Advanced breast cancer patients' perceptions of decision making for palliative chemotherapy

  • Grunfeld E
  • Maher E
  • Browne S
 et al. 
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Purpose To examine advanced breast cancer patients' perceptions of the
key decision-making consultation for palliative chemotherapy.
Patients and Methods One hundred two women with advanced breast cancer,
who were offered palliative chemotherapy, participated in a
study-specific semistructured interview examining perceptions of the
information they had received and their involvement in the
decision-making process. One hundred seventeen interviews included 70 in
relation to first-line chemotherapy and 47 in relation to second-line
chemotherapy (15 patients were interviewed in relation to both first-and
second-line chemotherapy).
Results Eighty-six percent of patient interviews (n = 101) reported
patient satisfaction with the information they received, and 91% (n =
106) reported satisfaction with the decision-making process. Factors
most influential in decisions to accept chemotherapy were the
possibility of controlling the tumor (45%, n = 53 of patient
interviews) and providing hope (33%, n = 28 of patient interviews;
19%, n = 13 being offered first-line chemotherapy v 43%, n = 20 being
offered second-line chemotherapy; P = .006). Thirty-eight percent of
patient interviews (n = 44) reported the patient as taking an active
role in the decision-making process (33%, n = 23 at first-line
chemotherapy v 43%, n = 20 at second-line chemotherapy; P = .06).
Conclusion Women offered second-line chemotherapy were more likely to
undergo chemotherapy because of the hope it offers and were more likely
to take an active role in that decision compared with women who were
offered first-line chemotherapy. Compassionate and honest communication
about prognosis and likelihood of benefit from treatment may help to
close the gap between hope and expectation and enable patients to make
fully informed decisions about palliative chemotherapy.

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  • E A Grunfeld

  • E J Maher

  • S Browne

  • P Ward

  • T Young

  • B Vivat

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