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

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posted on 2023-06-09, 00:53 authored by L J M Caldon, K A Collins, D J Wilde, S H Ahmedzai, T W Noble, A Stotter, D M Sibbering, S Holt, Malcolm Reed
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.

History

Publication status

  • Published

File Version

  • Published version

Journal

British Journal of Cancer

ISSN

0007-0920

Publisher

Nature Publishing Group

Issue

10

Volume

104

Page range

1551-1557

Department affiliated with

  • BSMS Publications

Full text available

  • Yes

Peer reviewed?

  • Yes

Legacy Posted Date

2016-04-15

First Open Access (FOA) Date

2016-04-15

First Compliant Deposit (FCD) Date

2016-04-15

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