Factors influencing the surgery intentions and choices of women with early breast cancer: the predictive utility of an extended theory of planned behaviour

Stephanie Sivell, Glyn Elwyn, Adrian Edwards, Antony S R Manstead, BresDex group, Lisa Caldon, Karen Collins, T J Day, Anne Donald, Rhodri Evans, Julietta Patnick, Malcolm W R Reed, Veronica Rogers, Stephanie Sivell, Glyn Elwyn, Adrian Edwards, Antony S R Manstead, BresDex group, Lisa Caldon, Karen Collins, T J Day, Anne Donald, Rhodri Evans, Julietta Patnick, Malcolm W R Reed, Veronica Rogers

Abstract

Background: Women diagnosed with early breast cancer (stage I or II) can be offered the choice between mastectomy or breast conservation surgery with radiotherapy due to equivalence in survival rates. A wide variation in the surgical management of breast cancer and a lack of theoretically guided research on this issue highlight the need for further research into the factors influencing women's choices. An extended Theory of Planned Behaviour (TPB) could provide a basis to understand and predict women's surgery choices. The aims of this study were to understand and predict the surgery intentions and choices of women newly diagnosed with early breast cancer, examining the predictive utility of an extended TPB.

Methods: Sixty-two women recruited from three UK breast clinics participated in the study; 48 women, newly diagnosed with early breast cancer, completed online questionnaires both before their surgery and after accessing an online decision support intervention (BresDex). Questionnaires assessed views about breast cancer and the available treatment options using items designed to measure constructs of an extended TPB (i.e., attitudes, subjective norms, perceived behavioural control, and anticipated regret), and women's intentions to choose mastectomy or BCS. Objective data were collected on women's choice of surgery via the clinical breast teams. Multiple and logistic regression analyses examined predictors of surgery intentions and subsequent choice of surgery.

Results: The extended TPB accounted for 69.9% of the variance in intentions (p <.001); attitudes and subjective norms were significant predictors. Including additional variables revealed anticipated regret to be a more important predictor than subjective norms. Surgery intentions significantly predicted surgery choices (p <.01).

Conclusions: These findings demonstrate the utility of an extended TPB in predicting and understanding women's surgery intentions and choices for early breast cancer. Understanding these factors should help to identify key components of interventions to support women while considering their surgery options.

References

    1. Fisher B, Anderson S, Bryant J, Margolese R, Deutsch M, Fisher E, Jeong J, Wolmark N. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233–1241. doi: 10.1056/NEJMoa022152.
    1. Fallowfield L. Offering choice of surgical treatment to women with breast cancer. Patient Educ Couns. 1997;30(3):209–214. doi: 10.1016/S0738-3991(96)00947-0.
    1. Caldon LJM, Collins KA, Wilde DJ, Ahmedzai SH, Noble TW, Stotter A, Sibbering DM, Holt S, Reed MWR. Why do hospital mastectomy rates vary? Differences in the decision-making experiences of women with breast cancer. Br J Cancer. 2011;104(10):1551–1557. doi: 10.1038/bjc.2011.141.
    1. Nattinger AB, Hoffmann RG, Howell-Pelz A, Goodwin JS. Effect of Nancy Reagan’s mastectomy on choice of surgery for breast cancer by US women. JAMA. 1998;279(10):762–766. doi: 10.1001/jama.279.10.762.
    1. Caldon LJM, Walters SJ, Reed JA, Murphy A, Worley A, Reed MWR. Case-mix fails to explain variation in mastectomy rates: management of screen-detected breast cancer in a UK region 1997–2003. Br J Cancer. 2005;92(1):55–59. doi: 10.1038/sj.bjc.6602264.
    1. Ajzen I. In: Action-control: From cognition to behavior. Kuhl J, Beckmann J, editor. Heidelberg, Germany: Springer; 1985. From intentions to actions: a theory of planned behaviour; pp. 11–39.
    1. Ajzen I. The theory of planned behaviour. Organ Behav Hum Decis Process. 1991;50:179–211. doi: 10.1016/0749-5978(91)90020-T.
    1. Swainston K, Campbell C, van Wersch A, Durning P. Treatment decision making in breast cancer: a longitudinal exploration of women’s experience. Br J Health Psychol. 2011;17(1):155–170.
    1. Franks HM, Roesch SC. Appraisals and coping in people living with cancer: a meta-analysis. Psychooncology. 2006;15(12):1027–1037. doi: 10.1002/pon.1043.
    1. Cimprich B. Pretreatment symptom distress in women newly diagnosed with breast cancer. Cancer Nurs. 1999;22(3):185–194. doi: 10.1097/00002820-199906000-00001.
    1. Ballinger RS, Mayer KF, Lawrence G, Fallowfield L. Patients’ decision-making in a UK specialist centre with high mastectomy rates. Breast. 2008;17(6):574–579. doi: 10.1016/j.breast.2008.08.001.
    1. Dixon J, Mak C. Predictors of mastectomy in a certified breast center: the surgeon is an independent risk factor. Breast J. 2008;14:321–323. doi: 10.1111/j.1524-4741.2008.00591.x.
    1. Lantz PM, Janz NK, Fagerlin A, Schwartz K, Liu L, Lakhani I, Morrow M, Katz SJ. Satisfaction with surgery outcomes and the decision process in a population-based sample of women with breast cancer. Health Serv Res. 2005;40(3):745–768. doi: 10.1111/j.1475-6773.2005.00383.x.
    1. Molenaar S, Oort F, Sprangers M, Rutgers E, Luiten E, Mulder J, De Haes H. Predictors of patients’ choices for breast-conserving therapy or mastectomy: a prospective study. Br J Cancer. 2004;90(11):2123–2130.
    1. Roberts CS, Cox CE. Medical and psychosocial treatment issues in breast cancer in older women. J Gerontol Soc Work. 1997;28(4):63–74. doi: 10.1300/J083v28n04_05.
    1. Halkett GKB, Arbon P, Scutter SD, Borg M. The experience of making treatment decisions for women with early stage breast cancer. Eur J Cancer Care. 2005;14:249–255. doi: 10.1111/j.1365-2354.2005.00565.x.
    1. Hughes K. Decision making by patients with breast cancer: the role of information in treatment selection. Oncol Nurs Forum. 1993;20:623–628.
    1. Smitt MC, Heltzel M. Women’s use of resources in decision-making for early-stage breast cancer: results of a community-based survey. Ann Surg Oncol. 1997;4(7):564–569. doi: 10.1007/BF02305537.
    1. McKinlay J, Burns R, Durante R, Feldman HA, Freund KM, Harrow BS, Irish JT, Kasten LE, Moskowitz MA. Patient, physician and presentational influences on clinical decision making for breast cancer: results from a factorial experiment. J Eval Clin Pract. 1997;3:23–57. doi: 10.1111/j.1365-2753.1997.tb00067.x.
    1. Katz SJ, Lantz PM, Janz NK, Fagerlin A, Schwartz K, Liu L, Deapen D, Salem B, Lakhani I, Morrow M. Patient involvement in surgery treatment decisions for breast cancer. J Clin Oncol. 2005;23(24):5526–5533. doi: 10.1200/JCO.2005.06.217.
    1. McVea KL, Minier WC, Johnson Palensky JE. Low-income women with early-stage breast cancer: physician and patient decision-making styles. Psychooncology. 2001;10(2):137–146. doi: 10.1002/pon.503.
    1. Osborn GD, Hodin M, Drew PJ, Fielder H, Vaughan-Williams E, Sweetland HM. Patient demographics and treatment for early breast cancer: an observational study. Breast. 2006;15(3):377–81. doi: 10.1016/j.breast.2005.07.004.
    1. Schwartz MD, Peshkin BN, Hughes C, Main D, Isaacs C, Lerman C. Impact of BRCA1/BRCA2 mutation testing on psychologic distress in a clinic-based sample. J Clin Oncol. 2002;20(2):514–520. doi: 10.1200/JCO.20.2.514.
    1. Sivell S, Edwards A, Elwyn G, Manstead ASR. Understanding surgery choices for breast cancer: how might the theory of planned behaviour and the common sense model contribute to decision support interventions? Heal Expect. 2011;14(S1):6–19.
    1. Ajzen I, Fishbein M. Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice Hall; 1980.
    1. Fishbein M, Ajzen I. Belief, attitude, intention and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley; 1975.
    1. Ajzen I. The theory of planned behaviour: reactions and reflections. Psychol Health. 2011;26(9):1113–1127. doi: 10.1080/08870446.2011.613995.
    1. McEachan RRC, Conner M, Taylor NJ, Lawton RJ. Prospective prediction of health-related behaviours with the theory of planned behaviour: a meta-analysis. Health Psychol Rev. 2011;5(2):97–144. doi: 10.1080/17437199.2010.521684.
    1. Mason TE, White KM. Applying an extended model of the theory of planned behaviour to breast self-examination. J Health Psychol. 2008;13(7):946–955. doi: 10.1177/1359105308095069.
    1. Manning M, Bettencourt A. Depression and medication adherence among breast cancer survivors: bridging the gap with the theory of planned behaviour. Psychol Health. 2011;26(9):1173–1187. doi: 10.1080/08870446.2010.542815.
    1. Drossaert CHC, Boer H, Seydel ER. Prospective study on the determinants of repeat attendance and attendance patterns in breast cancer screening using the theory of planned behaviour. Psychol Health. 2003;18:551–565. doi: 10.1080/0887044031000141207.
    1. Kasper J, Köpke S, Fischer K, Schäffler N, Backhus I, Solari A, Heesen C. Applying the theory of planned behaviour to multiple sclerosis patients' decisions on disease modifying therapy - questionnaire concept and validation. BMC Med Inform Decis Mak. 2012;12:60. doi: 10.1186/1472-6947-12-60.
    1. Sandberg T, Conner M. Anticipated regret as an additional predictor in the theory of planned behaviour: a meta-analysis. Br J Soc Psychol. 2008;47:589–606. doi: 10.1348/014466607X258704.
    1. Sivell S, Edwards A, Manstead ASR, Reed MWR, Caldon L, Collins K, Clements A, Elwyn G. on behalf of the BresDex group. Increasing readiness to decide and strengthening behavioral intentions: evaluating the impact of a web-based patient decision aid for breast cancer treatment options (BresDex: ) Patient Educ Couns. 2012;88(2):209–17. doi: 10.1016/j.pec.2012.03.012.
    1. Ajzen I, Fishbein M. The prediction of behavioural intentions in a choice situation. J Exp Soc Psychol. 1969;5:400–416. doi: 10.1016/0022-1031(69)90033-X.
    1. Lam W, Fielding R, Chan M, Chow L, Ho E. Participation and satisfaction with surgical treatment decision-making in breast cancer among Chinese women. Breast Cancer Res Treat. 2003;80(2):171–80. doi: 10.1023/A:1024568732213.
    1. Maly RC, Umezawa Y, Ratliff CT, Leake B. Racial/ethnic group differences in treatment decision-making and treatment received among older breast carcinoma patients. Cancer. 2006;106(4):957–965. doi: 10.1002/cncr.21680.
    1. Armitage CJ, Conner M. Efficacy of the theory of planned behaviour: a meta-analytic review. Br J Soc Psychol. 2001;40(4):471–499. doi: 10.1348/014466601164939.

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