Delivery No.: 119LA Times Cited: 0 Cited Reference Count: 46 Cited References: 1998, CAN MED ASS J S3, V158, S15 *AM JOINT COMM CAN, 1997, AJCC CANC STAG MAN *I MED COMM LIF SC, 1999, ENS QUAL CANC CAR *I MED, 2000, PROT DAT PRIV HLTH S *NIH, 1990, NIH CONSENSUS STATE, V8, P1 *U CHIC, 2002, 13 ANN COGG LECT ALEXANDER M, 2003, J CLIN HYPERTENS, V5, P254 ANEMA MG, 1995, J CONTIN ED NURS, V26, P109 ARORA NK, 2002, PATIENT EDUC COUNS, V47, P37 BARLETT FC, 1932, REMEMBERING CAMBRIDG BARRY MJ, 1997, DIS MANAGE CLIN OUTC, V1, P5 BRODY DS, 1980, ANN INTERN MED, V93, P718 COWARD DD, 1999, ONCOL NURS FORUM, V26, P1047 DILLMAN DA, 1978, MAIL TELEPHONE SURVE FAGERLIN A, 2004, ANN INTERN MED, V140, P721 FALLOWFIELD L, 1997, PATIENT EDUC COUNS, V30, P209 GAZMARARIAN JA, 2003, PATIENT EDUC COUNS, V51, P267 HAYNES RB, 1996, LANCET, V348, P383 JACOBSON B, 1995, BRIT MED BULL, V51, P869 JACOBSON JA, 1995, NEW ENGL J MED, V332, P907 JEDLICKAKOHLER I, 1996, PEDIATRICS, V97, P204 KEATING NL, 2002, J CLIN ONCOL, V20, P1473 KINMONTH AL, 1998, BRIT MED J, V317, P1202 LANTZ PM, 2002, HEALTH SERV RES, V37, P417 LERNER BH, 2001, BREAST CANC WARS HOP MAGUIRE P, 1988, BRIT MED J, V297, P907 MCCLEMENT SE, 1999, PATIENT EDUC COUNS, V36, P229 MONTINI T, 1997, WOMEN HEALTH, V26, P85 MORROW M, 2002, CA-CANCER J CLIN, V52, P277 MORROW M, 2005, CANCER, V104, P2340 MOYER A, 1998, WOMENS HLTH RES GEND, V4, P103 NAYFIELD SG, 1994, J NATL CANCER I, V86, P1202 NIELSENBOHLMAN L, 2004, HLTH LIT PRESCRIPTIO OCONNOR AM, 2003, COCHRANE DB SYST REV ROCHENAGLE G, 2003, IRAN MED J, V96, P211 SCHNEIDER CE, 1998, PRACTICE AUTONOMY PA SORG BA, 1992, J RES PERS, V26, P235 STEWART MA, 1995, CAN MED ASSOC J, V152, P1423 STREET RL, 1997, MED DECIS MAKING, V17, P298 TATTERSALL MHN, 1994, J CLIN ONCOL, V12, P1305 UBEL PA, 2001, MED DECIS MAKING, V21, P60 VANDONGEN JA, 2000, J NATL CANCER I, V92, P1143 VERONESI U, 2002, NEW ENGL J MED, V347, P1227 WEISS SM, 1996, ANN SURG ONCOL, V3, P285 WENNBERG JE, 2002, BRIT MED J, V325, P961 WENNBERG JE, 2002, PROMOTING DIS MANAGE