Women's decision styles and decision satisfaction related to their choice of surgical treatment for early breast cancer: implications for a systematic decision support role for nurses

Background: Over 13,000 Australian women are diagnosed with breast cancer each year. Women diagnosed with early breast cancer are generally asked by their doctor to choose between either mastectomy or breast conservation surgery with radiation therapy as initial treatment. Following a breast cancer diagnosis, women’s cognitive resources and abilities are often overloaded; subsequently they often feel distressed and confused about making the treatment choice between the surgical options offered to them. Women frequently turn to nurses for decision support and information at this time. Recently developed decision aids are available but these are not evidence-based nor do they assess women’s decision styles to profile individual decision support interventions. Research shows that women’s process for making decisions are affected not only by their decision styles but also by their levels of distress. This initial decision-making process and treatment decision ultimately affect women’s decision satisfaction and psychological outcomes. No published studies, nationally or internationally, have investigated the relationships between these variables. Research design and methods: The purpose of this prospective, longitudinal exploratory cohort study was to investigate the relationship between Queensland women’s decision styles and decision satisfaction, three to four months after their initial surgical treatment for early breast cancer. The non-probability sample of women (N = 132) were recruited from three locations in Queensland after women were diagnosed with early breast cancer and before treatment commenced. Data were collected using the Michigan Assessment of Decision Styles (MADS, Pierce 1995), and the Patient Treatment Decision Satisfaction questionnaire (PTDS) developed by the researcher (Budden & Pierce, 2001). The MADS questionnaire consists of 16 items describing patients’ pre-decision behaviours under the following four factors: Deferring Responsibility (_= 0.76); Avoidance (_= 0.63); Information Seeking (_= 0.80); and Deliberation (_= 0.85). The Patient Treatment Decision (TDS) questionnaire contains 16 items divided into three dimensions namely: Decision Process Satisfaction (_= 0.91); Decision Outcome Satisfaction (_= 0.95); and Global Decision Satisfaction (_= 0.95). Results: Data were analysed using descriptive and inferential statistics, which included stepwise multiple linear regression techniques. Specifically, a statistically significant positive relationship was identified between women’s decision styles and their decision satisfaction at three to four months (n = 104) following their initial surgery. A positive relationship was identified between women’s Information Seeking and Decision Process Satisfaction; Deliberation and Decision Outcome Satisfaction; Deferring Responsibility and Decision Outcome Satisfaction; and Deferring Responsibility and Global Decision Satisfaction. In contrast, a significant negative relationship was found between women’s Avoidance and Global Decision Satisfaction. The majority of women agreed, or strongly agreed, with all the Deliberation items (75.1%) and Deferring Responsibility items (84.8%). A smaller proportion (2.3%) of women agreed, or strongly agreed, with all the Avoidance items and the Information Seeking items (37.8%). Over half (53.7%) of the women agreed, or strongly agreed, with all the Decision Process Satisfaction items; 67.8% of women agreed, or strongly agreed, with all the Decision Outcome Satisfaction items; and 55.9% agreed, or strongly agreed, with all the Global Decision Satisfaction items. Conclusions: The major outcome of this research was the clear relationship between women’s decision styles to their decision satisfaction at three to four months following early breast cancer treatment. Nurses caring for women with breast cancer do not currently have any evidence-based assessment tools to guide decision support interventions based on women’s decision styles. The MADS instrument is an efficient and feasible assessment instrument that can be used by nurses to profile women’s decision styles to direct evidence-based decision support interventions. Thus, the delivery of individual decision support interventions by nurses using the MADS instrument can increase women’s post-treatment decision satisfaction following early breast cancer treatment. Clinical Implications: This study contributes to the discipline of nursing science by building evidence for best practice guidelines in the delivery of decision support interventions pre-treatment. The application of these guidelines will increase women’s decision satisfaction post-treatment after a diagnosis of early breast cancer. The ultimate goal of evidence-based decision support interventions provided by nurses is to improve women’s informed decision-making processes; minimise their psychological distress; and increase their decision satisfaction in selecting and following treatment for early breast cancer