Abstract
Introduction: Most breast cancer (BRC) cases are diagnosed at an early stage and can be treated with either breast-conserving therapy or mastectomy, followed by optional breast reconstruction. However, studies have indicated that mastectomy is more commonly performed than breast-conserving surgery among young women with BRC, despite the absence of significant difference in survival rates between the two surgical procedures [1,2]. Women undergoing mastectomy without breast reconstruction were likely to experience poorer physical health, body image, and sexual health compared with those undergoing breast reconstruction or breast-conserving surgery [3]. Value clarification helps patients make more informed clinical decisions [4], reducing decisional conflict and regret, thereby improving health-related quality of life.
Methods: A thorough literature review was firstly conducted to identify the most important factors affecting treatment decisions (i.e., treatment attributes). Then, we conducted qualitative interviews with women who had completed all active treatment for BRC (continuation of endocrine and/or maintenance therapy allowed) to explore other relevant attributes and levels of choice from their perspectives. A targeted sampling method based on age, education level, disease stage, and treatment modalities were used to recruit participants until data saturation achieved to ensure representativeness.
Results: A total of 19 women treated for BRC were recruited for the interviews. From the qualitative data and review findings, the treatment attributes included 10-year recurrence rate and side effects of each treatment, treatment costs, need for breast reconstruction, chance of receiving adjunctive radiotherapy, cosmetic outcomes, recovery time and possibility of re-operation. The participants were asked to prioritise the perceived level of importance as to how each treatment attribute affecting their treatment decisions, with scoring 0 as least important and 10 as most important. A consensus on the most crucial attributes with appropriate levels of choice has been achieved.
Conclusions: This value clarification exercise enables women diagnosed with BRC to weigh the pros and cons of treatment options, thereby helping them to make more informed clinical decisions. The next step will be construction of a discrete choice experiment survey by combining the established treatment attributes and different choice sets and administering to the target population for validation.
Notes
References:
1. Lovelace DL, McDaniel LR, Golden D. Long-term effects of breast cancer surgery treatment , and survivor care. J Midwifery Womens Health. 2019;64(6):713-24.
2. Ye JC, Yan W, Christos PJ, Nori D, Ravi A. Equivalent survival with mastectomy or breast-conserving surgery plus radiation in young women aged < 40 years with early-stage breast cancer: a national registry-based stage-by-stage comparison. Clin Breast Cancer. 2015;15(5):390-7.
3. Zehra S, Doyle F, Barry M, Walsh S, Kell MR. Health-related quality of life following breast reconstruction compared to total mastectomy and breast-conserving surgery among breast cancer survivors: a systematic review and meta-analysis. Breast Cancer. 2020;27(4):534-66.
4. Hawley ST, Newman L, Griggs JJ, Kosir MA, Katz SJ. Evaluating a decision aid for improving decision making in patients with early-stage breast cancer. Patient. 2016;9(2):161-9.
Sigma Membership
Pi Iota at-Large
Type
Poster
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Qualitative Research
Keywords:
Instrument and tool Development, Academic-clinical Partnership, Breast Cancer, Breast Cancer Treatment
Recommended Citation
Chow, Ka Ming; Chan, Carmen W. H.; Yeo, Winnie; Choi, Kai Chow; and Zhu, Jiemin, "Developing a Value Clarification Exercise for Identifying Preferences for Breast Cancer Treatment" (2025). International Nursing Research Congress (INRC). 73.
https://www.sigmarepository.org/inrc/2025/posters_2025/73
Conference Name
36th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Seattle, Washington, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Developing a Value Clarification Exercise for Identifying Preferences for Breast Cancer Treatment
Seattle, Washington, USA
Introduction: Most breast cancer (BRC) cases are diagnosed at an early stage and can be treated with either breast-conserving therapy or mastectomy, followed by optional breast reconstruction. However, studies have indicated that mastectomy is more commonly performed than breast-conserving surgery among young women with BRC, despite the absence of significant difference in survival rates between the two surgical procedures [1,2]. Women undergoing mastectomy without breast reconstruction were likely to experience poorer physical health, body image, and sexual health compared with those undergoing breast reconstruction or breast-conserving surgery [3]. Value clarification helps patients make more informed clinical decisions [4], reducing decisional conflict and regret, thereby improving health-related quality of life.
Methods: A thorough literature review was firstly conducted to identify the most important factors affecting treatment decisions (i.e., treatment attributes). Then, we conducted qualitative interviews with women who had completed all active treatment for BRC (continuation of endocrine and/or maintenance therapy allowed) to explore other relevant attributes and levels of choice from their perspectives. A targeted sampling method based on age, education level, disease stage, and treatment modalities were used to recruit participants until data saturation achieved to ensure representativeness.
Results: A total of 19 women treated for BRC were recruited for the interviews. From the qualitative data and review findings, the treatment attributes included 10-year recurrence rate and side effects of each treatment, treatment costs, need for breast reconstruction, chance of receiving adjunctive radiotherapy, cosmetic outcomes, recovery time and possibility of re-operation. The participants were asked to prioritise the perceived level of importance as to how each treatment attribute affecting their treatment decisions, with scoring 0 as least important and 10 as most important. A consensus on the most crucial attributes with appropriate levels of choice has been achieved.
Conclusions: This value clarification exercise enables women diagnosed with BRC to weigh the pros and cons of treatment options, thereby helping them to make more informed clinical decisions. The next step will be construction of a discrete choice experiment survey by combining the established treatment attributes and different choice sets and administering to the target population for validation.
Description
A value clarification exercise with a list of important factors affecting treatment decisions was developed, based on a thorough literature review and qualitative interviews with women completed all active treatment for breast cancer, to help women newly diagnosed with breast cancer make more informed clinical decisions, aiming at reducing decisional conflict and regret, thereby improving health-related quality of life.