Treatment decision-making among breast cancer patients in Malaysia

Figures & data

Table 1 Sociodemographic characteristics of patients

Characteristics of patients		Number of patients	Percentage of sample
Gender
Male		1	0.5
Female		203	99.5
Age (years)
21–40		31	15.2
41–60		110	53.9
61–80		60	29.4
>80		3	1.5
Mean ± SD	53.98±12.23
Median (IQR)	55 (44.25–62)
Range	23–85
Ethnicity
Malay		119	58.3
Chinese		47	23.0
Indian		33	16.2
Other		5	2.5
Religion
Muslim		122	59.8
Buddhist		40	19.6
Hindu		28	13.7
Christian		9	4.4
Catholic		1	0.5
Other		4	2.0
Educational qualification
No formal education		19	9.3
Elementary school		41	20.1
High school		107	52.5
Diploma/degree/postgraduate		37	18.1
Marital status
Single		29	14.2
Married		162	79.4
Widow		6	2.9
Divorced		7	3.4
Employment status
Employed		79	38.7
Unemployed		125	61.3
Monthly income
<RM2501		168	82.4
RM2501–RM5000		26	12.7
RM5000–RM10000		10	4.9
>RM10000		0	0

Abbreviation: IQR, interquartile range.

Table 2 Sociodemographic characteristics of physicians

Characteristics	n (%)
Gender
Male	23 (33.8)
Female	45 (66.2)
Ethnicity
Malay	36 (52.9)
Chinese	17 (25.0)
Indian	14 (20.6)
Other	1 (1.5)
Age (years)
Mean ± SD	32.12±4.42
Median (IQR)	31.00 (29–34)
Range	27–51
Educational qualification
Medical degree (MD)	58 (85.3)
MD + MS	8 (11.8)
MD + MS + subspecialty/fellowship	2 (2.9)
Country of study
Local	36 (52.9)
Oversea	32 (47.1)
General practice (years)
<5 years	22 (32.4)
5–10 years	37 (54.4)
>10 years	9 (13.2)
Mean ± SD	6.94±4.28
Median (IQR)	6.00 (4.00–8.75)
Range	1–26
Specialization
Surgeon	2 (2.9)
Oncologist	7 (10.3)
Medical officer	59 (86.8)

Abbreviations: IQR, interquartile range; MS, Physicians with Masters degree.

Table 3 Patients’ preferred role (before consultation), patients’ perceived role (after consultation), and doctors’ perceived patients’ role in decision-making (after consultation)

Patient perception scale	Patient preference scale, n (%)			Physician perception scale, n (%)			Total, n (%)
	Autonomous		Passive	Autonomous		Passive
	Active	Shared		Active	Shared
Autonomous
Active	18 (8.8)	0 (0)	1 (0.5)	10 (4.9)	5 (2.5)	4 (2.0)	19 (9.3)
Shared	1 (0.5)	93 (45.6)	11 (5.4)	64 (31.4)	34 (16.7)	7 (3.4)	105 (51.5)
Passive	1 (0.5)	4 (2.0)	75 (36.8)	42 (20.6)	28 (13.7)	10 (4.9)	80 (39.2)
Total, n (%)	20 (9.8)	97 (47.5)	87 (42.6)	116 (56.9)	67 (32.8)	21 (10.3)	204 (100)

Notes: Concordance: 54 of 204 patient–physician pairs (26.5%), Cohen’s kappa =0.042, p=0.405; Agreement between the preferred and the actual participation of patients: Cohen’s kappa =0.828, p<0.001.

Table 4 Association between patients’ sociodemographic characteristics and patients’ preferred role in decision-making

Characteristics of patients	Autonomous n=117	Passive n=87	Univariate analysis					Multivariate analysis
	n (%)	n (%)	Crude OR (95% CI)		χ^2-statistics (df)		p-value	Adjusted OR (95% CI)		χ^2-statistics (df)		p-value
Age (years)					0.83	(3)	0.843
21–40	19 (9.3)	12 (5.9)	Ref	–
41–60	60 (29.4)	50 (24.5)	0.76	(0.34, 1.71)	0.45	(1)	0.505
61–80	36 (17.6)	24 (11.8)	0.95	(0.39, 2.30)	0.01	(1)	0.905
>80	2 (1.0)	1 (0.5)	1.26	(0.10, 15.50)	0.03	(1)	0.855
Ethnicity					9.99	(3)	0.019a			3.37	(3)	0.338
Malay	78 (38.2)	41 (20.1)	2.93	(1.32, 6.48)	7.03	(1)	0.008	2.53	(0.11, 59.94)	0.33	(1)	0.565
Chinese	25 (12.3)	22 (10.8)	1.75	(0.71, 4.31)	1.47	(1)	0.225	5.06	(0.40, 63.88)	1.57	(1)	0.210
Indian	13 (6.4)	20 (9.8)	Ref	–				Ref	–
Others	1 (0.5)	4 (2.0)	0.39	(0.04, 3.84)	0.66	(1)	0.415	0.57	(0.03, 12.82)	0.13	(1)	0.723
Religion					7.85	(3)	0.049			1.63	(3)	0.652
Muslim	79 (38.7)	43 (21.1)	2.84	(1.22, 6.61)	5.87	(1)	0.015	1.04	(0.04, 26.46)	0	(1)	0.983
Buddhist	19 (9.3)	21 (10.3)	1.40	(0.53, 3.73)	0.45	(1)	0.503	0.38	(0.03, 5.76)	0.49	(1)	0.485
Hindu	11 (5.4)	17 (8.3)	Ref	–				Ref
Others	8 (3.9)	6 (2.9)	2.06	(0.56, 7.58)	1.18	(1)	0.276	1.20	(0.15, 9.88)	0.03	(1)	0.866
Educational qualification					12.94	(3)	0.005a			7.55	(3)	0.056
No formal education	6 (2.9)	13 (6.4)	Ref	–				Ref	–
Elementary school	19 (9.3)	22 (10.8)	1.87	(0.60, 5.88)	1.15	(1)	0.284	1.93	(0.58, 6.44)	1.13	(1)	0.287
High school	63 (30.9)	44 (21.6)	3.10	(1.10, 8.79)	4.54	(1)	0.033	2.99	(0.96, 9.30)	3.59	(1)	0.058
Diploma/degree/postgraduate	29 (14.2)	8 (3.9)	7.85	(2.26, 27.26)	10.54	(1)	0.001	7.52	(1.66, 34.13)	6.84	(1)	0.009
Marital status					0.25	(3)	0.969
Single	17 (8.3)	12 (5.9)	Ref	–
Married	92 (45.1)	70 (34.3)	0.93	(0.42, 2.07)	0.03	(1)	0.854
Widow	4 (2.0)	2 (1.0)	1.41	(0.22, 8.99)	0.13	(1)	0.715
Divorced	4 (2.0)	3 (1.5)	0.94	(0.18, 5.00)	0.01	(1)	0.943
Employment status
Employed	49 (24.0)	30 (14.7)	1.37	(0.77, 2.43)	1.15	(1)	0.284
Unemployed	68 (33.3)	57 (27.9)	Ref	–
Monthly income					3.03	(2)	0.220			0.29	(2)	0.866
<RM2501	92 (45.1)	76 (37.3)	Ref	–				Ref	–
RM2501–RM5000	17 (8.3)	9 (4.4)	1.56	(0.66, 3.70)	1.02	(1)	0.312	0.77	(0.28, 2.09)	0.27	(1)	0.604
RM5000–RM10000	8 (3.9)	2 (1.0)	3.30	(0.68, 16.03)	2.20	(1)	0.135	0.99	(0.15, 6.56)	0	(1)	0.988

Notes: Autonomous: shared and active role preference; passive: passive role preference;

a indicates the predictor(s) with significant difference.

Abbreviations: OR, odds ratio; CI, confidence interval.

Table 5 Preferences for information and behavioral involvements of patients

Krantz Health Opinion Survey (KHOS) item	Agree n (%)	Disagree n (%)	Score Mean ± SD Median (IQR) Range	Cronbach’s alpha
Information subscale (KHOS-I)			3.66±1.47 4.00 (3–5) 0–7	0.655
I usually don’t ask the doctor or the nurse many questions about what they’re doing during a medical exam. (1)a	165 (80.9)	39 (19.1)
I’d rather have doctors and nurses make the decisions about what’s best than for them to give me a whole lot of choices. (3)a	5 (2.5)	199 (97.5)
Instead of waiting for them to tell me, I usually ask the doctor or nurse immediately after an examination about my health. (4)	130 (63.7)	74 (36.3)
I usually ask the doctor or nurse lots of experience about the procedures during a medical exam. (8)	180 (88.2)	24 (11.8)
It is better to trust the doctor or nurse in charge of medical procedure than to question what they are doing. (10)a	4 (2.0)	200 (98.0)
I usually wait for the doctor or the nurse to tell me the results of a medical examination rather than asking them immediately. (15)a	97 (47.5)	107 (52.5)
I’d rather be given many choices about what’s best for my health then to have the doctor make the decision for me. (16)	165 (80.9)	39 (19.1)
Behavioral involvement subscale (KHOS-B)			2.20±0.84 2.00 (2–3) 0–5	0.293
Except for serious illness, it is generally better to take care of your own health than to seek professional help. (2)	193 (94.6)	11 (5.4)
It is better to reply on the judgements of doctors (who are experts) than to rely on “common sense” in taking care of your own body. (5)a	2 (1.0)	202 (99.0)
Clinics and hospitals are good places to go for help since it is best for medical experts to take responsibility for health care. (6)a	0 (0)	204 (100)
Learning how to cure some of your illness without contacting a physician is a good idea. (7)	100 (49.0)	104 (51.0)
It’s almost always better to seek professional help than to try to treat yourself. (9)a	1 (0.5)	203 (99.5)
Learning how to cure some of your illness without contacting a physician may create more harm than good. (11)a	3 (1.5)	201 (98.5)
Recovery is usually quicker under care of a doctor or a nurse than when patients take care of themselves. (12)a	0 (0)	204 (100)
If it costs the same, I’d rather have a doctor or a nurse give me treatments than to do the same treatments myself. (13)a	0 (0)	204 (100)
It is better to rely less on physicians and more on your own common sense when it comes to caring for your body. (14)	149 (73.0)	55 (27.0)
Total KHOS			5.85±1.78 6.00 (5–7) 1–12	0.578

Notes: Pearson correlation coefficient between the two subscales, r=0.123, n=204, p=0.079;

a indicates negatively worded item.

Abbreviations: SD, standard deviation; IQR, interquartile range.

Table 6 Association between patients’ sociodemographic characteristics and patients’ preference of information seeking

Characteristics of patients	Higher preference level n=162	Lower preference level n=42	Univariate analysis					Multivariate analysis
	n (%)	n (%)	Crude OR (95% CI)		χ^2-statistics (df)		p-value	Adjusted OR (95% CI)		χ^2-statistics (df)		p-value
Age (years)					2.10	(3)	0.552
21–40	27 (13.2)	4 (2.0)	Ref	–
41–60	88 (43.1)	22 (10.8)	0.59	(0.19, 1.87)	0.80	(1)	0.372
61–80	45 (22.1)	15 (7.4)	0.44	(0.13, 1.48)	1.75	(1)	0.186
>80	2 (1.0)	1 (0.5)	0.30	(0.02, 4.07)	0.83	(1)	0.363
Ethnicity					10.51	(3)	0.015a			4.76	(3)	0.190
Malay	102 (50.0)	17 (8.3)	1.92	(0.75, 4.95)	1.82	(1)	0.177	4.78	(0.15, 158.3)	0.77	(1)	0.381
Chinese	34 (16.7)	13 (6.4)	0.84	(0.30, 2.32)	0.12	(1)	0.733	0.75	(0.04, 13.58)	0.04	(1)	0.847
Indian	25 (12.3)	8 (3.9)	Ref	–				Ref	–
Others	1 (0.5)	4 (2.0)	0.08	(0.01, 0.82)	4.51	(1)	0.034	0.14	(0.01, 3.50)	1.44	(1)	0.230
Religion					5.16	(3)	0.161			0.78	(3)	0.853
Muslim	103 (50.5)	19 (9.3)	1.81	(0.67, 4.84)	1.39	(1)	0.239	0.33	(0.01, 11.98)	0.36	(1)	0.547
Buddhist	29 (14.2)	11 (5.4)	0.88	(0.29, 2.64)	0.05	(1)	0.818	1.89	(0.08, 42.44)	0.16	(1)	0.688
Hindu	21 (10.3)	7 (3.4)	Ref	–				Ref
Others	9 (4.4)	5 (2.5)	0.60	(0.15, 2.40)	0.52	(1)	0.471	1.43	(0.10, 20.92)	0.07	(1)	0.794
Educational qualification					15.41	(3)	0.002a			13.78	(3)	0.003a
No formal education	11 (5.4)	8 (3.9)	Ref	–				Ref	–
Elementary school	26 (12.7)	15 (7.4)	1.26	(0.42, 3.83)	0.17	(1)	0.683	1.22	(0.37, 4.02)	0.11	(1)	0.743
High school	92 (45.1)	15 (7.4)	4.46	(1.54, 12.90)	7.62	(1)	0.006	5.38	(1.59, 18.14)	7.35	(1)	0.007a
Diploma/degree/postgraduate	33 (16.2)	4 (2.0)	6.00	(1.51, 23.87)	6.47	(1)	0.011	6.67	(1.37, 32.37)	5.54	(1)	0.019a
Marital status					6.57	(3)	0.087			8.97	(3)	0.030a
Single	21 (10.3)	8 (3.9)	Ref	–				Ref	–
Married	134 (65.7)	28 (13.7)	1.82	(0.73, 4.53)	1.67	(1)	0.196	2.18	(0.81, 5.87)	2.37	(1)	0.123
Widow	3 (1.5)	3 (1.5)	0.38	(0.06, 2.29)	1.11	(1)	0.292	0.27	(0.04, 1.92)	1.71	(1)	0.191
Divorced	4 (2.0)	3 (1.5)	0.51	(0.09, 2.79)	0.61	(1)	0.436	0.37	(0.05, 2.59)	1.00	(1)	0.317
Employment status
Employed	61 (29.9)	18 (8.8)	0.81	(0.40, 1.60)	0.38	(1)	0.538
Unemployed	101 (49.5)	24 (11.8)	Ref
Monthly income					0	(2)	1.000
<RM2501	126 (61.8)	42 (20.6)	Ref	–
RM2501–RM5000	26 (12.7)	0 (0)	>999	(0)	0	(1)	0.998
RM5000–RM10000	10 (4.9)	0 (0)	>999	(0)	0	(1)	0.999

Notes: Higher preference level: medium scores (3–5) and high scores (6–7) of KHOS-I; lower preference level: low scores (≤2) of KHOS-I.

a Indicates the predictor(s) with significant difference.

Abbreviations: OR, odds ratio; CI, confidence interval.

Table 7 Association between patients’ sociodemographic characteristics and patients’ preference of behavior involvement

Characteristics of patients	Higher preference level n=79	Lower preference level n=125	Univariate analysis
	n (%)	n (%)	Crude OR (95% CI)		χ^2-statistics (df)		p-value
Age (years)					1.00	(3)	0.802
21–40	12 (5.9)	19 (9.3)	Ref	–
41–60	43 (21.1)	67 (32.8)	1.02	(0.45, 2.30)	0	(1)	0.969
61–80	22 (10.8)	38 (18.6)	0.92	(0.38, 2.24)	0.04	(1)	0.849
>80	2 (1.0)	1 (0.5)	3.17	(0.26, 38.85)	0.81	(1)	0.367
Ethnicity					1.91	(3)	0.591
Malay	43 (21.1)	76 (37.3)	0.77	(0.35, 1.68)	0.44	(1)	0.510
Chinese	21 (10.3)	26 (12.7)	1.10	(0.45, 2.69)	0.04	(1)	0.841
Indian	14 (6.9)	19 (9.3)	Ref	–
Others	1 (0.5)	4 (2.0)	0.34	(0.03, 3.38)	0.85	(1)	0.356
Religion					3.32	(3)	0.345
Muslim	45 (22.1)	77 (37.7)	0.78	(0.34, 1.79)	0.34	(1)	0.558
Buddhist	19 (9.3)	21 (10.3)	1.21	(0.46, 3.19)	0.14	(1)	0.705
Hindu	12 (5.9)	16 (7.8)	Ref	–
Others	3 (1.5)	11 (5.4)	0.36	(0.08, 1.60)	1.80	(1)	0.180
Educational qualification					1.18	(3)	0.758
No formal education	6 (2.9)	13 (6.4)	Ref	–
Elementary school	14 (6.9)	27 (13.2)	1.12	(0.35, 3.59)	0.04	(1)	0.844
High school	43 (21.1)	64 (31.4)	1.46	(0.51, 4.13)	0.50	(1)	0.480
Diploma/degree/postgraduate	16 (7.8)	21 (10.3)	1.65	(0.52, 5.30)	0.71	(1)	0.399
Marital status					2.07	(3)	0.559
Single	11 (5.4)	18 (8.8)	Ref	–
Married	63 (30.9)	99 (48.5)	1,040.33	(0.46, 2.35)	0.01	(1)	0.922
Widow	1 (0.5)	5 (2.5)	2.18	(0.03, 3.18)	0.93	(1)	0.336
Divorced	4 (2.0)	3 (1.5)		(0.41, 11.64)	0.83	(1)	0.361
Employment status
Employed	37 (18.1)	42 (20.6)	1.74	(0.98, 3.10)	3.55	(1)	0.060
Unemployed	42 (20.6)	83 (40.7)	Ref	–
Monthly income					0.71	(2)	0.701
<RM2501	65 (31.9)	103 (50.5)	Ref	–
RM2501–RM5000	9 (4.4)	17 (8.3)	0.84	(0.35, 1.99)	0.16	(1)	0.691
RM5000–RM10000	5 (2.5)	5 (2.5)	1.59	(0.44, 5.69)	0.50	(1)	0.480

Notes: Higher preference level: medium scores (3–4) and high scores (5–9) of KHOS-B; lower preference level: low scores (≤2) of KHOS-B.

Abbreviations: OR, odds ratio; CI, confidence interval.