br Conclusions Patients tend to follow physicians
Conclusions: Patients tend to follow physicians’ recommendation of UM or CPM; patients engaging in SDM tend to choose CPM. Most patients prefer to engage in active participation in decision-making with their physician but were equally satisfied with their surgical de-cision whether they engaged in active participation or not.
ª 2019 Elsevier Inc. All rights reserved.
To be presented at the Academic Surgical Congress held in Houston, TX, on February 6, 2019.
* Corresponding author. Department of Surgery, Yale University School of Medicine, 20 York Street, First Floor, Suite A, New Haven, CT
E-mail address: [email protected] (A. Chagpar).
Over the past few decades, rates of contralateral prophylactic mastectomy (CPM) have rapidly increased among patients with breast cancer opting for mastectomy for treatment of their breast cancer,1-6 nearly tripling between 2002 and 2012, from 3.9% to 12.7%, respectively.7 This increase comes at a time when there is still lack of consensus that CPM provides long-term survival benefits.7-10 How patients are making the decision between CPM and unilateral mastectomy (UM) re-mains to be fully elucidated. We have previously reported, like others, that “peace of mind” and a desire to avoid a potential increase in complications have been factors that patients consider in their decision to pursue CPM and UM, respec-tively.11 However, it AS1517499 is also clear that the interaction between the patient and the surgeon may also influence this decision.
Previous studies have examined the correlation of patient breast surgery decisions with various surgeon-related char-acteristics, such as surgeon gender, surgeon recommenda-tion, and practice settings.4,12-14 Fewer studies, however, have explored more qualitative aspects of how the physicianepatient relationship may influence decision-making, specifically the types of communication strategies employed by doctors when discussing the different surgical options available to the patient.
Active participation in decision-making has become increasingly prevalent, and decision-making enhanced and informed via patient decision aids has been shown to improve patient knowledge, reduce internal decisional conflict, and potentially alter the decisions patients make in terms of sur-gery.15-17 We sought to determine how various physicianepatient communication strategies influence pa-tients’ decision-making process, particularly vis-a`-vis CPM. We aimed to understand what types of communication styles patients preferred, and how satisfied Variable region were with their decision following various communication styles.
All female unilateral patients with breast cancer over the age of 18 y who had undergone mastectomy (with or without CPM) at our institution at any time in the past were approached at a follow-up visit between June 1 and August 31, 2017, regarding their willingness to participate in this study. The eligibility criteria did not enforce a limitation on time from surgery. Patients were asked to complete a confidential survey and to consent to an associated chart review for collection of clini-copathologic data.
In addition to querying patients on various sociodemo-graphic factors, the survey included author-generated ques-tions on their experience with physicianepatient communications during their decision-making process be-tween CPM and UM, and their satisfaction with the same. Active participation in decision-making was defined as the doctor explaining the advantages and disadvantages of each option (CPM and UM), making sure the patient understood both options without recommending a single decision, and