Predictors of patients’ choices for breast-conserving therapy or mastectomy: a prospective study

Abstract

A study was undertaken to describe the treatment preferences and choices of patients with breast cancer, and to identify predictors of undergoing breast-conserving therapy (BCT) or mastectomy (MT). Consecutive patients with stage I/II breast cancer were eligible. Information about predictor variables, including socio-demographics, quality of life, patients' concerns, decision style, decisional conflict and perceived preference of the surgeon was collected at baseline, before decision making and surgery. Patients received standard information (n ¼ 88) or a decision aid (n ¼ 92) as a supplement to support decision making. A total of 180 patients participated in the study. In all, 72% decided to have BCT (n ¼ 123); 28% chose MT (n ¼ 49). Multivariate analysis showed that what patients perceived to be their surgeons' preference and the patients' concerns regarding breast loss and local tumour recurrence were the strongest predictors of treatment preference. Treatment preferences in itself were highly predictive of the treatment decision. The decision aid did not influence treatment choice. The results of this study demonstrate that patients' concerns and their perceptions of the treatment preferences of the physicians are important factors in patients' decision making. Adequate information and communication are essential to base treatment decisions on realistic concerns, and the treatment preferences of patients.

Contextual factors in shared decision making: a randomised controlled trial in women with a strong suspicion of breast cancer

“…However, uptake rates of breast-conserving therapy significantly exceeded rates reported in other studies, especially in the control condition (Street et al, 1995;Molenaar et al, 2004;Whelan et al, 2004). Therefore, a ceiling effect may have emerged on this variable.…”

“…Therefore, a ceiling effect may have emerged on this variable. Other evidence demonstrated that the endorsement of breast loss and fear of recurrence predicted either uptake of lumpectomy or mastectomy and not the introduction of decision aids (Molenaar et al, 2004). With regards to chemotherapy, about Actual tumour size was different from pre-randomisation assessment which resulted in a higher proportion of patients clinically classified with T1 breast cancer than after tumour biologic analyses.…”

Guideline adherence for early breast cancer before and after introduction of the sentinel node biopsy

“…It is very likely that the observed inter-hospital variation in BCS reflects surgeon preference more than patient preference. A study evaluating the effect of an interactive treatment decision aid in a Dutch patient population (N ¼ 172) showed that the patients' perception of her physicians' treatment preference was an important factor in decision making (Molenaar et al, 2004). In a population-based study, Katz et al found that patients who did not feel they had had a choice between surgical options perceived less satisfaction with the decision-making process (Katz et al, 2001).…”

Do Variations in Provider Discussions Explain Socioeconomic Disparities in Postmastectomy Breast Reconstruction?

“…Studies suggest that patient perception of the surgeon's preference plays a major role in patient decision-making regarding breast surgery. 17,18 We also know that there are racial and ethnic variations in physician-patient communication and in patient perceptions of the quality of their communication with physicians. [19][20][21][22] Figure 1 illustrates how clinical factors, patient preference, provider bias in discussing reconstruction, and qualitative aspects of communication can contribute to whether or not a patient receives reconstruction.…”