Framing of outcome and probability of recurrence: Breast cancer patients' choice of adjuvant chemotherapy (ACT) in hypothetical patient scenarios

Purpose. To examine the effects of framing of outcome and probabilities of cancer occurrence on the treatment preference which breast cancer patients indicate for hypothetical patient scenarios. Methods. A modified version of the Decision Board Instrument (Levine et al. 1992) was administered to 35 breast cancer patients with past ACT experien ce. Patients expressed their choice regarding ACT for six scenarios which w ere characterized by either negative or positive framing of outcome and by one of the three levels of probability of recurrence (high, medium, low). Results. The framing had no influence on ACT choices over all three probabi lity levels. The majority chose ACT for high and medium risk and one third switched from ACT to No ACT in the low-risk condition. This switch was stat istically significant. Conclusion. Hypothetical treatment decisions against ACT occur only when th e probability of recurrence is low and the benefit of ACT is small. This fi nding for patients with past experience of ACT is similar to those reported for other oncological patient groups still in treatment.