Originally published as JCO Early Release 10.1200/JCO.2006.07.1159 on September 18 2006

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What Is the Impact of Shared Decision Making on Treatment and Outcomes for Older Women With Breast Cancer?

Jeanne Mandelblatt, Barbara Kreling, Melissa Figeuriedo, Shibao Feng

From the Department of Oncology, Georgetown University Medical Center; and the Cancer Control Program at Lombardi Comprehensive Cancer Center, Washington, DC

Address reprint requests to Jeanne Mandelblatt, MD, MPH, Georgetown University, 3300 Whitehaven Blvd, Suite 4100, Washington, DC 20007; e-mail: mandelbj{at}georgetown.edu

PURPOSE: Shared decision making (SDM) has been recommended as a standard of care, especially when there are treatment alternatives or uncertainty in outcomes. However, we know little about use of SDM in cancer care, and even less is known about SDM in older patients. We describe patient and physician determinants of SDM in older women with breast cancer and evaluate whether SDM is associated with treatment patterns or short-term outcomes of care.

PATIENTS AND METHODS: Women age 67 or older treated for early stage breast cancer in 29 sites from five geographic regions comprise the study sample (N = 718). Data were obtained from patients by in-person and telephone interviews. Physician data were collected via survey, and medical records were reviewed to ascertain comorbidity and tumor characteristics. Random effects and logistic regression models were used to assess associations between SDM and other factors.

RESULTS: Women who were age 67 to 74 years (v 75 or older) were accompanied to consultation and who sought information reported the highest SDM, after considering covariates. While SDM was not associated with surgical treatment, greater SDM was associated with higher odds of having adjuvant treatment, controlling for clinical factors. Greater SDM was also associated with improved short-term satisfaction.

CONCLUSION: SDM plays an important role in the process of care for older women with breast cancer. Physicians treating this growing population have a simple, but powerful tool for improving outcomes within their grasp—spending time to engage and involve older women in their breast cancer care.

published online ahead of print at www.jco.org on September 18, 2006.

Supported by Grant No. RO1 HS 08395 from the Agency for HealthCare Research and Quality, Grant No. K05 CA96940 from the National Cancer Institute, and Grant No. KO7 AG191655 from the National Institute on Aging.

Presented at the 24th Annual Meeting of the American Society of Preventive Oncology, San Francisco, CA, March 15, 2005.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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