Published in:
01-02-2021 | Breast Cancer | Breast Oncology
Medical Maximizing–Minimizing Preferences in Relation to Low-Value Services for Older Women with Hormone Receptor-Positive Breast Cancer: A Qualitative Study
Published in: Annals of Surgical Oncology | Issue 2/2021
Login to get accessAbstract
Background
Multiple studies have demonstrated the safety of omitting therapies in older women with breast cancer. Despite de-implementation guidelines, up to 65% of older women continue to receive one or more of these low-value services. Previous work has investigated the role of both provider and patient attitudes as barriers to de-implementation; however, the importance of the patient’s maximizing–minimizing preferences within this context remains unclear.
Methods
In this qualitative study, we conducted 30 semi-structured interviews with women ≥ 70 years of age without a previous diagnosis of breast cancer to elicit perspectives on breast cancer treatment in relation to their medical maximizing–minimizing preferences, as determined by the single-item maximizer–minimizer elicitation question (MM1). We used an interpretive description approach in analysis to produce a thematic survey.
Results
Participants were relatively evenly distributed across the MM1 (minimizer, n = 8; neutral, n = 13; maximizer, n = 9). Despite being told of recommendations allowing for the safe omission of sentinel lymph node biopsy and post-lumpectomy radiotherapy, maximizers consistently stated preferences for more medical intervention and aggressive therapies over minimizers and neutral individuals.
Conclusion
Medical maximizing–minimizing preferences in older women correspond with preferences for breast cancer treatment options that guidelines identify as potentially unnecessary. Increased awareness of patient-level variability in maximizing–minimizing preferences may be valuable in developing optimal intervention strategies to reduce utilization of low-value care.