Prescriptions for Health Providers

Tovia G. Freedman, DSW, LCSW

Disclosures

Cancer Nurs. 2003;26(4) 

In This Article

Abstract and Introduction

Women enter an increasingly complex medical system when they receive the diagnosis of breast cancer. Subsequently, they are confronted with numerous complicated, confusing, and less than certain decision-making episodes. Research was undertaken to follow and observe in vivo medical encounters between women and their oncologic physicians throughout the breast cancer diagnostic and treatment process. Empirical data was collected using qualitative techniques to deepen understanding of the decision-making process in the oncology setting. Physicians and patients alike make assumptions about each other that can hinder the development of a trusting and caring attitude that enables a more efficient delivery of healthcare. Patients offer recommendations for care to their physicians. In addition, ethical concerns regarding how medical options are presented to patients emerged in this study.

Women who cross the threshold into an increasingly complex medical system for the diagnosis and treatment of breast cancer encounter numerous complicated, confusing, and less than certain decision-making episodes. How women make the critical and often life-altering decisions that affect their cancer treatment and care is not well known. Definitive choices must be made from a myriad of medical options and alternatives for surgery, chemotherapy, and irradiation. Do women want to make their own decisions about breast cancer, or do they want their physicians to participate, and if so, to what degree and in what manner do they want physician assistance in making decisions? In essence, what do women want their physicians to do to enhance the medical decision-making process?

Fortunately, the claim made in 1913 by Adams that '[t]he only cure is the knife'[1] (p215) is no longer an adequate response to the care of breast cancer in 2003. Although surgical excision continues to be an integral part of breast cancer treatment, it no longer stands as the sole method of intervention. The knife is part of a sequence that involves physiologic, biologic, and chemical interventions intended to remove or slow the progress of a cancer. Coincident with increased knowledge about cancer mechanisms is the great preponderance of procedures, tests, and chemicals that proffer options and choices. These range from the standard procedures routinely offered to the new and innovative, even experimental, options. Each procedure, test, or chemical, whether new or more conventional, has known outcomes for the population in general, but unknown results for individual persons, creating concern and uncertainty. The use of each procedure, test, and chemical requires that an informed choice be made, and that the patient and physician agree on a definitive decision.

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