Paper
Saturday, July 14, 2007
Making Difficult Choices: When Breast Cancer Strikes Again
Penny F. Pierce, PhD, RN, FAAN, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| Learning Objective #1: identify the decision hazards involved when making treatment choices for recurrent breast cancer. |
| Learning Objective #2: understand how hindsight and optimistic biases influence the quality of future decisions. |
Very little research has been devoted to understanding the decisional challenges women face when cancer returns to threaten their lives once more. It is not known if the decision making experience at the initial diagnosis supports or impairs the capacity to make decisions regarding recurrent disease. Further, it is not known if the occurrence of recurrent disease causes a detrimental post-decision appraisal such as guilt, remorse, or regret concerning the decisions made for early stage cancer. The purpose is to close the gaps in our knowledge regarding the decision making experiences, challenges, and frustrations of women when breast cancer recurs to develop tailored decision support interventions to enhance decision quality and psychological well being. Using a qualitative approach, the theoretically challenging task is to find an explanation that accounts for the relative ease with which some women make a complicated and serious medical decision, and the overwhelmingly difficult and stressful experience of others. Intensive face-to-face interviews with 50 women at the time of diagnosis provide an elaborated description of decision behavior when facing recurrent cancer. Using the constant comparative method, the analysis furthers our understanding of how the initial decision making process shapes the confrontation with decisions inherent in recurrent disease, and how it informs our understanding regarding hindsight bias, regret, decision satisfaction, and resilience in the face of this life-threatening disease. Analysis of these data reveal ways in which naturalistic (unaided) decision processes express optimistic bias (looking ahead) and hindsight bias (looking back). Narratives inform us of the ways in which decision making processes and cognitive biasing influences decisional quality and psychological coping. Clinically, it is important to understand the processes which lead women to select unnecessarily aggressive therapies or decline therapy altogether form a sense of despair rather than reasoned deliberation.