What Drives Patient Choice: Preferences for Approaches to Surgical Treatments for Breast Cancer Beyond Traditional Clinical Benchmarks

Storm-Dickerson, Toni; Das, Lopamudra; Gabriel, Allen; Gitlin, Matthew; Farías, Jorge G.; Macarios, David

doi:10.1097/gox.0000000000001746

Cited by 17 publications

(9 citation statements)

References 39 publications

(33 reference statements)

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“…This is also a noteworthy finding, as previous studies outline a plethora of key demographic and socioeconomic factors correlated with a woman’s decision to choose reconstruction. 1–6 However, our quantitative analysis points only to a woman’s age as a possible predictor of breast reconstruction choice. In relation to factors influencing a woman’s decision to choose solely implant-based approaches and/or combined implant-based and tissue-based approaches, we find no key demographic or socioeconomic factors impacting choice, except for patient age, body mass index, self-rated health, and time elapsed between mastectomy and reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Cognitive Bias and Therapy Choice in Breast Reconstruction Surgery Decision-Making

Whyte

Bray

Chan

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Understanding how medical experts and their patients process and transfer information is of critical importance for efficient health care provision. Behavioral economics has explored similar credence markets where economic incentives, information asymmetry, and cognitive bias can impact patient and surgeon choice. The aim of the current study is to explore how framing and behavioral bias affect elective restorative surgery decision-making, such as breast reconstruction following cancer treatment. Methods: The authors’ study uses a cross-sectional survey data set of specialist surgeons (n = 53), breast care nurses (n = 101), and former or current breast cancer patients (n = 689). Data collected include participant demographics, medical history, a battery of cognitive bias tests, and a behavioral framing experiment. Results: This study finds statistically significant differences in breast reconstruction surgery preference by patients and nurses when decision options are framed in different ways (i.e., positively versus negatively). The authors’ analysis of surgeons, nurses, and patients shows no statistically significant difference across eight common forms of cognitive bias. Rather, the authors find that the behavioral biases are prevalent to the same extent in each group. This may indicate that differences in experience and education seem not to mitigate biases that may affect patient choices and medical professional’s recommendations. The authors’ multivariate analysis identifies patient age (p < 0.0001), body mass index, and self-perceived health (p < 0.05) as negative correlates for choice of implant-based reconstruction. Conclusion: For surgeons, nurses, and patients, the authors find uniform evidence of cognitive bias; more specifically, for patients and nurses, the authors find inconsistency in preference for type of surgical therapy chosen when alternative procedures are framed in different ways (i.e., framing bias).

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Section: Discussionmentioning

confidence: 99%

Cognitive Bias and Therapy Choice in Breast Reconstruction Surgery Decision-Making

Whyte

Bray

Chan

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…Third, because participants in this study provided their consent via completion of the questionnaire, we could not compare clinicopathologic data between participants and nonparticipants. Fourth, we did not collect data associated with patients' preference for breast surgical procedure, such as patient educational level, insurance type, marital status, or comorbidities (16). Finally, the lack of patient participation in the planning of this study is a limitation.…”

Section: Discussionmentioning

confidence: 99%

Preferences Regarding Breast Surgery Omission Among Patients With Breast Cancer Who Receive Neoadjuvant Chemotherapy

Nakamura

Ishitobi

Oshiro

et al. 2023

In Vivo

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Background/Aim: Currently, several ongoing prospective studies are investigating the safety of breast surgery omission in patients with breast cancer who are exceptional responders to neoadjuvant chemotherapy. However, there is little information about the preferences of these patients regarding omission of breast surgery. Patients and Methods: We conducted a questionnaire survey to assess preferences regarding omission of breast surgery among patients with breast cancer who had human epidermal growth factor receptor 2-positive or estrogen receptornegative tumors and good clinical response after neoadjuvant chemotherapy. Patients' estimation of the risk of ipsilateral breast tumor recurrence (IBTR) after definitive surgery or breast surgery omission was also assessed. Results: Of 93 patients, only 22 (23.7%) said they would omit breast surgery. Under the scenario of omitting breast surgery, the 5-year IBTR rate estimated by patients who said they would omit breast surgery was significantly lower (median, 10%) than the rate estimated by patients who preferred undergoing definitive surgery (median, 30%) (p=0.017). Conclusion: The proportion of our surveyed patients who were willing to omit breast surgery was low. Patients who said they preferred to omit breast surgery overestimated the 5-year IBTR risk.Neoadjuvant chemotherapy (NAC) for breast cancer has become the standard therapy not only for locally advanced cases but also for operable, early-stage breast cancer. Recently, owing to the advances in chemotherapy and targeted therapy, the rate of pathologic complete response (pCR) is reaching 60% among human epidermal growth factor receptor 2 (HER2)-positive and triple-negative breast cancer (1, 2). This finding has attracted physicians' interest in "breast surgery omission" in reference to the ultimate breast-conserving therapy (3). Several ongoing worldwide prospective studies are investigating the safety of breast surgery omission in patients with breast cancer who are exceptional responders to NAC (4, 5). To date, however, these prospective studies have not provided sufficient safety data on omission of breast surgery.In addition of the lack of safety data about breast surgery omission, a remaining problem for the introduction of breast surgery omission into clinical practice is the lack of information about the preferences of patients with breast cancer. In their commentary to an article about research into breast surgery omission, Caballero et al. stated that an important aspect of de-escalation strategies such as breast surgery omission is to listen to the patient's perspective during the early stages of developing future clinical trials, and to 794

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“…Salbach et al 13 used a similar approach. Including such relevance statements may better orient readers to CRR that is aimed at advancing their interests or care, expediting the dissemination of clinically meaningful interventions to the clinicians and patients whom they are intended to benefit 3,13,29 …”

Section: Operationalizing Relevancementioning

confidence: 99%

“…Including such relevance statements may better orient readers to CRR that is aimed at advancing their interests or care, expediting the dissemination of clinically meaningful interventions to the clinicians and patients whom they are intended to benefit. 3,13,29 Measuring Relevance in Reporting Guidelines By encouraging researchers to state why and to whom a study is relevant, relevance could then be measured through process-driven metrics, such as whether an article includes a relevance statement. Including a relevance component in the grading systems that SRs use to evaluate the quality of underlying studies is one possibility.…”

Section: Including a Relevance Statement In Crrmentioning

confidence: 99%

Incorporating the Concept of Relevance in Clinical Rehabilitation Research and Its Reviews May Improve Uptake by Stakeholders

Pomeroy¹,

Sanchez²,

Cai³

et al. 2022

Am J Phys Med Rehabil

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The "relevance" of research to stakeholders is an important factor in influencing the uptake of new knowledge into practice; however, this concept is neither well defined nor routinely incorporated in clinical rehabilitation research. Developing a uniform definition, measurement standards, stakeholder engagement strategies, and guiding frameworks that bolster relevance may help incorporate the concept as a key element in research planning and design. This article presents a conceptual argument for why relevance matters, proposes a working definition, and suggests strategies for operationalizing the construct in the context of clinical rehabilitation research. We place special emphasis on the importance of promoting relevance to patients, caregivers, and clinicians and provide preliminary frameworks and innovative study designs that can assist clinical rehabilitation researchers in doing so. We argue that researchers who include a direct statement regarding why and to whom a study is relevant and who incorporate considerations of relevance throughout all phases of study design produce more useful research for patients, caregivers, and clinicians, increasing its chance of uptake into practice. Consistent consideration of relevance, particularly to nonacademic audiences, during the conceptualization, study design, presentation, and dissemination of clinical rehabilitation research may promote the uptake of findings by patients, caregivers, and providers.

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What Drives Patient Choice: Preferences for Approaches to Surgical Treatments for Breast Cancer Beyond Traditional Clinical Benchmarks

Abstract: Supplemental Digital Content is available in the text.

Cited by 17 publications

References 39 publications

Cognitive Bias and Therapy Choice in Breast Reconstruction Surgery Decision-Making

Cognitive Bias and Therapy Choice in Breast Reconstruction Surgery Decision-Making

Preferences Regarding Breast Surgery Omission Among Patients With Breast Cancer Who Receive Neoadjuvant Chemotherapy

Incorporating the Concept of Relevance in Clinical Rehabilitation Research and Its Reviews May Improve Uptake by Stakeholders

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