An In-Visit Decision Aid for Surgeons to Address Decision Making for Bilateral Mastectomy for Newly Diagnosed Breast Cancer Patients

Yao, Katharine; Belkora, Jeffrey; Lee, Clara; Kuchta, Kristine; Pesce, Catherine; Kopkash, Katherine; Rabbitt, Sarah; Barrera, Ermilo; Simovic, Sandra; Sepucha, Karen

doi:10.1245/s10434-019-07912-9

Cited by 9 publications

(12 citation statements)

References 27 publications

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“…In CPM decisionmaking, decision aids were acceptable and feasible to patients and healthcare professionals and associated with higher levels of knowledge [14,99,100]. An online interactive breast cancer in-visit decision aid (BIDA) has been used successfully by patients during breast surgery decision-making; under 'Evaluation', this tool showed published estimates using pictograms of 100 women for outcomes such as the risk of getting a new cancer in the other breast stratified by the three proceduresdlumpectomy, unilateral mastectomy, and bilateral mastectomydto compare those options [14,101]. Patients who had used the BIDA during the consultation estimated the 5-year contralateral breast cancer risk of women with breast cancer significantly more accurate than patients after usual care [101].…”

Section: Recommendationsmentioning

confidence: 99%

“…An online interactive breast cancer in-visit decision aid (BIDA) has been used successfully by patients during breast surgery decision-making; under 'Evaluation', this tool showed published estimates using pictograms of 100 women for outcomes such as the risk of getting a new cancer in the other breast stratified by the three proceduresdlumpectomy, unilateral mastectomy, and bilateral mastectomydto compare those options [14,101]. Patients who had used the BIDA during the consultation estimated the 5-year contralateral breast cancer risk of women with breast cancer significantly more accurate than patients after usual care [101]. If valid contralateral breast cancer risk prediction models are established, individual risk information calculated with these models could be incorporated in the decision aids for each patient.…”

Section: Recommendationsmentioning

confidence: 99%

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Contralateral prophylactic mastectomy: A narrative review of the evidence and acceptability

et al. 2021

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The uptake of contralateral prophylactic mastectomy (CPM) has increased steadily over the last twenty years in women of all age groups and breast cancer stages. Since contralateral breast cancer is relatively rare and the breast cancer guidelines only recommend CPM in a small subset of patients with breast cancer, the drivers of this trend are unknown. This review aims to evaluate the evidence for and acceptability of CPM, data on patient rationales for choosing CPM, and some of the factors that might impact patient preferences. Based on the evidence, future recommendations will be provided. First, data on contralateral breast cancer risk and CPM rates and trends are addressed. After that, the evidence is structured around four main patient rationales for CPM formulated as questions that patients might ask their surgeon: Will CPM reduce mortality risk? Will CPM reduce the risk of contralateral breast cancer? Can I avoid future screening with CPM? Will I have better breast symmetry after CPM? Also, three different guidelines regarding CPM will be reviewed. Studies indicate a large gap between patient preferences for radical risk reduction with CPM and the current approaches recommended by important guidelines. We suggest a strategy including shared decision-making to enhance surgeons’ communication with patients about contralateral breast cancer and treatment options, to empower patients in order to optimize the use of CPM incorporating accurate risk assessment and individual patient preferences.

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Section: Recommendationsmentioning

confidence: 99%

Section: Recommendationsmentioning

confidence: 99%

Contralateral prophylactic mastectomy: A narrative review of the evidence and acceptability

et al. 2021

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“…All (4/4, 100%) the randomized studies included a high risk of bias because of the practices observed when assigning participants, adhering to the intervention, and accounting for missing outcome data. Of the 10 studies, 6 (60%) were nonrandomized studies ( Multimedia Appendix 2 , Table S2 [ 36 , 37 , 39 , 40 , 42 , 43 ]). Of these 6 nonrandomized studies, 1 (17%) [ 39 ] included a moderate risk of bias, whereas the remaining 5 (83%) [ 36 , 37 , 40 , 42 , 43 ] included serious risk of bias due to confounding [ 36 , 37 , 40 ], bias in selecting participants [ 43 ], bias in accounting for missing data, and measurement of outcomes [ 42 ].…”

Section: Resultsmentioning

confidence: 99%

“…However, information quality factors included information-sharing and knowledge retention. Transfer of information between patients and physicians was assessed by 30% (3/10) of the studies, which reported that patients retained a high level of treatment knowledge after consultations with physicians who used a computer-based decision tool [ 37 , 40 , 43 ]. Of the 10 studies, 5 (50%) assessed the level of information-sharing.…”

Section: Resultsmentioning

confidence: 99%

“…Patients’ satisfaction with consultations and clinic visits when computer-based decision tools were used was estimated to have a mean satisfaction score of 4.53 (SD 0.1) out of a maximum score of 5 [ 43 ]. However, of the 10 studies, 3 (30%) disclosed that computer-based decision tools did not improve therapeutic decision-making or found no statistically significant difference between decisions made using the technology and usual care and did not change physicians’ usual behavior [ 37 , 39 , 40 ].…”

Section: Resultsmentioning

confidence: 99%

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Computer-Based Decision Tools for Shared Therapeutic Decision-making in Oncology: Systematic Review

Yung¹,

Kay²,

Beale³

et al. 2021

JMIR Cancer

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Background Therapeutic decision-making in oncology is a complex process because physicians must consider many forms of medical data and protocols. Another challenge for physicians is to clearly communicate their decision-making process to patients to ensure informed consent. Computer-based decision tools have the potential to play a valuable role in supporting this process. Objective This systematic review aims to investigate the extent to which computer-based decision tools have been successfully adopted in oncology consultations to improve patient-physician joint therapeutic decision-making. Methods This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist and guidelines. A literature search was conducted on February 4, 2021, across the Cochrane Database of Systematic Reviews (from 2005 to January 28, 2021), the Cochrane Central Register of Controlled Trials (December 2020), MEDLINE (from 1946 to February 4, 2021), Embase (from 1947 to February 4, 2021), Web of Science (from 1900 to 2021), Scopus (from 1969 to 2021), and PubMed (from 1991 to 2021). We used a snowball approach to identify additional studies by searching the reference lists of the studies included for full-text review. Additional supplementary searches of relevant journals and gray literature websites were conducted. The reviewers screened the articles eligible for review for quality and inclusion before data extraction. Results There are relatively few studies looking at the use of computer-based decision tools in oncology consultations. Of the 4431 unique articles obtained from the searches, only 10 (0.22%) satisfied the selection criteria. From the 10 selected studies, 8 computer-based decision tools were identified. Of the 10 studies, 6 (60%) were conducted in the United States. Communication and information-sharing were improved between physicians and patients. However, physicians did not change their habits to take advantage of computer-assisted decision-making tools or the information they provide. On average, the use of these computer-based decision tools added approximately 5 minutes to the total length of consultations. In addition, some physicians felt that the technology increased patients’ anxiety. Conclusions Of the 10 selected studies, 6 (60%) demonstrated positive outcomes, 1 (10%) showed negative results, and 3 (30%) were neutral. Adoption of computer-based decision tools during oncology consultations continues to be low. This review shows that information-sharing and communication between physicians and patients can be improved with the assistance of technology. However, the lack of integration with electronic health records is a barrier. This review provides key requirements for enhancing the chance of success of future computer-based decision tools. However, it does not show the effects of health care policies, regulations, or business administration on physicians’ propensity to adopt the technology. Nevertheless, it is important that future research address the influence of these higher-level factors as well. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42021226087; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021226087

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What is the relationship between body image and the quality of life of women who underwent surgery for breast cancer? A scoping review

Battistello,

da Silva,

Remor

2024

Psycho-Oncology

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PurposeThis review aimed to identify, characterize, map, and summarize existing knowledge about the relationship of perceived body image with the quality of life (QoL) of women who have undergone surgical treatment for breast cancer.MethodsA scoping review was conducted following the PRISMA‐ScR guidelines. PubMed, PsycINFO and Scopus databases were searched, and articles published until August 2022 were included.ResultsThe search resulted in 796 records, and 51 articles were included for analysis. A significant negative impact on body image perception and QoL after surgical treatment for breast cancer was found in the majority of studies. Sociodemographic variables such as age, education, socioeconomic status, unstable attachment styles and time after the surgery may have an effect on a worsening of the overall body image and QoL score of women. It was found that there was greater dissatisfaction with body image in women who underwent mastectomy compared to those who underwent conservative surgery.ConclusionEvidence has shown that breast cancer surgery affects the perceived body image and QoL of patients worldwide. Age, education, socioeconomic status, and the type of surgery are potential factors influencing these outcomes. It is worth noting that the review encompassed articles from various countries, reflecting a significant cultural diversity among the studied populations. However, most of these articles did not delve into an analysis of these cultural disparities. This review also indicated insufficient details regarding the assessment instruments used to assess perceived body image.

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An In-Visit Decision Aid for Surgeons to Address Decision Making for Bilateral Mastectomy for Newly Diagnosed Breast Cancer Patients

Cited by 9 publications

References 27 publications

Contralateral prophylactic mastectomy: A narrative review of the evidence and acceptability

Contralateral prophylactic mastectomy: A narrative review of the evidence and acceptability

Computer-Based Decision Tools for Shared Therapeutic Decision-making in Oncology: Systematic Review

What is the relationship between body image and the quality of life of women who underwent surgery for breast cancer? A scoping review

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