TY - JOUR
T1 - Patient and Family Caregiver Considerations When Selecting Early Breast Cancer Treatment
T2 - Implications for Clinical Pathway Development
AU - Schulman-Green, Dena
AU - Cherlin, Emily
AU - Capasso, Renee
AU - Mougalian, Sarah S.
AU - Wang, Shiyi
AU - Gross, Cary P.
AU - Bajaj, Preeti S.
AU - Eakle, Katherine
AU - Patel, Sharmi
AU - Douglas, Karin
AU - Adelson, Kerin
N1 - Funding Information:
Dr. Schulman-Green received funds from Genentech, Inc. to help conduct this study, including manuscript preparation and travel to present research findings. Dr. Cherlin received funds from Genentech, Inc. to help conduct this study, including manuscript preparation. Dr. Mougalian declares research funding to her institution provided by Genentech and Pfizer, and consulting services to Eisai, Celgene, and Bristol Myers Squibb. Dr. Wang received funds from Genentech, Inc. to help conduct this study. Dr. Gross declares funding support from the National Comprehensive Cancer Network, Johnson and Johnson, Pfizer, and Flatiron. Drs. Bajaj, Eakle, and Patel are employed by Genentech, Inc. Dr. Adelson received funds from Genentech, Inc. to conduct this study, and has consulted for Celgene, Huron Pharmaceutials, and Roche Diagnostics. Mrs. Capasso and Mrs. Douglas have no conflicts of interest to report.
Funding Information:
This study was funded by Genentech, Inc. Acknowledgements
Publisher Copyright:
© 2020, Springer Nature Switzerland AG.
PY - 2020/12
Y1 - 2020/12
N2 - Background: While clinical pathways have been widely adopted to decrease variation in cancer treatment patterns, they do not always incorporate patient and family caregiver perspectives. We identified shared patient and family caregiver considerations influencing treatment preferences/decision making to inform development of a shared decision pathway. Methods: We conducted qualitative interviews with women who completed initial definitive treatment for stage I–III breast cancer and their family caregivers. As part of a broader interview, we asked participants what they considered when choosing a treatment option for themselves/their loved one. We coded transcribed interviews, analyzed patient and family caregiver datasets separately, and compared findings. Findings Patients’ (n = 22) mean age was 55.7 years, whereas family caregivers’ (n = 20) mean age was 59.5 years, with most (65%) being patients’ spouses/partners. Considerations reported by both groups included cancer status, treatment issues, physical/psychosocial/family consequences, and provider/health care system issues. Data revealed three key tensions that arise during treatment decision making: (1) having enough information to set expectations but not so much as to be overwhelming; (2) balancing the highest likelihood of cure with potential physical/emotional/social/financial consequences of the chosen treatment; and (3) wanting to make data-driven decisions while having a personalized treatment plan. Discussion: Patients and family caregivers identified several considerations of shared relevance reflecting different perspectives. Efforts to balance considerations can produce tensions that may contribute to decision regret if unaddressed. Conclusion: Clinical pathways can increase exposure to decision regret if treatment options are selected without consideration of patients’ priorities. A shared decision pathway that incorporates patient-centeredness could facilitate satisfactory decision making.
AB - Background: While clinical pathways have been widely adopted to decrease variation in cancer treatment patterns, they do not always incorporate patient and family caregiver perspectives. We identified shared patient and family caregiver considerations influencing treatment preferences/decision making to inform development of a shared decision pathway. Methods: We conducted qualitative interviews with women who completed initial definitive treatment for stage I–III breast cancer and their family caregivers. As part of a broader interview, we asked participants what they considered when choosing a treatment option for themselves/their loved one. We coded transcribed interviews, analyzed patient and family caregiver datasets separately, and compared findings. Findings Patients’ (n = 22) mean age was 55.7 years, whereas family caregivers’ (n = 20) mean age was 59.5 years, with most (65%) being patients’ spouses/partners. Considerations reported by both groups included cancer status, treatment issues, physical/psychosocial/family consequences, and provider/health care system issues. Data revealed three key tensions that arise during treatment decision making: (1) having enough information to set expectations but not so much as to be overwhelming; (2) balancing the highest likelihood of cure with potential physical/emotional/social/financial consequences of the chosen treatment; and (3) wanting to make data-driven decisions while having a personalized treatment plan. Discussion: Patients and family caregivers identified several considerations of shared relevance reflecting different perspectives. Efforts to balance considerations can produce tensions that may contribute to decision regret if unaddressed. Conclusion: Clinical pathways can increase exposure to decision regret if treatment options are selected without consideration of patients’ priorities. A shared decision pathway that incorporates patient-centeredness could facilitate satisfactory decision making.
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U2 - 10.1007/s40271-020-00426-7
DO - 10.1007/s40271-020-00426-7
M3 - Article
C2 - 32508006
AN - SCOPUS:85086125143
SN - 1178-1653
VL - 13
SP - 683
EP - 697
JO - Patient
JF - Patient
IS - 6
ER -