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Advanced Breast Cancer Patients' Perceptions of Decision Making for Palliative Chemotherapy

From the Department of Psychology and Cancer Research, United Kingdom London Psychosocial Group, Institute of Psychiatry, King’s College, London; Lynda Jackson Macmillan Centre, Mount Vernon Hospital, Northwood; School of Health Sciences and Social Care, Brunel University, Isleworth, Middlesex, United Kingdom.

Address reprint requests to Elizabeth Grunfeld, PhD, Section of Health Psychology, Department of Psychology, 5th Fl, Thomas Guy House, Guy's Hospital, London, SE1 9RT, United Kingdom; e-mail: beth.grunfeld{at}kcl.ac.uk

PURPOSE: To examine advanced breast cancer patients' perceptions of the key decision-making consultation for palliative chemotherapy.

PATIENTS AND METHODS: One hundred two women with advanced breast cancer, who were offered palliative chemotherapy, participated in a study-specific semistructured interview examining perceptions of the information they had received and their involvement in the decision-making process. One hundred seventeen interviews included 70 in relation to first-line chemotherapy and 47 in relation to second-line chemotherapy (15 patients were interviewed in relation to both first- and second-line chemotherapy).

RESULTS: Eighty-six percent of patient interviews (n = 101) reported patient satisfaction with the information they received, and 91% (n = 106) reported satisfaction with the decision-making process. Factors most influential in decisions to accept chemotherapy were the possibility of controlling the tumor (45%, n = 53 of patient interviews) and providing hope (33%, n = 28 of patient interviews; 19%, n = 13 being offered first-line chemotherapy v 43%, n = 20 being offered second-line chemotherapy; P = .006). Thirty-eight percent of patient interviews (n = 44) reported the patient as taking an active role in the decision-making process (33%, n = 23 at first-line chemotherapy v 43%, n = 20 at second-line chemotherapy; P = .06).

CONCLUSION: Women offered second-line chemotherapy were more likely to undergo chemotherapy because of the hope it offers and were more likely to take an active role in that decision compared with women who were offered first-line chemotherapy. Compassionate and honest communication about prognosis and likelihood of benefit from treatment may help to close the gap between hope and expectation and enable patients to make fully informed decisions about palliative chemotherapy.

Supported through project Grant No. NCO/GO1 from the National Health Services Cancer Research and Development Programme and by Cancer Research UK.

Presented in part at the 2nd Annual Conference of the American Psychosocial Oncology Society, Phoenix, AZ, January 27-29, 2005.

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

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