Practitioner Opinion on Contralateral Prophylactic Mastectomy: How Do We Steer a Patient-Driven Discussion?
| Autor: | Claire M. B. Holloway, Andrea Eisen, Adena S. Scheer, Amanda Stypulkowski, Angela E Schellenberg, Erin Cordeiro |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Decision support system Health Knowledge Attitudes Practice Attitude of Health Personnel Decision Making MEDLINE Decisional conflict Risk Assessment 03 medical and health sciences 0302 clinical medicine Breast cancer Contralateral Prophylactic Mastectomy Surveys and Questionnaires medicine Unilateral Breast Neoplasms Humans Practice Patterns Physicians' Aged Breast surgeons business.industry Patient Preference Middle Aged medicine.disease Prophylactic Mastectomy Oncology 030220 oncology & carcinogenesis Family medicine Needs assessment Practice Guidelines as Topic 030211 gastroenterology & hepatology Surgery Female business Risk assessment |
| Zdroj: | Annals of surgical oncology. 26(11) |
| ISSN: | 1534-4681 |
| Popis: | Contralateral prophylactic mastectomy (CPM) is increasing despite a recent statement from The American Society of Breast Surgeons discouraging average-risk women with unilateral breast cancer (BC) from undergoing CPM. The objective of our study was to conduct a needs assessment of BC health practitioners to gather information about their opinions, attitudes, and experiences surrounding CPM. The Ottawa Decision Support Framework was the theoretical framework for the development of the interview guide. Semistructured interviews were conducted until data saturation with a convenience sample of 16 BC practitioners (Ontario, Canada), including oncologic and reconstructive surgeons, medical oncologists, and nurse navigators. Nearly all practitioners identified the discussion regarding CPM as patient-initiated. The majority of practitioners (13/16) described their role as supporting the patient in the decision-making process. Practitioners described educating patients on the lack of survival benefit and in general discouraging CPM. Practitioners agreed that most patients demonstrate decisional conflict (11/16) as a barrier to decision-making, and it is a challenge to realign patients’ understanding and expectations. Almost all practitioners (15/16) identified a need for information materials to help educate patients on the risks and benefits of CPM and to help realign expectations. Practitioners have identified CPM in average-risk women with unilateral BC as a patient-driven phenomenon that is on the rise, despite highlighting the increased risk of complications and lack of survival benefit. Our practitioner needs assessment identifies the need for a dynamic decision aid to help guide the shared decision-making process for practitioners and patients. |
| Databáze: | OpenAIRE |
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