DOING NOTHING IS NO CHOICE - LAY CONSTRUCTIONS OF TREATMENT DECISION-MAKING AMONG WOMEN WITH EARLY-STAGE BREAST-CANCER

Open-ended personal interviews were conducted with 20 women with early stage breast cancer attending a regional cancer centre in Southwester n Ontario. We explored three related issues: (1) the extent to which t hese women perceived that they had treatment options; (2) their unders tanding of treatment benefits and risks; and (3) the role they wanted for themselves and their oncologists in treatment decision-making. We found, first, that many women who were presented with the choice to un dergo some form of adjuvant treatment versus no treatment felt that 'd oing nothing was no choice'. Second, when interpreting probabilistic i nformation on treatment benefits and risks, some women retained the id ea of probability but thought that they personally would beat the odds . Others transformed the information to make it more personally meanin gful, and still others assessed their risk status by comparing themsel ves with friends or relatives having the same disease. Third, many wom en preferred some form of shared treatment decisionmaking process with their oncologists. Women perceived treatment decisions as either 'rig ht' or 'wrong' which raised the issue of blame for a 'bad' decision sh ould the cancer return. Implications of these findings for clinical pr actice and for models of treatment decision-making are discussed.