Understanding Cancer Treatment Decision-Making in Young Adults and their Partners

Background: Decision-making among adolescents and young adults (AYAs, defined as 15-39 years of age) with cancer is a complex process. Partners are significantly involved in treatment-related decision-making and engagement of partners in this process contributes to a more positive experience for the patient. However, the preponderance of the research regarding the patient/partner dyad has not focused on young adults, a population with unique challenges including emerging financial independence, family planning considerations, and distancing from previous familial support. Aims: To better characterize patterns of decision-making in the young adult patient/partner dyad and to identify potential targets for intervention to support young adults and their partners throughout the inevitable decision-making processes associated with cancer treatment. Methods: Semi-structured interviews with 10 young adult patient/partner dyads designed to elicit the cognitive and emotional representations of the cancer-related decision, and the strategies used to cope with these influences on decision making, in accord with the CEDM (cognitive and emotional decision-making) framework. Qualitative analysis included hypothesis coding followed by reflexive thematic analysis. Results: 10 heterosexual dyads (median patient age 32.1 years) with relationship statuses of husband/wife, fiance, partner and girlfriend/boyfriend. Generated CEDM themes included: Controlling the Controllable and Sharing the Information Burden (Cognitive), Fear as a Motivator and Finding a Third Party (Emotional), Role Transition and Relying on Individual Strengths (Shared Decision-Making). Appreciation of Long-Term Consequences and Growing through Adversity emerged as themes related to learning opportunities for future decisions. Conclusion: Young adults with cancer and their partners approach treatment decisions as a dyad that relies on individual cognitive and emotional processing while also appreciating the value of shared decision-making. Themes identified in this study suggest that when both members of the dyad are informed of their options and provided the opportunity to share their desires and concerns with supportive parties, decision-making satisfaction and perhaps even increased dyad relationship strength can be obtained. Collaboration between dyads, oncological care teams and supportive personnel with an appreciation of the unique challenges facing AYAs is needed to ensure these needs are met.