Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
J Geriatr Oncol. 2022 Mar;13(2):170-175. doi: 10.1016/j.jgo.2021.11.018. Epub 2021 Dec 23.
Few studies have focused on the therapeutic decision-making process in older adults with breast cancer. This study investigated older adult breast cancer patients' perspectives on neo/adjuvant chemotherapy, thereby identifying informational needs and preferences as patients navigate the treatment decision-making process.
Women ≥65 years diagnosed with early-stage breast cancer were recruited from an academic cancer center after deciding whether or not to receive neo/adjuvant chemotherapy. Participants completed surveys assessing sociodemographic characteristics, health literacy/numeracy, and shared decision making. They took part in individual semi-structured interviews to explore their perspectives, experiences, and values regarding treatment. Interviews were audio-recorded and transcribed. Transcripts were analyzed using the Sort and Sift, Think and Shift qualitative approach. Quantitative data was summarized using descriptive statistics.
Of the 26 participants (age range 65-92 years; 81% non-Hispanic White; 72% ≥ college degree; 50% unmarried), 58% elected to undergo chemotherapy and 42% declined. The majority of participants had adequate health literacy/numeracy and engaged in shared decision-making. Thematic analysis revealed several commonalities regardless of the decision to undergo chemotherapy. Participants sought information regarding their disease/treatment. They referenced subjective experiences of friends/family members with cancer. Self-perception of health and the side effects of chemotherapy were also key factors. Participants placed importance on the maintenance of quality of life throughout treatment.
Decision-making strategies in older patients were shaped by knowledge, values, and the anecdotal experiences of others. Results can inform the development of decision support tools for older patients and physicians to better facilitate the shared decision-making process.
很少有研究关注老年乳腺癌患者的治疗决策过程。本研究调查了老年乳腺癌患者对新辅助/辅助化疗的看法，从而确定了患者在治疗决策过程中需要的信息和偏好。
在决定是否接受新辅助/辅助化疗后，从一家学术癌症中心招募了≥65 岁被诊断为早期乳腺癌的女性。参与者完成了评估社会人口统计学特征、健康素养/算术和共同决策的调查。他们参加了个人半结构化访谈，以探讨他们对治疗的看法、经验和价值观。访谈进行了录音并转录。使用 Sort and Sift、Think and Shift 定性方法分析转录本。使用描述性统计对定量数据进行总结。
在 26 名参与者（年龄 65-92 岁；81%非西班牙裔白人；72%≥大学学历；50%未婚）中，58%选择接受化疗，42%选择不接受。大多数参与者有足够的健康素养/算术能力，并参与共同决策。主题分析显示，无论是否决定接受化疗，都存在一些共同之处。参与者寻求有关疾病/治疗的信息。他们参考了朋友/家人患癌症的主观经验。对自己健康状况和化疗副作用的看法也是关键因素。参与者重视在治疗过程中维持生活质量。
老年患者的决策策略受知识、价值观和他人的轶事经验的影响。研究结果可以为老年患者和医生开发决策支持工具提供信息，以更好地促进共同决策过程。
