Decision-Making Process for Breast Cancer Surgery Patients Requires Improvement

Many early-stage breast cancer survivors need more knowledge regarding their disease, are not significantly involved in treatment discussions, and are not asked their preferences related to treatment options, according to the results of a new study published in the Journal of the American College of Surgeons.

The retrospective study is the first study to attempt an examination of how often treatments truly reflect patient preferences. Researchers evaluated the quality of the decision-making process regarding surgical treatment options, in which “quality” was the degree to which a decision was informed and consistent with patient preferences.

Surveys were mailed to 746 adult women with a history of stage I and II breast cancer treated at 1 of 4 academic medical centers: The Dana-Farber Cancer Institute, Boston; Massachusetts General Hospital, Boston; University of California, San Francisco; and University of North Carolina, Chapel Hill.

Women who participated in the survey numbered 440 (59%), and the data were collected an average of 2.5 years following the surgical procedure.

Researchers found:

• The average knowledge score was 52.7%, indicating large disparities in knowledge regarding information deemed critical by providers
• Regarding their surgical treatment preference, less than half (48.6%) of the women had a surgeon who asked for their preference
• Of the surveyed patients, only half knew the survival rates were the same for breast-conservation therapy and mastectomy
• Study participants who received partial mastectomy were less aware of local recurrence rates than the women who had a mastectomy

“This finding was concerning because patients who opt for partial mastectomy need to be aware of their slightly higher risk of local recurrence,” said lead author of the study, Clara N. Lee, MD, MPP, FACS, an associate professor and director of surgical research at the University of North Carolina School of Medicine in Chapel Hill. “Patients and providers need to have transparent conversations about treatment options, risks and goals in order to make fully informed decisions.”

Lee and colleagues believe improving the quality of breast cancer surgery decisions will necessitate methods for increasing patient knowledge and including patient preferences in the decision-making process. “Two things are needed to help improve the quality of decisions. First, it is important to have a way to measure decision quality so that providers can get feedback on how they are doing. Second, we need to use decision tools that have been proven to inform and engage patients, more consistently,” added senior study author, Karen Sepucha, PhD, assistant professor at Harvard Medical School and director of the Health Decision Sciences Center at Massachusetts General Hospital.

Source: American College of Surgeons.