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Lesley F. Degner, RN, PhD; Linda J. Kristjanson, RN, PhD; David Bowman, MD; Jeffrey A. Sloan, PhD; K. C. Carriere, PhD; John O'Neil, PhD; Barbara Bilodeau, MN; Peter Watson, MB, FRCPC; Bryan Mueller, RN, BN

JAMA. 1997;277(18):1485-1492.

Abstract
Objective.
—To determine the degree of involvement women with breast cancer wanted in medical decision making, extent to which they believed they had achieved their preferred level of involvement, and types of information they judged to be most important.

Design and Setting.
—Cross-sectional survey at 2 tertiary oncology referral clinics and 2 community hospital oncology clinics in Winnipeg, Manitoba.

Patients.
—Consecutive sample of 1012 women with a confirmed diagnosis of breast cancer who were scheduled for a visit at 1 of 4 hospital oncology clinics.

Main Outcome Measures.
—The following measures were used: (1) Preferences about various levels of participation in treatment decision making; (2) the extent to which subjects believed they had achieved their preferred levels of involvement in decision making; and (3) priority needs for information and how these needs differed by selected sociodemographic, disease, and treatment variables.

Results.
—A total of 22% of women wanted to select their own cancer treatment, 44% wanted to select their treatment collaboratively with their physicians, and 34% wanted to delegate this responsibility to their physicians. Only 42% of women believed they had achieved their preferred level of control in decision making. The 2 most highly ranked types of information were related to knowing about chances of cure and spread of disease. Women younger than 50 years rated information about physical and sexual attractiveness as more important than did older women (P<.001); women older than 70 years rated information about self-care as more important than did younger women (P=.002); and women who had a positive family history of breast cancer rated information about family risk as more important than did other women (P=.03).

Conclusions.
—The substantial discrepancy between women's preferred and attained levels of involvement in treatment decision making suggests that systematic approaches to assess and respond to women's desired level of participation in treatment decision making need to be evaluated. Priorities for information identified in this study provide an empirical basis to guide communication with women seeking care for breast cancer.

Author Affiliations
From the Faculty of Nursing (Drs Degner, Kristjanson, and Sloan, and Mr Mueller), Departments of Internal Medicine (Dr Bowman and Ms Bilodeau), Community Health Sciences (Dr O'Neil), and Pathology (Dr Watson), Faculty of Medicine, University of Manitoba, and Manitoba Cancer Treatment and Research Foundation (Dr Bowman and Ms Bilodeau), Winnipeg; and Department of Mathematical Sciences, University of Alberta, Edmonton (Dr Carriere).

Footnotes
Reprints: Lesley F. Degner, RN, PhD, St Boniface General Hospital Research Centre, 351 Taché Ave, Winnipeg, Manitoba, Canada R2H 2A6.

The Patient-Physician Relationship section editor: Richard M. Glass, MD, Deputy Editor, JAMA.

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