Breast cancer is the single most common cancer in women in the United States (Centers for Disease Control and Prevention [CDC], 2010). The most recent data collected in 2006 revealed that 191,410 women were diagnosed with and 40,820 women died from breast cancer that year (CDC, 2010). Based on corollary census data, this translates to an incidence rate of 119.3 per 100,000 women and a death rate of 23.4 per 100,000 women overall (CDC, 2010). As it stands, breast cancer is the leading cause of cancer death in Hispanic women and is the second leading cause of cancer death in all other ethnic groups (CDC, 2010). Taken alone, this would make breast cancer one of the top ten killers of women in the United States overall (CDC, 2010).

As is the case with all cancers, the diagnosis, treatment, and recovery from breast cancer forms a continuum of care commonly referred to as “the cancer journey”. Because cancer survivors run a constant risk of future relapse, a diagnosis of breast cancer necessitates a patient’s continuous contact with the healthcare system for the rest of their lives. While the physical execution of a particular treatment may lie under the purview of the health professional, the breast cancer journey necessitates active participation from the patient themselves. A self-reported measure of active self-determination is often referred to as the “locus of control” and lies at the core of a patient’s quality of life.

Not surprisingly, a diagnosis of breast cancer carries with it a fear of death, elevated anxiety levels, and a higher incidence of depression (Chintamani et al., 2011). Over the course of the cancer journey these negative affects may rise and fall with treatment progress and setbacks (Chintamani et al., 2011). Indeed, positive response to chemotherapy, despite its side effects, has been inversely correlated to depression in breast cancer patients and may serve as a variable in determining the psychological status of patients (Chintamani et al., 2011). Likewise, it has been found that reactions to cancer-related stress have significant ethnic and racial components and may vary widely across cultures (Chintamani et al., 2011).

The timing of these psychological maladies could not be worse, as the cancer sufferer must wade through and process complicated diagnoses, treatment options, and treatment regimens on the long road to remission. As an instructive example, the staging of breast cancer, which predicts survival rates and determines treatment options for the patient, involves medical variables such as tumor size and nodal pathological status and complicated biological factors such as estrogen receptor status, cathespin D levels, and urokinase plasminogen activator inhibitor-1 and thymidine kinase gene expression (Mazouni et al., 2011). Understandably, the breast cancer patient runs the risk of feeling helpless in the face of such an arduous journey ahead. Indeed, recently diagnosed breast cancer patients with high self-reported levels of helplessness, depression, and anxiety were found to score poorly on measures of coping and had a severely diminished quality of life overall (Karakoyun-Celik et al., 2010).

Empowerment and Shared Decision Making

Because of this, researchers and healthcare professionals have begun to examine all of the factors that contribute to a patient’s active participation in and successful completion of the cancer journey, beyond the technical execution of the practitioner. An important predictor of this success involves the empowerment of the patient while on the journey.

One such concept that has emerged as a means to this end is shared decision making (SDM). SDM is an ideal, which seeks to include the patient and combat the medicalization and social control of our modern healthcare system. Indeed, in a quantitative survey of cancer patients, almost all participants preferred treatment decisions to be the outcome of a shared process (Pieterse, Baas-Thijssen, Marijnen,& Stiggelbout, 2008). However, there is some disagreement between clinicians and cancer patients on the means and goals of such SDM. While clinicians viewed patient participation more often as reaching agreement on treatment options, patients more often defined it exclusively as being informed (Pieterse, Baas-Thijssen, Marijnen,& Stiggelbout, 2008). Although most clinicians believe not all patients are able to participate in this decision making, most patients beleive that clinicians were not always able to weigh the pros and cons of treatment for patients, especially where the quality of life was concerned (Pieterse, Baas-Thijssen, Marijnen,& Stiggelbout, 2008).

With applications for any disease, empowerment and SDM have been primarily studied in chronic conditions which require extensive decision making on the part of the patient, with a particular focus on cancer. As such, empowerment and SDM may ultimately incorporate several fields of study that have each been found to affect positive quality of life changes in patients and increase their involvement during the cancer journey. These include interaction and communication with healthcare professionals, patient support networks, patient education, and complementary and alternative medicine.

Patient-Provider Interaction and Communication

While on the cancer journey, the patient will obviously be partnered with the healthcare system and its professionals for the foreseeable future. This partnership extends beyond the actual cancer treatment and informs how the patient cares for their self. Healthcare providers are active coaches in a breast cancer patient’s self-care, encouraging them to conserve energy, engage in relationships, and maintain a positive outlook by suggesting activities that help patients cope, adapt, and manage symptoms during and after treatment (Seegers et al., 1998).

A survey of cancer survivors revealed that the most frequently unmet needs during treatment included the need for a case-manager to coordinate care and the need for communication between treating doctors (Lobb et al., 2009). In the recovery phase of their cancer journey, the same survivors most frequently unmet needs involved preventing recurrence and managing the fear of recurrence (Lobb et al., 2009). While concrete medical concerns are indeed important, additional studies have also found that talking with healthcare professionals about existential issues such as hope and suffering made patients feel that they were part of a trustful relationship and a healing experience overall (Benzein & Saveman, 2008). This in turn gave them the opportunity to unburden themselves, as well as to learn and find new strategies for managing daily life with cancer (Benzein & Saveman, 2008). What is agreed upon, is that clinicians should acknowledge the legitimacy of patients’ values, especially if they hope to empower and involve them in their treatment (Pieterse, Baas-Thijssen, Marijnen,& Stiggelbout, 2008).

Patient-provider interaction and communication also has an obvious effect on the effectiveness and retention of information following patient education. Studies have shown that both patients and professionals experience insufficient exploration of the patients’ personal situation and individual information needs (Posma, van Weert, Jansen, & Bensing, 2009). In this regard, patients have emphasized the importance of sensitive communication by showing empathy and emotional support throughout the continuum of cancer care (Posma, van Weert, Jansen, & Bensing, 2009). Moreover, this communication demands that healthcare providers look beyond the patient to engage relatives and encourage them to ask questions as part of the healing process (Posma, van Weert, Jansen, & Bensing, 2009).

As such, the importance of effective communication skills to sustain a cancer patient’s quality of life and their satisfaction with healthcare professionals is well documented (Fukui et al., 2010). To this end, the development and training of patient communication skills is now a cornerstone of the education of healthcare professionals. With advances in cancer research, the importance of such training has only increased, as the complexity of communicated messages has only increased and may be increasingly lost on individuals in lower socioeconomic groups (Goldman et al., 2008). Such training programs look beyond biomedical information, and include skills such as responding to emotional cues, and reducing blocking behaviors that discourage a patient from opening up to their provider (Butow et al., 2008). Indeed, these are skills to be developed over a lifetime, as the fields of breast cancer research and patient facilitation are constantly developing. A recent study of oncology residents, revealed that only 56% of the participants reached a basic level of core competency in communication skills after a week-long training program (Bylund et al., 2009). Oncologists that attended more training modules in this area also showed the most improvement in communication skills with cancer patients (Bylund et al., 2010). Fittingly, female oncologists have also demonstrated far greater communication skills with breast cancer patients than their male counterparts (Bylund et al., 2010).

As a means to facilitate patient empowerment and SDM, a new profession has arisen in oncology nursing. Called patient navigators, these health professionals can address insurance, financial, and logistical issues such as transportation, appointment scheduling, and child or elder care (Schwaderer & Itano, 2007). They can also provide understandable health education that may lessen fears of cancer diagnosis and treatment (Schwaderer & Itano, 2007). Preliminary studi