ABSTRACT
OBJECTIVES: Poor enrollment into prevention trials is a major obstacle to the conduct of clinical investigations. This study focuses on cognitive and affective influences on the decision to participate in a clinical trial aimed at reducing biomarkers of breast cancer risk. METHODS: Following a decision to participate or not in a clinical trial focused on reduction of breast cancer risk, women were recruited into the present study. Data were gathered via telephone survey. RESULTS: One hundred healthy women took part in the current study, 72 of whom had participated in the clinical trial, and 28 of whom had declined participation. Women who decided to enroll perceived more benefits and fewer costs, and they experienced more positive emotions and fewer negative emotions. They also made the decision more quickly, more easily, were more satisfied with it, and had fewer regrets than women who declined participation in the clinical trial. CONCLUSIONS: Participants to this clinical trial differed from nonparticipants in terms of antecedents, process, and outcomes of the decision to enroll. PRACTICE IMPLICATIONS: Although obstacles exist, accrual might be improved by greater emphasis on the practical and psychosocial benefits to participants.
Subject(s)
Clinical Trials as Topic/psychology , Decision Making , Neoplasms/psychology , Patient Participation/psychology , Research Subjects/psychology , Adult , Female , Health Knowledge, Attitudes, Practice , Humans , Logistic Models , Multivariate Analysis , Neoplasms/drug therapy , Patient Satisfaction , Patient Selection , Surveys and QuestionnairesABSTRACT
Being diagnosed with breast cancer requires that women make a number of decisions about their medical treatments. To gain insight into the variety of forces that shape a woman's breast cancer treatment decisions, we conducted semistructured interviews with 44 breast cancer survivors. Through an interpretive analysis, we identified five treatment decision-making styles: (a) medical expert, (b) self-efficacy, (c) relationship embedded, (d) inhibition, and (e) constellation of information, which are differentiated by two dimensions: (a) low versus high information needs and (b) self versus other preferences.
Subject(s)
Breast Neoplasms/psychology , Breast Neoplasms/therapy , Decision Making , Patient Participation/methods , Patient Participation/psychology , Adult , Aged , Consumer Health Information/methods , Female , Humans , Middle Aged , Qualitative Research , Self EfficacyABSTRACT
Literature relevant to medical decision making was reviewed, and a model was outlined for testing. Two studies examined whether older adults make more immediate decisions than younger adults about treatments for prostate or breast cancer in authentic scenarios. Findings clearly showed that older adults were more likely to make immediate decisions than younger adults. The research is important because it not only demonstrates the consistency of this age-related effect across disease domains, gender, ethnic groups, and prevalent education levels but begins to investigate a model to explain the effect. Major reasons for the effect focus on treatment knowledge, interest and engagement, and cognitive resources. Treatment knowledge, general cancer knowledge, interest, and cognitive resources relate to different ways of processing treatment information and preferences for immediate versus delayed decision making. Adults with high knowledge of treatments on a reliable test tended to make immediate treatment decisions, which supports the knowledge explanation. Adults with more cognitive resources and more interest tended to delay their treatment decisions. Little support was found for a cohort explanation for the relationship between age and preference for immediate medical decision making.
Subject(s)
Breast Neoplasms/psychology , Decision Making , Prostatic Neoplasms/psychology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Biopsy/psychology , Brachytherapy/psychology , Breast Neoplasms/diagnosis , Breast Neoplasms/therapy , Decision Trees , Female , Health Knowledge, Attitudes, Practice , Health Surveys , Humans , Male , Mastectomy, Segmental/psychology , Middle Aged , Ohio , Patient Education as Topic , Patient Participation , Pennsylvania , Problem Solving , Prostatectomy/psychology , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/therapy , Sex FactorsABSTRACT
A model is presented to predict the readability of documents encountered by older adults. The documents studied are contained in the Educational Testing Service's Test of Basic Skills (1977 edition) and require readers to answer questions about charts (e.g., bus schedules), labels (e.g., plant spray labels and prescriptions), and forms (e.g., tax forms). The components of the model came from theoretical and empirical work on discourse processing and include such factors as discourse structure, emphasis, and position of an answer in a linguistic analysis of the everyday document.A sample of 482 adults from 52 to 93 years of age took the everyday problems test as well as a psychometric ability battery. The correlation was .54 (p < .01) between the readability scores for test items predicted by the model and the percentage of older adults correctly answering those items. In addition, the more difficult test items as identified by the model were correlated more highly with fluid intelligence abilities (figural relations and induction), crystallized intelligence abilities (vocabulary, experiential evaluation), and with memory span.
