Incongruence between women's survey- and interview-determined decision control preferences: A mixed methods study of decision-making in metastatic breast cancer

作者：Ejem Deborah^*; Dionne Odom J Nicholas; Turkman Yasemin; Knight Sara J; Willis Dan; Kaufman Peter A; Bakitas Marie

来源：Psycho-Oncology, 2018, 27(8): 1950-1957.

DOI：10.1002/pon.4747

• advance care planning
• cancer
• decision support
• metastatic breast cancer
• oncology
• shared decision-making

ObjectiveWomen with metastatic breast cancer face numerous, complex treatment and advance care planning (ACP) decisions. Our aim was to develop a better understanding of women with metastatic breast cancer's decision-making preferences overtime and relative to specific types of decisions.
MethodsConvergent, parallel mixed-methods study. Participants completed the Control Preferences Scale (CPS) and a semi-structured interview of decision-making experiences at enrollment (T1; n=22) and when facing a decision or 3months later (T2; n=19). We categorized women's decision-making experience descriptions into one of the CPS decisional styles and compared them to their CPS response. We constructed an analytic grid that aligned the interview-determined treatment and ACP decisional preferences with the CPS categories at T1 and T2 and calculated Cohen's kappa coefficient and congruence percentages.
ResultsParticipants (n=22) were White (100%), averaged 62years, married (54%), retired (45%), and had a bachelor's degree (45%). Congruence between CPS response and interview-determined treatment preferences at T1 was 32% (kappa=0.083) and 33% (kappa=0.120) at T2. Congruence between CPS survey response and interview-determined ACP preferences at T1 was 22.7% (kappa =0.092) at T1 and 11% (kappa=0.011) at T2.
ConclusionsAlthough women selected a shared treatment decision-making style using the CPS validated tool, when interviewed their descriptions generally reflected a passive process in which they followed the oncologists' treatment suggestions. Future research should explore whether the incongruence between stated and actual decision-making style is a function of misinterpreting the CPS choices or a true inconsistency that could lead to adverse consequences such as decisional regret.

• 出版日期2018-8