Understanding Patient Preferences Regarding the Important Determinants of Breast Cancer Treatment: A Narrative Scoping Review

Abstract

Objective: Conventionally, optimal treatment strategies for breast cancer have been largely determined by physicians, with a scant understanding of patients’ treatment values and preferences. Incorporating patient preferences in the decision-making process for breast cancer treatment is gaining recognition and can potentially improve treatment outcomes and compliance. This scoping review aims to synthesize evidence on the key determinants that are most valued by breast cancer patients when deciding on their treatment options. Methods: We searched three electronic databases (PubMed/MEDLINE, SCOPUS, and CINAHL Plus) utilizing a systematic scoping review method. Two reviewers independently screened, applied inclusion criteria, reviewed, and synthesized findings. A mixed-method narrative approach combining the inductive thematic analysis and content analysis methodologies was used to synthesize and summarize the findings. Results: The review included 22 studies, leading to the conceptualization of 5 overarching themes and 17 sub-themes. Among these, the most frequently cited theme was treatment benefits, followed by treatment-related process, treatment-related risk, quality of life, and cost of treatment. Women with breast cancer highly value treatments that offer good effectiveness, prolong survival, prevent recurrence, and maintain quality of life. Patient concerns include treatment-related side effects, safety, the risk of secondary cancer, and direct or indirect out-of-pocket costs. Additionally, patients also consider treatment duration, mode of administration, physician recommendation, and treatment availability and accessibility when deciding on their preferred treatment. Conclusion: The evidence synthesized in this review offers insights into refining breast cancer treatment strategies to align more closely with patient values. Recognizing and integrating patient perspectives in breast cancer care could potentially lead to improved treatment outcomes, enhanced patient compliance, and more personalized care. Healthcare professionals are encouraged to incorporate these key determinants in their treatment decision-making processes, aiming to deliver a patient-centered care that aligns with the unique preferences and values of each patient. Plain Language Summary: Breast cancer is a significant health concern, and treatment decisions have traditionally driven by physicians, often without due consideration for patients’ preferences in their treatment choices. This scoping review aimed to explore and summarize what matters most to breast cancer patients when deciding on their treatment options. We found five main themes that were important to patients: (1) Effectiveness: Patients highly value treatments that are effective in fighting cancer, prolonging survival, and preventing recurrence. (2) Treatment-related process: The length of treatment and availability of different therapies influenced patients’ choices. Patients trust their doctors’ expertise but also value being involved in the decision-making process to have their preferences considered. (3) Side Effects and Safety: Concerns about treatment-related side effects and the risk of secondary cancer were critical factors in decision-making. (4) Quality of Life: Maintaining a good quality of life during treatment is crucial for patients. (5) Financial Burden: The additional direct and indirect out-of-pocket costs of treatment were important considerations for patients. Understanding patients’ preferences is vital in developing personalized treatments that align with their values. Healthcare professionals need to communicate effectively with patients and involve them in the decision-making process. Patient decision aids and tailored financial assistance programs could also be helpful. Further research is needed to identify effective strategies to tailor treatments to meet patients’ preferences. Overall, this review sheds light on what matters most to breast cancer patients, empowering them to be more active participants in their treatment decisions and potentially improving treatment outcomes and overall well-being.