What Decisions Matter to Women Facing a Breast Cancer Diagnosis? A Case Study From the Global South on Treatment Shared Decision-Making and the Management of Distress.

BACKGROUND

Breast cancer (BC) is the leading cause of cancer deaths among Chilean women. BC treatment is guaranteed by Chilean law through the Explicit Health Guarantees (GES) plan. There is insufficient evidence on how women navigate the healthcare system and how they exercise shared decision-making (SDM) following a BC diagnosis in global South scenarios.

AIM

To understand how women make decisions about BC treatment.

METHODS

A qualitative study based on 29 individual, semi-structured, in-depth interviews with women undergoing BC treatment in three hospitals in Santiago. Recruitment took place from November 2022 until July 2023. Thematic analysis was performed with AtlasTi.

RESULTS

The experience that care is not happening quickly enough organizes the trajectory of BC patients under the major, in vivo theme of "Everything is slow." Managing this wait mobilizes women through clinical milestones, configuring high or low participation scenarios. Scenarios of high participation comprised decisions mostly regarding practical issues, financial and insurance decisions and whatever actions could be taken to shorten waiting times. Scenarios of low-experienced participation coincided with clinical encounters with health professionals, with treatment decisions delegated to or exclusively made by clinicians.

CONCLUSION

BC is experienced as a distressing diagnosis. Women prioritize decisions that they perceive will speed up their care and do not effectively participate in treatment decision-making. This study is part of a larger mixed-methods project that aims to elucidate factors influencing SDM in BC. Future directions should provide strategies to patients and clinicians to build more symmetrical relationships and evaluate the satisfaction with care of universal coverage-oriented policies, as well as how this could influence the exercise of patients' autonomy.