Factors involved in treatment decision making for women diagnosed with ductal carcinoma in situ: A qualitative study

Amy Hatton; Natalie Heriot; John Zalcberg; Darshini Ayton; Jill Evans; David Roder; Boon H Chua; Jolyn Hersch; Jocelyn Lippey; Jane Fox; Christobel Saunders; G Bruce Mann; Jane Synnot; Robin J Bell

doi:10.1016/j.breast.2021.09.007

Factors involved in treatment decision making for women diagnosed with ductal carcinoma in situ: A qualitative study

Breast. 2021 Dec:60:123-130. doi: 10.1016/j.breast.2021.09.007. Epub 2021 Oct 1.

Authors

Amy Hatton¹, Natalie Heriot¹, John Zalcberg², Darshini Ayton³, Jill Evans⁴, David Roder⁵, Boon H Chua⁶, Jolyn Hersch⁷, Jocelyn Lippey⁸, Jane Fox⁹, Christobel Saunders¹⁰, G Bruce Mann⁸, Jane Synnot¹¹, Robin J Bell¹²

Affiliations

¹ Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia.
² Cancer Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia; Medical Oncology Unit, Alfred Health, 55 Commercial Rd, Melbourne, Victoria, 3004, Australia.
³ Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia.
⁴ BreastScreen Victoria, Australia.
⁵ Cancer Epidemiology and Population Health, University of South Australia, Australia.
⁶ Faculty of Medicine and Health, UNSW Sydney, Australia.
⁷ School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia.
⁸ Department of Surgery University of Melbourne, Australia.
⁹ Department of Surgery Monash University, Monash Health Clayton Road Clayton Victoria, Australia.
¹⁰ Department of Surgery, School of Medicine, University of Western Australia, Australia.
¹¹ Consumer Representative Breast Cancer Network Australia, Australia.
¹² Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia. Electronic address: robin.bell@monash.edu.

Abstract

Whilst some of the diversity in management of women with ductal carcinoma in situ (DCIS) may be explained by tumour characteristics, the role of patient preference and the factors underlying those preferences have been less frequently examined. We have used a descriptive qualitative study to explore treatment decisions for a group of Australian women diagnosed with DCIS through mammographic screening. Semi-structured telephone interviews were performed with 16 women diagnosed with DCIS between January 2012 and December 2018, recruited through the LifePool dataset (a subset of BreastScreen participants who have agreed to participate in research). Content analysis using deductive coding identified three themes: participants did not have a clear understanding of their diagnosis or prognosis; reported involvement in decision making about management varied; specific factors including the psychosexual impact of mastectomy and perceptions of radiotherapy, could act as barriers or facilitators to specific decisions about treatment. The treatment the women received was not simply determined by the characteristics of their disease. Interaction with the managing clinician was pivotal, however many other factors played a part in individual decisions. Recognising that decisions are not purely a function of disease characteristics is important for both women with DCIS and the clinicians who care for them.

Keywords: Content analysis; DCIS; Decision making; Ductal carcinoma in-situ; Qualitative methods.

MeSH terms

Australia
Breast Neoplasms* / diagnosis
Breast Neoplasms* / therapy
Carcinoma, Intraductal, Noninfiltrating* / surgery
Carcinoma, Intraductal, Noninfiltrating* / therapy
Decision Making
Female
Humans
Mastectomy