Instrumental Relating and Treatment Decision Making Among Older Women With Early-Stage Breast Cancer

Purpose/Objectives: To understand how women aged 70 years and older who had recently undergone treatment for early-stage breast cancer experienced treatment decision making.

Research Approach: Qualitative, descriptive study guided by grounded theory.

Setting: Participants' houses and apartments in southern California.

Participants: 18 women, aged 70-94 years, who completed treatment for primary, early-stage breast cancer 3-15 months prior (X = 8.5 months).

Methodologic Approach: Twenty-eight semistructured personal interviews that lasted, on average, 104 minutes. Data were collected and analyzed using constructivist grounded theory.

Main Research Variables: Gero-oncology perspective of treatment decision making.

Findings: A major finding was that the power of relating spontaneously was used as a vehicle to connect with others. That process, which the authors called "instrumental relating," was grounded in a foundation of mutual caring for themselves and others. Within that mutual caring, the women participated in three ways of relating to share in treatment decision making: obtaining information, interpreting healthcare providers, and determining the trustworthiness of their providers. Those ways of relating were effortlessly and simultaneously employed.

Conclusions: The women used their expert abilities of relating to get the factual and emotional information that they needed. That information supported what the women perceived to be decisions that were shared and effective.

Interpretation: The findings are the first evidence of the importance of relating as a key factor in decision making from the personal perspective of older women with early-stage breast cancer. This work serves as a springboard for future clinical interventions and research opportunities to individualize communication and enhance effective decision making for older patients who wish to participate in their cancer care.