INCREASING PATIENT INVOLVEMENT IN CHOOSING TREATMENT FOR EARLY BREAST-CANCER

Background. This investigation examined factors affecting patient invo lvement in consultations to decide local treatment for early breast ca ncer and the effectiveness of two methods of preconsultation education aimed at increasing patient participation in these discussions. Metho ds. Sixty patients with Stage I or II breast cancer (1) were pretested on their knowledge about breast cancer treatment and optimism for the future, (2) were randomly assigned to one of two methods for preconsu ltation education: interactive multimedia program or brochure, (3) com pleted knowledge and optimism measures, (4) consulted with a medical o ncologist, radiation oncologist, and general surgeon, and (5) complete d self-report measures assessing their involvement in the consultation s and control over decision-making. The consultations were audiorecord ed and analyzed to identify behavioral indicators of patient involveme nt (question-asking, opinion-giving, and expressing concern) and physi cian utterances encouraging patient participation. Results. College-ed ucated patients younger than 65 years of age were more active particip ants in these consultations than were older, less educated patients. I n addition, patients showed more involvement when they interacted with physicians who encouraged and facilitated patient participation, The method of education did not affect patient involvement although patien ts tended to learn more about breast cancer treatment after using the multimedia program than after reading the brochure. Conclusions. Altho ugh patients vary in their expressiveness, physicians may be able to i ncrease patient participation in deciding treatment by using patient-c entered behavior. Also, preconsultation education appears to be an eff ective clinical strategy for helping patients gain an accurate underst anding of their treatment options before meeting with physicians.