Age Differences in Treatment Decision Making for Breast Cancer in a Sample of Healthy Women: The Effects of Body Image and Risk Framing
Purpose/Objectives: To examine the effects of age, body image, and risk framing on treatment decision making for breast cancer using a healthy population.
Design: An experimental 2 (younger women, older women) X 2 (survival, mortality frame) between-groups design.
Setting: Midwestern university.
Sample: Two groups of healthy women: 56 women ages 18-24 from undergraduate psychology courses and 60 women ages 35-60 from the university community.
Methods: Healthy women imagined that they had been diagnosed with breast cancer and received information regarding lumpectomy versus mastectomy and recurrence rates. Participants indicated whether they would choose lumpectomy or mastectomy and why.
Main Research Variables: Age, framing condition, treatment choice, body image, and reasons for treatment decision.
Findings: The difference in treatment selection between younger and older women was mediated by concern for appearance. No main effect for risk framing was found; however, older women were somewhat less likely to select lumpectomy when given a mortality frame.
Conclusions: Age, mediated by body image, influences treatment selection of lumpectomy versus mastectomy. Framing has no direct effect on treatment decisions, but younger and older women may be affected by risk information differently.
Implications for Nursing: Nurses should provide women who recently have been diagnosed with breast cancer with age-appropriate information regarding treatment alternatives to ensure women's active participation in the decision-making process. Women who have different levels of investment in body image also may have different concerns about treatment, and healthcare professionals should be alert to and empathetic of such concerns.
Jump to a section
References
American Cancer Society. (2005). Cancer facts and figures 2005. Atlanta. GA: Author.
Andersen, B.L., & Jochimsen, P.R. (1985). Sexual functioning among breast cancer, gynecologic cancer, and healthy women. Journal of Consulting and Clinical Psychology, 53, 25-32.
Anderson, M.S, & Johnson, J. (1994). Restoration of body image and self-esteem for women after cancer treatment: A rehabilitative strategy. Cancer Practice, 2, 345-349.
Apfel, R., Love, S., Kalinowski, B., & Hansen, B. (1994). Keep abreast: Women and breast cancer in context. In M. Mirkin (Ed.), Women in context: Toward a feminist reconstruction of psychotherapy (pp. 217-236). New York: Guilford Press.
Ashcroft, J.J., Leinster, S.J., & Slade, P.O. (1985). Breast cancer—Patient choice of treatment: Preliminary communication. Journal of the Royal Society of Medicine, 78, 43-46.
Beckmann, J., Johansen, L., Richardt, C., & Blichert-Toft, M. (1983). Psychological reactions in younger women operated on for breast cancer. Amputation versus resection of the breast with special reference to body-image, sexual identity and sexual function. Danish Medical Bulletin, 30(Suppl 2), 10-13.
Early Breast Cancer Trialists' Collaborative Group. (1995). Effects of radiotherapy and surgery in early breast cancer: An overview of the randomized trials. New England Journal of Medicine, 333, 1444-1456.
Edwards, A., Elwyn, G., Covey, J., Matthews, E., & Pill, R. (2001). Presenting risk information—A review of the effects of "framing" and other manipulations on patient outcomes. Journal of Health Communication, 6, 61-82.
Fisher, B., Anderson, S., Redmond, C.K., Wolmark, N., Wickerham, D.L., & Cronin, W.M. (1995). Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. New England Journal of Medicine, 333, 1456-1461.
Franzoi, S.L., & Koehler, V. (1998). Age and gender differences in body attitudes: A comparison of young and elderly adults. International Journal of Aging and Human Development, 47, 1-10.
Ganz, P.A., Rowland, J., Desmond, K., Meyerowitz, B.E., & Wyatt, G.E. (1998). Life after breast cancer: Understanding women's health-related quality of life and sexual functioning. Journal of Clinical Oncology, 16, 501-514.
Goldberg, J.A., Scott, R.N., Davidson, P.M., Murray, G.D., Stallard, S., George, W.D., et al. (1992). Psychological morbidity in the first year after breast surgery. European Journal of Surgical Oncology, 18, 327-331.
Gurm, H.S., & Litaker, D.G. (2000). Framing procedural risks to patients: Is 99% safe the same as a risk of 1 in 100? Academic Medicine, 75, 840-842.
Hetherington, M., & Burnett, L. (1994). Ageing and the pursuit of slimness: Dietary restraint and weight satisfaction in elderly women. British Journal of Clinical Psychology, 33, 391-400.
Hughes, K.K. (1993). Decision making by patients with breast cancer: The role of information in treatment selection. Oncology Nursing Forum, 20, 623-628.
Jacobson, J.A., Danforth, D.N., Cowan, K.H., d'Angelo, T., Steinberg, S.M., Pierce, L., et al. (1995). Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and stage II breast cancer. New England Journal of Medicine, 332, 907-911.
Kasper, A.S. (1995). The social construction of breast loss and reconstruction. Women's Health, 1, 197-219.
Katz, M.R., Rodin, G., & Devins, G.M. (1995). Self-esteem and cancer: Theory and research. Canadian Journal of Psychiatry, 40, 608-615.
Kemeny, M.M., Wellisch, O.K., & Schain, W.S. (1988). Psychosocial outcome in a randomized surgical trial for treatment of primary breast cancer. Cancer, 62, 1231-1237.
Lasry, J.C., Margolese, R.G., Poisson, R., Shibata, H., Fleischer, D., Lafleur, D., et al. (1987). Depression and body image following mastectomy and lumpectomy. Journal of Chronic Diseases, 40, 529-534.
Levy, S.M., Haynes, L.T., Herberman, R.B., Lee, J., McFeeley, S., & Kirkwood, J. (1992). Mastectomy versus breast conservation surgery: Mental health effects at long-term follow-up. Health Psychology, 11, 349-354.
Margolis, G., Goodman, R.L., & Rubin, A. (1990). Psychological effects of breast-conserving cancer treatment and mastectomy. Psychosomatics, 31, 33-39.
Margolis, G.J., Goodman, R.L., Rubin, A., & Pajac, T.F. (1989). Psychological factors in the choice of treatment for breast cancer. Psychosomatics, 30, 192-197.
McArdle, J.M., Hughson, A.V., & McArdle, C.S. (1990). Reduced psychological morbidity after breast conservation. British Journal of Surgery, 77, 1221-1223.
McNeil, B., Pauker, S., & Tversky, A. (1988). On the framing of medical decisions. In D. Bell, H. Raiffa, & A. Tversky (Eds.), Decision making: Descriptive, normative, and prescriptive interactions (pp. 562-568). New York: Cambridge University Press.
McVea, K.L., Minier, W.C., & Johnson Palensky, J.E. (2001). Low-income women with early-stage breast cancer: Physician and patient decision-making styles. Psycho-Oncology, 10, 137-146.
Mock, V. (1993). Body image in women treated for breast cancer. Nursing Research, 42, 153-157.
Morris, J., & Ingham, R. (1988). Choice of surgery for early breast cancer: Psychosocial considerations. Social Science and Medicine, 27, 1257-1262.
Moyer, A. (1997). Psychosocial outcomes of breast-conserving surgery versus mastectomy: A meta-analytic review. Health Psychology, 16, 284-298.
O'Connor, A.M., Pennie, R.A., & Dales, R.E. (1996). Framing effects on expectations, decisions, and side effects experienced: The case of influenza immunization. Journal of Clinical Epidemiology, 49, 1271-1276.
Paxton, S., & Phythian, K. (1999). Body image, self-esteem, and health status in middle and later adulthood. Australian Psychologist, 34, 116-121.
Petrisek, A.C., Laliberte, L.L., Allen, S.M., & Mor, V. (1997). The treatment decision-making process: Age differences in a sample of women recently diagnosed with nonrecurrent, early-stage breast cancer. Gerontologist, 37, 598-608.
Price, B. (1998). Cancer: Altered body image. Nursing Standard, 12(21), 49-55.
Reaby, L.L. (1998). The quality and coping patterns of women's decision-making regarding breast cancer surgery. Psycho-Oncology, 7, 252-262.
Repetto, L., Costantini, M., Campora, E., Amoroso, D., Gianni, W., Catturich, A., et al. (1997). A retrospective comparison of detection and treatment of breast cancer in young and elderly patients. Breast Cancer Research and Treatment, 43, 27-31.
Schain, W.S., d'Angelo, T.M., Dunn, M.E., Lichter, A.S., & Pierce, L.J. (1994). Mastectomy versus conservative surgery and radiation therapy: Psychosocial consequences. Cancer, 73, 1221-1228.
Schover, L.R., Yetman, R.J., Tuason, L.J., Meisler, E., Esselstyn, C.B., Hermann, R.E., et al. (1995). Partial mastectomy and breast reconstruction. A comparison of their effects on psychosocial adjustment, body image, and sexuality. Cancer, 75, 54-64.
Siminoff, L.A., & Fetting, J.H. (1991). Factors affecting treatment decisions for a life-threatening illness: The case of medical treatment of breast cancer. Social Science and Medicine, 32, 813-818.
Tversky, A., & Kahneman, D. (1981). The framing of decisions and the psychology of choice. Science, 211, 453-458.
Valanis, B., & Rumpler, C. (1982). Healthy women's preferences in breast cancer treatment. Journal of the American Medical Women's Association, 37, 311-316.
Waldman, T, & Eliasof, B. (1997). Cancer. In M. Sipski & C. Alexander (Eds.), Sexual functioning in people with disability and chronic illness: A health professional's guide (pp. 337-354). Gaithersburg, MD: Aspen Publishers.
Ward, S., Heidrich, S., & Wolberg, W. (1989). Factors women take into account when deciding upon type of surgery for breast cancer. Cancer Nursing, 12, 344-351.
Wellisch, D.K., DiMatteo, R., Silverstein, M., Landsverk, J., Hoffman, R., Waisman, J., et al. (1989). Psychosocial outcomes of breast cancer therapies: Lumpectomy versus mastectomy. Psychosomatics, 30, 365-373.