Primary care provider-reported involvement in breast cancer treatment decisions.
Lauren P Wallner, Yun Li, M Chandler McLeod, Joan Gargaro, Allison W Kurian, Reshma Jagsi, Archana Radhakrishnan, Ann S Hamilton, Kevin C Ward, Sarah T Hawley, Steven J Katz
Author Information
Lauren P Wallner: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan. ORCID
Yun Li: Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.
M Chandler McLeod: Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.
Joan Gargaro: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Allison W Kurian: Department of Medicine, Stanford University, Stanford, California. ORCID
Reshma Jagsi: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. ORCID
Archana Radhakrishnan: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan. ORCID
Ann S Hamilton: Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California.
Kevin C Ward: Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia.
Sarah T Hawley: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan. ORCID
Steven J Katz: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
BACKGROUND: Treatment decisions for patients with early-stage breast cancer often involve discussions with multiple oncology providers. However, the extent to which primary care providers (PCPs) are involved in initial treatment decisions remains unknown. METHODS: A stratified random sample of PCPs identified by newly diagnosed patients with early-stage breast cancer from the Georgia and Los Angeles Surveillance, Epidemiology, and End Results registries were surveyed (n = 517; a 61% response rate). PCPs were asked how frequently they discussed surgery, radiation, and chemotherapy options with patients; how comfortable they were with these discussions; whether they had the necessary knowledge to participate in decision making; and what their confidence was in their ability to help (on 5-item Likert-type scales). Multivariate logistic regression was used to identify PCP-reported attitudes associated with more PCP participation in each treatment decision. RESULTS: In this sample, 34% of PCPs reported that they discussed surgery, 23% discussed radiation, and 22% discussed chemotherapy options with their patients. Of those who reported more involvement in surgical decisions, 22% reported that they were not comfortable having a discussion, and 17% did not feel that they had the necessary knowledge to participate in treatment decision making. PCPs who positively appraised their ability to participate were more likely to participate in all 3 decisions (odds ratio [OR] for surgery, 6.01; 95% confidence interval [CI], 4.16-8.68; OR for radiation, 8.37; 95% CI, 5.16-13.58; OR for chemotherapy, 6.56; 95% CI, 4.23-10.17). CONCLUSIONS: A third of PCPs reported participating in breast cancer treatment decisions, yet gaps in their knowledge about decision making and in their confidence in their ability to help exist. Efforts to increase PCPs' knowledge about breast cancer treatment options may be warranted.
