Behavioral Health, Mental Health, Substance Abuse
Examining Patient and Caregiver Narratives to Understand Colon Cancer Treatment Decisions
Nora Mueller (School of Public Health (UMD) Behavioral and Community Health Doctoral Student)
Purpose: The purpose of this study was to examine how patients and their caregivers made the decision to undergo adjuvant chemotherapy for Stage II and Stage III colon cancer. Background: Colorectal Cancer (CRC) is the third leading cause of cancer death and, despite being the focus of national public health efforts, continues to have an unnecessarily large impact on US men and women. It is estimated that CRC was diagnosed in about 71,830 men and 65,000 women in the US in 2014. Methods: Stage II and III Colorectal Cancer survivors and their caregivers (n= 14 patient/caregiver dyads) recruited from local oncology clinics underwent a digitally recorded scripted interview and demographic questionnaire aimed to investigate decision-making about adjuvant chemotherapy. Participants were stratified by race and gender. A narrative analysis approach with NVIvo 10 qualitative software was used to illustrate how patients and caregivers navigate the cancer diagnosis and treatment decision-making process. Findings: The average age for survivors and caregivers was 67.1 and 66.6, respectively. Five of the survivors had stage III cancer, all of which underwent chemotherapy. Two survivors did not undergo chemotherapy; disparity characteristics included being black, widowed, and having an income between $10,000 and $19,999. None of the survivors and caregivers expressed regret about their treatment decision. Having previous experience with CRC through friends or family members who had the disease influenced the decisions of both patients and caregivers, as did the relationship participants had with their providers. Significance: Research suggests that shared personal narratives about illness experiences can help patients to process information and feel more confident making treatment decisions. Giving feedback to providers, patients and caregivers on the reasoning and motivation behind treatment decisions of others may help to create open and empathic discussions about the CRC experience.
Importance to public health: