Abstract PS5-10-10: “You have to work with me”: a thematic analysis of patient experiences in breast cancer treatment decision-making

Abstract Background: Shared decision-making has been increasingly incorporated into guidelines for breast cancer care. However, there has been little study on how patients with breast cancer are presented with options in their care and the level of involvement they prefer. When deciding between non-inferior options such as 6 versus 12 months of adjuvant trastuzumab, shared decision-making and elicitation of patient preferences are critical. In this study, we sought to understand patient communication preferences and their prior experiences with oncologists regarding decision-making in their breast cancer treatment. Methods: We recruited 20 people diagnosed with breast cancer in the past year from across the US to participate in semi-structured interviews regarding their cancer journeys, experiences with treatment decision-making, and communication with their oncologist. Participants were also presented with an infographic displaying the efficacy and toxicity of 6 versus 12 months of adjuvant trastuzumab for early-stage HER2-positive breast cancer to elicit feedback on the presentation of data as well as their prior experiences with oncologists sharing data in their treatment process. Interviews were transcribed and deidentified before being independently coded by two study team members using Dedoose. Discordant coding was reconciled for each transcript. Themes were identified via inductive thematic analysis. Results: Participants shared both positive and negative factors that contributed to their experiences of breast cancer treatment decision-making. Positive factors were patient engagement in care, patient-centered communication, support systems, and socioeconomic advantage. Negative factors were insufficient explanations, ineffective oncologist communication, higher degree of mental and physical treatment burdens, and systemic barriers to care. Participants frequently shared that oncologists did not present them with treatment options, with one participant stating, “Not a lot of this is my choice, you know? It’s just, ‘This is the treatment.’” There were various preferences regarding control in their care, ranging from one participant saying, “just give me whatever you need to make me feel better” to another sharing, “I feel like that's my choice, so I should decide, but I do want the doctor to have ideas about what's going on.” Participants also appreciated the infographic and wished a similar tool had been used in their own care to help them better engage in treatment decision-making conversations. All patients interviewed expressed a desire for more information in their breast cancer care. Conclusion: We identified factors that support or inhibit patient involvement in shared decision-making for breast cancer treatment. While patients varied in how much they wanted to be involved in final decisions, there was a consensus overall that patients wanted more information-sharing and more deliberation about treatment options, two core components of shared decision-making. Presenting efficacy and toxicity information as an infographic to patients with breast cancer may improve their ability to engage in shared decision-making, especially for non-inferior breast cancer treatment options. Citation Format: M. E. Boll, L. J. Schmitt, L. Rabinovich, H. M. Earl, M. E. Peek, A. Wesevich. “You have to work with me”: a thematic analysis of patient experiences in breast cancer treatment decision-making [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-10-10