IngentaConnect Conflicts in Decision-Making for Breast Cancer Surgery

Authors: Opatt, Diane; Morrow, Monica¹; Hawley, Sarah; Schwartz, Kendra; Janz, Nancy; Katz, Steven

Source: Annals of Surgical Oncology, Volume 14, Number 9, September 2007 , pp. 2463-2469(7)

Publisher: Springer

Abstract:

Little is known about the interaction among surgeons, patients, and other physicians in selecting breast cancer surgery.

We contacted attending surgeons (n = 456) of a population-based sample of 2645 breast cancer patients diagnosed in Detroit and Los Angeles from December 2001 to January 2003. Eighty percent completed a written survey with clinical scenarios.

The mean surgeon age was 50 years, 50% practiced in a community hospital, and breast cancer averaged 31% of practice volume. The mean number of years in practice was 17.2. Female surgeons made up 14.4% of the sample and 35% of the high-volume surgeons. Conflict with patients and other providers was reported by 58% and 32% of surgeons, respectively. When the patient preferred mastectomy and the surgeon favored BCS, conflict was reported by 49.9% of surgeons. Compared with low-volume surgeons, high-volume surgeons were significantly more likely to report conflict in this scenario (44% vs 62%; P = .047). When another provider preferred mastectomy and the respondent surgeon favored BCS, conflict was reported by 34% of surgeons and was more common for high-volume surgeons (P < .001). In a logistic regression model, surgeon volume and practice setting were strongly associated with conflict in this scenario.

High-volume surgeons and those in cancer centers more frequently endorse current clinical guidelines that favor BCS over mastectomy, resulting in greater conflict with patients. These findings support patient reports that patient choice is a key factor in continued mastectomy use.

Keywords: Breast cancer; Decision making; Breast conserving surgery; Conflict

Document Type: Research article

DOI: 10.1245/s10434-007-9431-7

Affiliations: 1: Email: Monica.Morrow@fccc.edu

The full text electronic article is available for purchase. You will be able to download the full text electronic article after payment.

$47.00 plus tax Refund Policy