A Qualitative Study of Breast Cancer Treatment Decisions: Evidence for Five Decision-Making Styles

Abstract

Being diagnosed with breast cancer requires that women make a number of decisions about their medical treatments. To gain insight into the variety of forces that shape a woman's breast cancer treatment decisions, we conducted semistructured interviews with 44 breast cancer survivors. Through an interpretive analysis, we identified five treatment decision-making styles: (a) medical expert, (b) self-efficacy, (c) relationship embedded, (d) inhibition, and (e) constellation of information, which are differentiated by two dimensions: (a) low versus high information needs and (b) self versus other preferences.

Notes

¹We acknowledge differences in the circumstances and choices faced by women with cancers of different stages; however, we ultimately elected to be inclusive of the stages of breast cancer about which women were making treatment decisions because we saw this as being important to the formative work we were conducting. Moreover, all of the women in the study were confronted with a surgical treatment decision, except one woman who, at the time of the interview, had not yet been given a surgical treatment decision option. We saw this as a sign that although staging may present some variability in circumstances to breast cancer patients, there was some commonality among treatment options available to the women in our sample.

²We made the decision to include women in our study who were reporting on a breast cancer experience that occurred within months of our data collection to one that occurred more than 10 years ago for a number of reasons. First, in a prior study we conducted on breast cancer patients, we received feedback that women who experienced breast cancer more than 10 years ago were still profoundly affected by their breast cancer; moreover, they expressed regret that their experiences were being left out of current breast cancer research. A second reason that we elected to include women who have ever experienced a diagnosis of breast cancer in our sample is because research shows that people are able to recall highly emotional events with more clarity and detail than neutral events (Haman, 2001). Given the emotion-laden nature of a diagnosis of breast cancer, we reasoned that participants would be able to recall the circumstances surrounding their breast cancer diagnosis with accuracy.

³We carefully considered the inclusion of the four women who were reporting on a recurrence of breast cancer. Because we were interested in understanding the diversity of influences that could shape a breast cancer patient's treatment decision, we decided to include women who faced a recurrence of breast cancer because they could shed light on other influences not applying to women facing an initial diagnosis of breast cancer.

⁴The pie chart technique was selected for use because it allowed us to meet our goal of understanding the association between the forces that drive a woman's breast cancer treatment decision. Providing women with a blank pie chart offered women a venue for describing the influences on their treatment selection relative to other influences. Moreover, giving them the opportunity to represent these complex processes visually allowed them the chance to articulate an experience that is often hard to put into words. Thus, this approach is consistent with the work of some scholars who contend that the use of visual signs and signals can be used to help people express and redefine traumatic experiences (Pearson & Wilson, 2001) or intangible experiences more generally (Aron, Aron, & Smollan, 1992).

FIGURE 1 Sample pie chart for the relationship-embedded decision style. The pie chart offered a venue to identify influences steering the treatment decision and their relative weights (color figure available online).

⁵For additional samples of the pie charts that were analyzed, please contact the first author.

⁶Because the interviewer was unable to transcribe all quotes in their entirety onto the pie charts while the interviews were being conducted, portions of the interviews relevant to the current study were transcribed and used to supplement the analysis of the pie charts. Specifically, quotes were identified based on notes taken on the pie charts during the interviews and subsequently transcribed.

⁷For more information regarding circumplex models, see Gurtman and Pincus (2003).

⁸For details on the prevalence of each decision-making style within the data, please contact the first author.

⁹Pseudonyms were used in place of the participant's name to maintain her privacy. Pseudonyms were also used in place of the names of health care providers and friends or loved ones that were mentioned during the interviews.

¹⁰ Show Me: A Photo Collection of Breast Cancer Survivors’ Lumpectomies, Mastectomies, Breast Reconstructions and Thoughts on Body Image is a book produced by the breast cancer support group from the Penn State Milton S. Hershey Medical Center. The book shows typical surgical results for different procedures related to breast cancer. Specifically, the book offers pictures of women's breasts before and after their breast surgery.

¹¹The genesis of this label developed out of thinking about behavioral motivations systems (Carver & White, 1994). Specifically, the activation system prompts people to act to achieve rewards and the inhibition system prompts people to act to avoid costs.

¹²Although women following the constellation-of-information decision style did mention more sources of information, a one-way analysis of variance (ANOVA) revealed that interviews with these women were no longer than the women who followed the other model types (F(4, 39) = 1.33, p = .28). Thus, we ruled out the possibility that women following the constellation-of-information decision style merely spoke at greater lengths than women following other decision-making styles.