Why do hospital mastectomy rates vary? Differences in the decision-making experiences of women with breast cancer

Background:Hospital mastectomy rates vary. This study explores the relationship between mastectomy rates and breast cancer patients’ consultation and decision-making experiences with specialist clinicians.Methods:Qualitative semi-structured interviews were conducted with 65 patients from three purposively selected breast units from a single UK region. Patients provided with a choice of breast cancer surgery (breast conservation therapy (BCT) or mastectomy) were purposively recruited from high, medium and low case-mix-adjusted mastectomy rate units.Results:Low mastectomy rate unit patients’ consultation and decision-making experiences were markedly different to those of the medium and high mastectomy rate breast units. Treatment variation was associated with patients’ perception of the most reassuring and least disruptive treatment; the content and style of information provision (equipoise or directed); level of patient participation in decision making; the time and process of decision making and patient autonomy in decision making. The provision of more comprehensive less directive information and greater autonomy, time and support of independent decision making were associated with a lower uptake of BCT.Conclusion:Variation in hospital mastectomy rates was associated with differences in the consultation and decision-making experiences of breast cancer patients. Higher mastectomy rates were associated with the facilitation of more informed autonomous patient decision making.

[1]  J. M. Davies,et al.  Qualitative Research in Health Care , 1996, Journal of the Royal College of Physicians of London.

[2]  K. Kuwabara,et al.  A first look at variations in use of breast conserving surgery at five teaching hospitals in Japan. , 2002, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[3]  R. Thomson,et al.  Decision aids for people facing health treatment or screening decisions. , 2003, The Cochrane database of systematic reviews.

[4]  S J Walters,et al.  Case-mix fails to explain variation in mastectomy rates: management of screen-detected breast cancer in a UK region 1997–2003 , 2005, British Journal of Cancer.

[5]  P. Butow,et al.  Cancer consultation preparation package: changing patients but not physicians is not enough. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[6]  Karen R. Sepucha,et al.  Can women with early-stage breast cancer make an informed decision for mastectomy? , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[7]  Eduardo Bruera,et al.  Treatment decisions for breast carcinoma , 2002, Cancer.

[8]  L. Irwig,et al.  Quality of life after breast conservation or mastectomy: a systematic review. , 1997, The Australian and New Zealand journal of surgery.

[9]  J. Ratcliffe,et al.  What influences clinicians' operative preferences for women with breast cancer? An application of the discrete choice experiment. , 2007, European journal of cancer.

[10]  B. E. F. Isher,et al.  Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. , 2002 .

[11]  M. Sprangers,et al.  Predictors of patients’ choices for breast-conserving therapy or mastectomy: a prospective study , 2004, British Journal of Cancer.

[12]  Richard Fielding,et al.  Participation and Satisfaction with Surgical Treatment Decision-Making in Breast Cancer Among Chinese Women , 2003, Breast Cancer Research and Treatment.

[13]  R. Street,et al.  Patient Participation in Deciding Breast Cancer Treatment and Subsequent Quality of Life , 1997, Medical decision making : an international journal of the Society for Medical Decision Making.

[14]  Angela Fagerlin,et al.  Satisfaction with surgery outcomes and the decision process in a population-based sample of women with breast cancer. , 2005, Health services research.

[15]  K C Carriere,et al.  Information needs and decisional preferences in women with breast cancer. , 1997, JAMA.

[16]  Irene J. Higginson,et al.  Interactive technologies and videotapes for patient education in cancer care: systematic review and meta-analysis of randomised trials , 2006, Supportive Care in Cancer.

[17]  R. Owens,et al.  Taking responsibility for cancer treatment. , 2001, Social science & medicine.

[18]  T. Koperna.  Cost-effectiveness of defunctioning stomas in low anterior resections for rectal cancer: a call for benchmarking. , 2003, Archives of surgery.

[19]  M. Reed,et al.  Changing trends in the decision‐making preferences of women with early breast cancer , 2008, The British journal of surgery.

[20]  S. Ramsey,et al.  Why do men choose one treatment over another? , 2006, Cancer.

[21]  Sue Ziebland,et al.  Analysing qualitative data , 2000, BMJ : British Medical Journal.

[22]  S. Helmer,et al.  Factors influencing a woman's choice to undergo breast-conserving surgery versus modified radical mastectomy. , 2000, American journal of surgery.

[23]  M. Stewart.  Effective physician-patient communication and health outcomes: a review. , 1995, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[24]  D. McCready,et al.  Surgical management of early stage invasive breast cancer: a practice guideline. , 2005, Canadian journal of surgery. Journal canadien de chirurgie.

[25]  Mary Beth Landrum,et al.  Treatment decision making in early-stage breast cancer: should surgeons match patients' desired level of involvement? , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[26]  R. Kåresen,et al.  Do women newly diagnosed with breast cancer and consulting surgeon assess decision-making equally? , 2002, Breast.

[27]  J. Willis.  Foundations of Qualitative Research: Interpretive and Critical Approaches , 2007 .

[28]  I. Olivotto,et al.  Patterns of initial management of node-negative breast cancer in two Canadian provinces. British Columbia/Ontario Working Group. , 1997, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[29]  Melanie C. Smitt,et al.  Women's use of resources in decision-making for early-stage breast cancer: Results of a community-based survey , 1997, Annals of Surgical Oncology.

[30]  Peter Watson,et al.  Do patients benefit from participating in medical decision making? Longitudinal follow‐up of women with breast cancer , 2006, Psycho-oncology.

[31]  L. Kristjanson,et al.  Factors influencing women's decisions for choice of surgery for Stage I and Stage II breast cancer in Western Australia. , 2001, Journal of advanced nursing.

[32]  E van der Schueren,et al.  Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. , 2001, Journal of the National Cancer Institute.

[33]  S. Ziebland,et al.  Analysing qualitative data , 2000, BMJ : British Medical Journal.

[34]  J F Wilson,et al.  Factors predicting the use of breast-conserving therapy in stage I and II breast carcinoma. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[35]  M. Marshall.  Sampling for qualitative research. , 1996, Family practice.

[36]  J. Lowery,et al.  Patient-physician concordance: preferences, perceptions, and factors influencing the breast cancer surgical decision. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.