TABLE 3—
Summarization of Findings on Shared Decision-Making From the Quantitative Literature
| Article | Main Outcome Variables | Findings |
| Back and Huak26 | Nondisclosure of diagnosis | A “family-centered decision-making model” was important, with family-initiated nondisclosure of diagnosis to patients in 58 of 66 cases. Nondisclosure occurred more often when patients were older (OR = 7.7; 95% CI = 3.5, 16.8), female (OR = 6.0; 95% CI = 2.7, 13.7), non-English speaking (OR = 7.6; 95% CI = 1.7, 34.5), and in palliative care (OR = 3.2; 95% CI = 1.3, 7.9). |
| Hawley et al.28 | Match between actual and preferred decision-making role; satisfaction with decision or decision-making process | Decision-making: 37% of patients reported shared decision-making. Low-acculturated Latina women were more likely to report surgeon-based decision-making (31% vs 22%–28%; P not reported) and less likely to report patient-based decision-making (30% vs 33%–41%; P < .1). 93% of patients reported a match between preferred and actual involvement. |
| Dissatisfaction and regret: low-acculturated Latina women had the greatest likelihood of dissatisfaction (OR = 5.5; 95% CI = 2.9, 10.5) and regret (OR = 4.1; 95% CI = 2.2, 8.0). Companion presence was associated with lower dissatisfaction (OR = 0.65; 95% CI = 0.44, 0.96). | ||
| Hawley et al.27 | Treatment received | Patient–provider decision-making: surgeon-based decision-making was highest (33.1% vs 24.0%–26.7%) and patient-based decision-making lowest (29.5% vs 33.4%–39.8%) among low-acculturated Latina women. |
| Decision-making role of family and important others: African Americans had the significantly lowest frequency of being accompanied by anyone to a consultation (71.2% vs 77.5%–79.2%; P = .032). Family role in decision-making was significantly highest among low-acculturated Latina women (75.9%), followed by African American (50.3%), high-acculturated Latina (49.4%), and White women (34.1%; P for overall trend < .001). | ||
| Accompaniment to the consultation was associated with greater receipt of mastectomy (relative risk = 1.62; 95% CI = 1.14, 2.21). | ||
| Kaplan et al.29 | Type of treatment received | Patient–provider decision-making: more White women reported that the provider indicated radiation as optional (32.2%) than did high-acculturated Latina (18.7%) and low-acculturated Latina (10.2%) women. |
| Provider recommendation and concerns about survival were the most important influences on surgery decision-making reported by all ethnicities. | ||
| Compared with a recommendation that radiation was optional, provider indication that radiation was necessary was significantly associated with radiation therapy (OR = 8.05; 95% CI = 4.04, 16.03). | ||
| Among patients with breast-conserving surgery who did not undergo radiation therapy, low-acculturated Latina (67%) and high-acculturated Latina (69%) patients more frequently reported lack of provider recommendation as the reason than White women (57%). | ||
| Family influence on decision-making: low-acculturated Latina women rated family influences (P ≤ .01) as a greater influence on decision-making than other groups. | ||
| Katz et al.30 | Type of treatment received; treatment delay; satisfaction with decision or decision-making process | Low-acculturated Latina women had highest odds of low satisfaction with the decision-making process (OR = 3.6; 95% CI = 2.9, 6.9), followed by African American women (OR = 2.2; 95% CI = 1.7, 3.9) and high-acculturated Latina women (OR = 1.3; 95% CI = 1.0, 1.9; P for overall trend < .001). |
| Katz et al.48 | Treatment received | Decision-making: 37.1% of all women reported shared decision-making, 41.0% reported patient-based decision-making, and 21.9% reported provider-based decision-making. Patient-based decision-making was associated with the highest rate of mastectomy receipt. |
| Communication with surgeons: ethnic differences in mastectomy receipt were partially related to information exchange with surgeons. Among women who reported surgeon-based decision-making, more White women reported a discussion only about breast-conserving surgery (50.7%) than did African American (31.4%) and “other” women (26.0%; P = .029). Surgeons were more likely to recommend breast-conserving surgery to White women (51.6%) than to African American (41.7%) and “other” women (41.0%; P < .001). | ||
| Lantz et al.31 | Satisfaction with treatment; satisfaction with decision or decision-making process; regret with decision or decision-making process | Satisfaction with decision-making: most patients were satisfied with the decision-making process (80.6%). Low satisfaction with decision-making was associated with being African American (OR = 1.56; P < .001) and being “other” ethnicity (OR = 2.21; P < .001). Women whose decision-making role was less than or more than their preferred role had increased risk of low satisfaction with the decision-making process (OR = 3.23 [P < .001] and 2.48 [P < .001], respectively). |
| Regret with decision-making: increased regret was associated with being African American (OR = 1.82; P < .001) and being “other” ethnicity (OR = 2.58; P < .001). Women whose decision-making role was less than or more than their preferred role had increased risk of regret (OR = 2.42 [P < .001] and 1.71 [P < .001], respectively). | ||
| Maly et al.33 | Type of treatment received; final treatment decision-maker | Final decision-maker: compared with other ethnicities, low-acculturated Latina women were the least likely to identify themselves as the final decision-maker (36.6%) and most likely to have family or friend make the final decision (49.3%). |
| Family as the decision-maker: low-acculturated Latina (OR = 7.97; 95% CI = 2.43, 26.20) and high-acculturated Latina (OR = 4.48; 95% CI = 1.09, 18.45) women were significantly more likely than White and African American women to have family making the treatment decision. Women who felt efficacious in their ability to communicate with surgeons were less likely to have the family as the final decision-maker (OR = 0.95; 95% CI = 0.91, 0.99). Women whose surgeons had a participatory decision-making style were less likely to have the family as the final decision-maker (OR = 0.98; 95% CI = 0.97, 0.997). Family decision-making was associated with lower odds of breast-conserving surgery (OR = 0.39; 95% CI = 0.18, 0.85). | ||
| Maly et al.32 | Breast cancer knowledge; treatment delay; type of treatment received | Interactive information giving was associated with greater odds of breast cancer knowledge (OR = 1.15; 95% CI = 1.03, 1.27) and breast-conserving surgery (OR = 1.18; 95% CI = 1.05, 1.31) and lower odds of treatment delay (OR = 0.81; 95% CI = 0.72, 0.91). |
| Phipps et al.34 | Patients’ decision-making role | Most patients (42%) reported shared decision-making, followed by patient-based decision-making (31%). Patients reporting shared decision-making had significantly lower religiosity than those reporting provider-based decision-making (P = .02) and minimally higher than those reporting patient-based decision-making (P = .28). |
| Steenland et al.35 | Type of treatment received | Provider communication: African American men were more likely to report communication difficulties with the provider than White men (OR = 3.95; 95% CI = 1.52, 10.30). Men who received no treatment were more likely to report poor communication with the provider than men who received treatment (OR = 5.77; 95% CI = 1.88, 11.46). |
| Provider recommendation: provider recommendation was inversely associated with surgery (OR = 0.25; 95% CI = 0.11, 0.60) and no treatment (OR = 0.16; 95% CI = 0.05, 0.52). | ||
| Spouse, family, and friend recommendation: spouse recommendation was not associated with any treatment. Other family or friend recommendation was positively associated with receiving no treatment (OR = 4.47; 95% CI = 1.45, 13.8) but was not associated with any other treatment choice. |
Note. CI = confidence interval; OR = odds ratio.