Doing nothing is no choice: lay constructions of treatment decision-making among women with early-stage breast cancer

被引:124
作者
Charles, C
Redko, C
Whelan, T
Gafni, A
Reyno, L
机构
[1] McMaster Univ, Dept Clin Epidemiol & Biostat, Ctr Hlth Econ & Policy Anal, Hamilton, ON L8N 3Z5, Canada
[2] McMaster Univ, Dept Sociol, Hamilton, ON L8S 4L8, Canada
[3] McGill Univ, Dept Anthropol, Montreal, PQ H3A 2T5, Canada
[4] McMaster Univ, Support Canc Care Res Unit, Hamilton, ON L8S 4L8, Canada
[5] OCTRF, Hamilton Reg Canc Ctr, Hamilton, ON, Canada
[6] McMaster Univ, Dept Med, Hamilton, ON L8S 4L8, Canada
关键词
shared decision-making; risk; patient preferences; lay perspectives; physician-patient relationship; breast cancer;
D O I
10.1111/1467-9566.00081
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Open-ended personal interviews were conducted with 20 women with early stage breast cancer attending a regional cancer centre in Southwestern Ontario. We explored three related issues: (1) the extent to which these women perceived that they had treatment options; (2) their understanding of treatment benefits and risks; and (3) the role they wanted for themselves and their oncologists in treatment decision-making. We found, first, that many women who were presented with the choice to undergo some form of adjuvant treatment versus no treatment felt that 'doing nothing was no choice'. Second, when interpreting probabilistic information on treatment benefits and risks, some women retained the idea of probability but thought that they personally would beat the odds. Others transformed the information to make it more personally meaningful, and still others assessed their risk status by comparing themselves with friends or relatives having the same disease. Third, many women preferred some form of shared treatment decisionmaking process with their oncologists. Women perceived treatment decisions as either 'right' or 'wrong' which raised the issue of blame for a 'bad' decision should the cancer return. Implications of these findings for clinical practice and for models of treatment decision-making are discussed.
引用
收藏
页码:71 / 95
页数:25
相关论文
共 72 条
[1]   The meaning of 6.8: Numeracy and normality in health information talks [J].
Adelsward, V ;
Sachs, L .
SOCIAL SCIENCE & MEDICINE, 1996, 43 (08) :1179-1187
[2]  
[Anonymous], 1983, Consumerism in Medicine
[3]  
[Anonymous], SOCIAL RES METHODS
[4]  
Beck Ulrich., 1992, Risk society: Towards a new modernity
[5]  
BEGIN M, 1991, CHEPA 4 ANN HLTH POL
[6]  
Blumer H., 1986, SYMB INTERACT
[7]   WHEN COMPETENT PATIENTS MAKE IRRATIONAL CHOICES [J].
BROCK, DW ;
WARTMAN, SA .
NEW ENGLAND JOURNAL OF MEDICINE, 1990, 322 (22) :1595-1599
[8]  
BROWN P, 1995, SOCIOLOGY HLTH ILLNE, V1
[9]   Coming to terms with the risk of breast cancer: Perceptions of women with primary relatives with breast cancer [J].
Chalmers, K ;
Thomson, K .
QUALITATIVE HEALTH RESEARCH, 1996, 6 (02) :256-282
[10]   LAY PARTICIPATION IN HEALTH-CARE DECISION-MAKING - A CONCEPTUAL-FRAMEWORK [J].
CHARLES, C ;
DEMAIO, S .
JOURNAL OF HEALTH POLITICS POLICY AND LAW, 1993, 18 (04) :881-904