Table 3 Appraisals of treatment options and preference construction
From: Understanding older women’s decision making and coping in the context of breast cancer treatment
A-Generic CODE question | B-Adapted CODE question^ | C-Example quote† | |
|---|---|---|---|
A. Primary appraisals: treatment options* | What are my options, what do they involve? | What does mastectomy/lumpectomy/hormone therapy (HT) involve? | “…I think I’d like explained what would happen in the surgery and the after effects, in relation to what would happen if you don’t have it done and have the hormone treatment.” |
What are the risks and benefits? | What are the risks and benefits and prognosis of mastectomy/lumpectomy/HT? | “…I would want to know what the results was of the people that had an operation… surgery, or people that had had the tablets…” | |
What are the follow-on decisions? | What are the consequences and follow-on decisions of mastectomy/lumpectomy/HT? | “I may have just had the lumpectomy if it had been easier to have the radiotherapy. That did have a bearing I must admit…” | |
How would this affect my life? | How would mastectomy/lumpectomy/HT affect/fit into my life? | “…maybe I'm a bit wary if I had an operation would I then be, not be as active as I am?” | |
How would mastectomy/lumpectomy/HT affect/fit into important others’ life? | “…you don’t really want to be bothering other people … I have two sons … they were supportive but you don’t want to have to have them trailing and interfering with their jobs …”” | ||
Do I have experiences that could help me imagine what it would be/feel like? What did others decide? | What experiences do I have of surgery/mastectomy/lumpectomy/HT? | “…what I’ve heard about it, people and friends going, I would not want to be going every day for radiotherapy somewhere. I thought this I cannot do.” | |
How do I feel about this option? | How do I feel about having surgery and about experiencing the potential consequences of surgery? | “I was frightened about the fact that I might have had to have an operation…” | |
How do I feel about radiotherapy (and chemotherapy)? | “Radiotherapy, I’d got a dread of that…” | ||
How do I feel about breast reconstruction? | “…when I think about that [reconstruction of breasts], I think, you’re having something taken out and then you’re having something put back in! … it doesn’t sit right with me.” | ||
How do I feel about taking tablets every day? | “But er, no way did I want to take tablets…” | ||
B. Primary appraisals: preference construction** | Is this the right time? | What do I want to do at my age? | “…I had no intention in being operated on … I had no intention. I was in my eighties, I thought if I got to pop off I’ll pop off quietly.” |
Could I still change my mind/is this option reversible? | …I thought, “No, I don’t, I don’t fancy having it [the breast] off.” … I’ll try, I’ll try, because I felt if it was to come off I could have it done later. | ||
Is this option congruent with my/ my family’s/my doctor’s beliefs, goals and values? | What is my doctor’s recommendation? | “Well they said that the operation wasn’t necessary, it wasn’t a choice duck so I thought well that’s grand, … I didn’t query it duck, because they’re professional people, I accepted it…” | |
Is this option congruent with my personal goals, values and beliefs? | “…‘I am not having chemo, and I’m not having radium’, I said, ‘I don’t want to live any longer, but I do want to stay in my own house as long as I possibly can … what I insisted on was, trying to give me the best quality of life they could give me, not to live longer, to stay here.” | ||
Is this option congruent with important others’ goals, values and beliefs? | “My son was with me and he really agreed with me when I just wanted to have treatment straightaway I wanted surgery and I didn’t really want to delay it…” | ||
n/a | Do I have a gut feeling/reaction? | “…I’d already made my mind up because I knew that it was cancer before (I) – you know and in my own mind and I'd made my mind up that I was having … the breast taken off.” | |
n/a | Does one option feel better/safer than the others? | “…I can’t explain it really, but I felt happy to go that way and to have the tablet.” | |
C. Secondary appraisals: resources to cope with treatment options and preference construction*** | Can I seek support/information elsewhere? | How can I find out more about my options? | “…the only reason I knew I think was because my sister bought me a book and that told you a lot more…” |
Who can I discuss this with? | Can I talk to someone who has had BC and BC treatment? | “…she said come and see her you know so we both poled over and she bared all and she said she wouldn’t have a lumpectomy because of the radiotherapy which finished her off. So you know it was quite useful information.” | |
Are there any more alternatives or additional actions I could take? | Can I take action against my BC in another way? | “…she’s been giving me supplements and put me, been put on a regime and things like that, which has helped me…” | |
Can my body cope with surgery/am I healthy enough? | “…I explained to them I think, that it wasn’t that, it was just that I, I felt, I knew I couldn’t cope with that. And also, I just, I just couldn’t. It wasn’t anything to do with my body or anything like that, but I knew that I wasn’t, I wasn’t fit, to be quite honest…” | ||
What support do I have? | What instrumental support do I have? | “…you don’t really want to be bothering other people, I mean, my son lives nearby and he was very supportive. … so they were supportive but you don’t want to have to have them trailing and interfering with their jobs and what have you…” | |
What emotional support do I have? | “Oh I talked to my family about it, yeah, and anybody who sort of, and my friend… I’ve got one very close friend and I always talk to her about everything…” | ||
n/a | Can I cope emotionally with treatment/am I emotionally strong enough? | “The only thing I was frightened of, and I was petrified, anaesthetic … And I spoke to an anaesthetist the day before and he were brilliant and he explained it all and he said, you will be fine.” | |
Can I find the answer in my faith? | Can I find strength in my faith? | Interviewer: …did you think ‘oh dear I need to have it off’ or did you think… “no I didn’t actually. I just – I just thought it was another answered prayer. I did not question anything and I have never had any trouble with it.” | |
Can I make this decision easier? | Can I ignore information about options and make a decision without looking into details? | “I’ve never gone into things to do with illness too deeply. I’ve always thought ignorance is bliss … Don't get me wrong, I’m sure it’s very good that the information is there, but it doesn’t, I don’t think it was my way of doing it, I prefer not to know about all the things that could go wrong…” |