Factors that Affect the Surgical Decision-making Process among Women with Breast Cancer

Abstract

There are multiple factors that influence surgical treatment decision making at the time of diagnosis for women with breast cancer. The purpose of this study is to identify these factors that may be related to the surgical choice made in the treatment of breast cancer by women. Gaps in the existing research literature revealed a lack of prospective (pre-surgical) studies. The proposed study addresses this gap by focusing on pre-surgical decision making regarding the various factors that impact why women choose mastectomy when the stage of and type of their cancer allows breast conserving surgery as an option. This prospective, mixed mode design was conducted in a mid-Michigan oncology private practice setting. The purposive sample included a total of 10 participants, 3 scheduled for modified radical mastectomy (MRM) surgery and the other 7 scheduled for breast conserving surgery (BCS). A Factor List developed by Ward and colleagues (1989) was adapted to use in content analysis of narrative data from an open-ended question for participants' thoughts and feelings about their surgical treatment decisions. Results revealed most participants were ≤60 years of age, Caucasian, married, employed, and had full coverage health insurance. The following content analysis findings were consistent with previous post-op findings. Among the 10 participants, 90% stated that their physician's opinion was an impact in surgical treatment choice. Fear of side effects from chemo and radiation, length of recovery, and fear of recurrence were also discovered as influences regarding type of surgical treatment chosen. In addition, 10 new factors/themes emerged including fear (nonspecified) (60%), involved support system (60%), information given (40%), personal decision (30%) and strong faith/spirituality beliefs (30%). Other factors/themes (10-20%) were previous experience with someone with breast cancer, guidance from the nurse navigator, trust (nonspecified), age, and fear of subsequent surgeries. Fisher's Exact test revealed no significant relationship between type of surgery (MRM, BCS) and actual breast satisfaction ratings by participants. There was no significant relationship between demographic variables and breast satisfaction. Findings are beneficial to nurse practitioners and other health care providers who can enhance their understanding about the experience women go through during this difficult time, and may ultimately facilitate the surgical treatment decision making process for patients with breast cancer.