Experiencing Breast Cancer Treatment Decision-making in Managed Care

Paper

Wednesday, 19 July 2006

This presentation is part of : International Perspectives on the Individual Cancer Experience

Jennifer A. Wenzel, PhD, RN, CCM, School of Nursing, Johns Hopkins University, Baltimore, MD, USA

The purpose of this study was to examine patients’ experiences related to cancer treatment in managed care. Patients’ experiences with cancer treatment decision-making in managed care organizations (MCO) were also explored.

This study used a hermeneutic/phenomenological approach, relying on 21 semi-structured interviews with 14 managed care enrollees diagnosed with breast cancer. Interviews were conducted during at least one of the following points: (1) diagnosis (2) treatment, and (3) post-treatment/follow-up. Participants had cancer requiring treatment, were ³18 years, were literate/articulate in English, and had been enrolled in their MCO ³ 1 year. Analysis was accomplished through a reflexive process of transcript review, categorization and interpretation.

Findings are presented as three themes: “the cancer process”, “managed care tasks” and “managing between the MCO and the cancer” which depict the increased burden of women experiencing breast cancer in managed care. Women described a limited desire to participate in treatment-related decisions other than selecting a treating physician and facility. They also realized that these decisions can be limited by the MCO. They reported treatment decisions, which they felt less comfortable making, required the most active participation on their part. Women in this study perceived they were solely accountable for all issues occurring between their cancer treatment and the MCO. They also believed they had high responsibility with few resources related to decision-making. Although enrolled in less restrictive managed care plans, these women expressed difficulty, frustration and fatigue in managing the dissimilar and disconnected demands of the cancer and the MCO as well as in treatment decision-making. This distress may interfere with women’s ability to “map out” the future.

This research provides information which may serve as a basis for policy and practice changes to decrease the distress and burden experienced by cancer patients in managed care. Findings may also direct cancer support interventions.

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