Deciding on breast cancer risk reduction: The role of counseling in individual decision-making - A qualitative study.

Author(s): Blakeslee SB,  McCaskill-Stevens W,  Parker PA,  Gunn CM,  Bandos H,  Bevers TB,  Battaglia TA,  Fagerlin A,  Müller-Nordhorn J,  Holmberg C

Journal: Patient Educ Couns

Date: 2017 Dec

Major Program(s) or Research Group(s): COPTRG, NCORP

PubMed ID: 28734560

PMC ID: PMC5683919

Abstract: 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.