Shared Decision Making in Breast Cancer: National Practice Patterns of Surgeons

Schubart, Jane R.; Dominici, Laura; Farnan, Michelle; Kelly, Tricia; Manahan, Eric; Rahman, E; Js, Smith; Kass, Rena

doi:10.1245/s10434-013-3112-5

Cited by 10 publications

(2 citation statements)

References 22 publications

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“…This approach has been supported by numerous studies showing that DAs for breast reconstruction patients enhance satisfaction with information, increase perceived participation in the decision-making process, and reduce decisional conflict. 3 , 13 , 14 There are some DA tools that have been tested in randomized clinical trials. An example is the BREASTChoice tool, which also allows estimating patients’ personal risk of potential complications of reconstruction, in addition to helping patients understand the pros and cons of different options.…”

Section: Discussionmentioning

confidence: 99%

Shared Decision-making in Breast Cancer Reconstructive Surgery: Experience in a Leading Hospital

Herrera de la Muela,

Sanz Medrano,

Leyva

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Background: The paradigm of healthcare has evolved toward patient-centered approaches, where shared decision-making (SDM) plays a pivotal role. This study aimed to explore the implementation of SDM during breast cancer reconstruction consultations and assess its impact on patient satisfaction and the decision-making process as a whole. Methods: A total of 102 female patients undergoing breast reconstruction were included in a multidisciplinary breast pathology unit. A streamlined SDM model involving choice introduction, option description, and preference exploration was implemented. A validated Spanish version of the nine-item Shared Decision Making Questionnaire was used alongside a complementary questionnaire. Data analysis was carried out using electronic data capture software. Results: The nine-item Shared Decision Making Questionnaire results indicate strong agreement in presenting various options and explaining their advantages and disadvantages. Patients were less confident about their participation in decision-making. The Complementary Shared Decision Making Questionnaire highlighted high satisfaction with interview times and language clarity but areas for improvement in consultation space and therapeutic choice participation. Conclusions: Integrating SDM into breast reconstruction consultations empowers patients in the decision-making process and enhances satisfaction. Decision aids prove effective in this context, facilitating patients’ comprehension and reducing decisional conflict. There are areas for improvement within the SDM strategy, and they are detectable through scales. Although challenges in information transmission and patient involvement persist, adopting an SDM model has potential benefits that warrant further investigation.

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Section: Discussionmentioning

confidence: 99%

Shared Decision-making in Breast Cancer Reconstructive Surgery: Experience in a Leading Hospital

Herrera de la Muela,

Sanz Medrano,

Leyva

et al. 2024

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

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“…Both objective factors, such as treatment guidelines, and subjective factors, such as physician preferences, have been shown to influence physicians' disease management recommendations and treatment patterns for their BC patients . While several studies have focused on physician variability in treating early BCs , there is limited information on physician treatment preferences for advanced BC and their real‐world prescribing experiences . The objective of this physician survey is to describe physicians' preferences and self‐reported prescribing patterns in treating HR+/HER2− mBC among community oncology practices in the United States.…”

Section: Introductionmentioning

confidence: 99%

Physician experiences and preferences in the treatment of HR+/HER2− metastatic breast cancer in the United States: a physician survey

et al. 2015

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Sequential endocrine therapy (ET) is recommended for postmenopausal women with hormone receptor‐positive (HR+)/human epidermal growth factor receptor 2‐negative (HER2−) metastatic breast cancer (mBC) and without visceral symptoms. Chemotherapy (CT) can be considered after sequential ETs, but is associated with adverse side effects. We assessed physicians' preferences and self‐reported prescribing patterns for ET and CT in the treatment of HR+/HER2− mBC at community practices in the United States. Community‐based oncologists/hematologists from a nationwide online panel who treated postmenopausal women with HR+/HER2− mBC were invited to complete a survey, blinded to the identity of study sponsor. Treatment preferences were collected by treatment class of ET‐based regimens versus CT and by agent for postmenopausal HR+/HER2− mBC patients after prior nonsteroidal aromatase inhibitor use in the adjuvant or mBC setting. Among 213 physicians who completed the survey, 78% were male, 71% were based in small/intermediate practices (2–9 oncologists/subspecialists), 55% had >10 years of experience, and 58% referred to the National Comprehensive Cancer Network Guidelines when treating mBC. Among first‐line ETs, anastrozole was the most frequently used treatment (35%), followed by everolimus‐based (EVE, 34%) and fulvestrant‐based (FUL, 15%) therapy. After first‐line ET, the most preferred second‐ and third‐line treatments were ET monotherapy (48% and 39%), ET combination therapy (31% and 19%), and CT monotherapy (13% and 30%). Comparing EVE versus FUL, physicians preferred EVE in all lines but first line. Efficacy was the most important consideration for treatment choice. Physicians prescribed CT in early lines mainly because of visceral symptoms. This survey of treatment patterns for HR+/HER2− mBC in community practice suggested that after first‐line ET, ET mono‐ or combination therapy was commonly used for the second‐ and third‐line treatments and CT monotherapy for third‐ or later line treatments. CTs were used in early lines for patients with visceral symptoms.

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Breast Cancer Surgery Decision-Making and African-American Women

2014

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Prior research has used focus group methodology to investigate cultural factors impacting the breast cancer experience of women of various ethnicities including African-Americans; however, this work has not specifically addressed treatment decision-making. This study identifies key issues faced by African-American women diagnosed with breast cancer regarding treatment decisions. We used an interpretive-descriptive study design based on qualitative data from three focus groups (n = 14) representing a population of African-American women in central Pennsylvania. Participants were asked to think back to when they were diagnosed with breast cancer and their visit with the breast surgeon. Questions were asked about the actual visit, treatment choices offered, sources of information, and whether the women felt prepared for the surgery and subsequent treatments. The prompts triggered memories and encouraged open discussion. The most important themes identified were fear across the breast cancer disease trajectory, a preference for visual information for understanding the diagnosis and surgical treatment, and support systems relying on family and friends, rather than the formal health-care system. Our results have implications for practice strategies and development of educational interventions that will help breast cancer patients better understand their diagnosis and treatment options, encourage their participation in treatment decision-making, and provide psychosocial support for those at high risk for emotional distress.

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Shared Decision Making in Breast Cancer: National Practice Patterns of Surgeons

Cited by 10 publications

References 22 publications

Shared Decision-making in Breast Cancer Reconstructive Surgery: Experience in a Leading Hospital

Shared Decision-making in Breast Cancer Reconstructive Surgery: Experience in a Leading Hospital

Physician experiences and preferences in the treatment of HR+/HER2− metastatic breast cancer in the United States: a physician survey

Breast Cancer Surgery Decision-Making and African-American Women

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