--- title: "Decision-making: adjuvant endocrine therapy breast cancer. | Sutter Health" description: "Adjuvant endocrine therapy has a long decision-making process and implementation pd. Clinical approaches should explore decisional resolve and med adherence." url: "https://www.sutterhealth.org/research/publications/decision-making-adjuvant-endocr-tx-breast-ca-1055312417" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Decision-making: adjuvant endocrine therapy breast cancer. # Mapping the decision-making process for adjuvant endocrine therapy for breast cancer: the role of decisional resolve. Beryl LL, Rendle KA, Halley MC, Gillespie KA, May SG, Glover J, Yu P, Chattopadhyay R, & Frosch DL. _Med Decis Making. pii: 0272989X16640488. \[Epub ahead of print\]_ 2016-04-06 ## Abstract BACKGROUND: Studies show adjuvant endocrine therapy increases survival and decreases risk of breast cancer recurrence for hormone receptor-positive tumors. Yet studies also suggest that adherence rates among women taking this therapy may be as low as 50% owing largely to adverse side effects. Despite these rates, research on longitudinal patient decision making regarding this therapy is scant. OBJECTIVE: We sought to map the decision-making process for women considering and initiating adjuvant endocrine therapy, paying particular attention to patterns of uncertainty and decisional change over time. METHODS: A longitudinal series of semistructured interviews conducted at a multispecialty health care organization in Northern California with 35 newly diagnosed patients eligible for adjuvant endocrine therapy were analyzed. Analysis led to the identification and indexing of 3 new decision-making constructs-decisional phase, decisional direction, and decisional resolve-which were then organized using a visual matrix and examined for patterns characterizing the decision-making process. RESULTS: Our data reveal that most patients do not make a single, discrete decision to take or not take hormone therapy but rather traverse multiple decisional states, characterized by 1) phase, 2) direction, and 3) strength of resolve. Our analysis tracks these decisional states longitudinally using a grayscale-coded matrix. Our data show that decisional resolve wavers not just when considering therapy, as the existing concept of decisional conflict suggests, but even after initiating it, which may signal future decisions to forgo therapy. CONCLUSIONS: Adjuvant endocrine therapy, like other chronic care decisions, has a longer decision-making process and implementation period. Thus, theoretical, empirical, and clinical approaches should consider further exploring the new concept and measurement of decisional resolve, as it may help to improve subsequent medication adherence. [PubMed abstract](https://www.ncbi.nlm.nih.gov/pubmed/?term=Beryl+LL%2C+Rendle+KA%2C+Halley+MC%2C) ## Research topics - [All Cancer](https://www.sutterhealth.org/research-search-results?query=%22%5C%22All+Cancer%5C%22%22) - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) - [Women's Health](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Women%27s+Health%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Redefining risk and benefit: understanding the decision to undergo contralateral prophylactic mastectomy.](https://www.sutterhealth.org/research/publications/decsion-for-contralateral-prophylactic-mastectomy-1055312294) Rendle KA, Halley MC, May SG, Frosch DL. Qual Health Res. 25(9):1251-9. doi: 10.1177/1049732314557085. Epub 2014 Nov 4. 2015 Sep 01 - Publication ### [Beyond barriers: fundamental 'disconnects' underlying the treatment of breast cancer patients' sexual health.](https://www.sutterhealth.org/research/publications/disconnects-in-breast-cancer-tx-and-sexual-health-1055312906) Halley MC, May SG, Rendle KA, Frosch DL, Kurian AW. Cult Health Sex. 1-12. \[Epub ahead of print\] 2014 Aug 20 - Publication ### [In absentia: an exploratory study of how patients are considered in multidisciplinary cancer team meetings.](https://www.sutterhealth.org/research/publications/pt-consideration-multidisciplin-cancer-team-mtgs-1055312430) Hahlweg P, Hoffmann J, Härter M, Frosch DL, Elwyn G, Scholl I. PLoS One. 10(10):e0139921. doi: 10.1371/journal.pone.0139921. eCollection 2015. 2015 Oct 06 - Publication ### [The importance of integrating narrative into health care decision making.](https://www.sutterhealth.org/research/publications/integrate-narrative-in-healthcare-decision-making-1055312429) Dohan D, Garrett SB, Rendle KA, Halley M, Abramson C. Health Aff (Millwood). 35(4):720-5. doi: 10.1377/hlthaff.2015.1373. 2016 Apr 01 - Publication ### [Redefining risk and benefit: understanding the decision to undergo contralateral prophylactic mastectomy.](https://www.sutterhealth.org/research/publications/risk-benefit-contralateral-prophylactic-mastectomy-1055312871) Rendle KA, Halley MC, May SG, Frosch DL. Qual Health Res. pii: 1049732314557085. \[Epub ahead of print\] 2014 Nov 04 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/decision-making-adjuvant-endocr-tx-breast-ca-1055312417#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Decision-making: adjuvant endocrine therapy breast cancer."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/decision-making-adjuvant-endocr-tx-breast-ca-1055312417#medicalscholarlyarticle","name":"Mapping the decision-making process for adjuvant endocrine therapy for breast cancer: the role of decisional resolve.","headline":"Decision-making: adjuvant endocrine therapy breast cancer.","abstract":"BACKGROUND: Studies show adjuvant endocrine therapy increases survival and decreases risk of breast cancer recurrence for hormone receptor-positive tumors. Yet studies also suggest that adherence rates among women taking this therapy may be as low as 50% owing largely to adverse side effects. Despite these rates, research on longitudinal patient decision making regarding this therapy is scant. OBJECTIVE: We sought to map the decision-making process for women considering and initiating adjuvant endocrine therapy, paying particular attention to patterns of uncertainty and decisional change over time. METHODS: A longitudinal series of semistructured interviews conducted at a multispecialty health care organization in Northern California with 35 newly diagnosed patients eligible for adjuvant endocrine therapy were analyzed. Analysis led to the identification and indexing of 3 new decision-making constructs-decisional phase, decisional direction, and decisional resolve-which were then organized using a visual matrix and examined for patterns characterizing the decision-making process. RESULTS: Our data reveal that most patients do not make a single, discrete decision to take or not take hormone therapy but rather traverse multiple decisional states, characterized by 1) phase, 2) direction, and 3) strength of resolve. Our analysis tracks these decisional states longitudinally using a grayscale-coded matrix. Our data show that decisional resolve wavers not just when considering therapy, as the existing concept of decisional conflict suggests, but even after initiating it, which may signal future decisions to forgo therapy. CONCLUSIONS: Adjuvant endocrine therapy, like other chronic care decisions, has a longer decision-making process and implementation period. Thus, theoretical, empirical, and clinical approaches should consider further exploring the new concept and measurement of decisional resolve, as it may help to improve subsequent medication adherence.","description":"Adjuvant endocrine therapy has a long decision-making process and implementation pd. 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