What Decisions Matter to Women Facing a Breast Cancer Diagnosis? A Case Study From the Global South on Treatment Shared Decision-Making and the Management of Distress.
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引用次数: 0
Abstract
Background: Breast cancer (BC) is the leading cause of cancer deaths among Chilean women. BC treatment is guaranteed by Chilean law through the Explicit Health Guarantees (GES) plan. There is insufficient evidence on how women navigate the healthcare system and how they exercise shared decision-making (SDM) following a BC diagnosis in global South scenarios.
Aim: To understand how women make decisions about BC treatment.
Methods: A qualitative study based on 29 individual, semi-structured, in-depth interviews with women undergoing BC treatment in three hospitals in Santiago. Recruitment took place from November 2022 until July 2023. Thematic analysis was performed with AtlasTi.
Results: The experience that care is not happening quickly enough organizes the trajectory of BC patients under the major, in vivo theme of "Everything is slow." Managing this wait mobilizes women through clinical milestones, configuring high or low participation scenarios. Scenarios of high participation comprised decisions mostly regarding practical issues, financial and insurance decisions and whatever actions could be taken to shorten waiting times. Scenarios of low-experienced participation coincided with clinical encounters with health professionals, with treatment decisions delegated to or exclusively made by clinicians.
Conclusion: BC is experienced as a distressing diagnosis. Women prioritize decisions that they perceive will speed up their care and do not effectively participate in treatment decision-making. This study is part of a larger mixed-methods project that aims to elucidate factors influencing SDM in BC. Future directions should provide strategies to patients and clinicians to build more symmetrical relationships and evaluate the satisfaction with care of universal coverage-oriented policies, as well as how this could influence the exercise of patients' autonomy.
期刊介绍：
Psycho-Oncology is concerned with the psychological, social, behavioral, and ethical aspects of cancer. This subspeciality addresses the two major psychological dimensions of cancer: the psychological responses of patients to cancer at all stages of the disease, and that of their families and caretakers; and the psychological, behavioral and social factors that may influence the disease process. Psycho-oncology is an area of multi-disciplinary interest and has boundaries with the major specialities in oncology: the clinical disciplines (surgery, medicine, pediatrics, radiotherapy), epidemiology, immunology, endocrinology, biology, pathology, bioethics, palliative care, rehabilitation medicine, clinical trials research and decision making, as well as psychiatry and psychology.
This international journal is published twelve times a year and will consider contributions to research of clinical and theoretical interest. Topics covered are wide-ranging and relate to the psychosocial aspects of cancer and AIDS-related tumors, including: epidemiology, quality of life, palliative and supportive care, psychiatry, psychology, sociology, social work, nursing and educational issues.
Special reviews are offered from time to time. There is a section reviewing recently published books. A society news section is available for the dissemination of information relating to meetings, conferences and other society-related topics. Summary proceedings of important national and international symposia falling within the aims of the journal are presented.
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