Top

Published in:

01-01-2017 | Breast Oncology

Impact of an In-visit Decision Aid on Patient Knowledge about Contralateral Prophylactic Mastectomy: A Pilot Study

Authors: Katharine Yao, MD, Jeff Belkora, PhD, Isabelle Bedrosian, MD, Shoshana Rosenberg, PhD, Mark Sisco, MD, Ermilo Barrera, MD, Alexandra Kyrillios, BS, Jon Tilburt, MD, Chihsiung Wang, PhD, Sarah Rabbitt, RN, Catherine Pesce, MD, Sandra Simovic, BS, David J. Winchester, MD, Karen Sepucha, PhD

Published in: Annals of Surgical Oncology | Issue 1/2017

Abstract

Background

Studies have reported that breast cancer patients have limited understanding about the oncologic outcomes following contralateral prophylactic mastectomy (CPM). We hypothesized that an in-visit decision aid (DA) would be associated with higher patient knowledge about the anticipated short and long term outcomes of CPM.

Methods

We piloted a DA which used the SCOPED: (Situation, Choices, Objectives, People, Evaluation and Decision) framework. Knowledge, dichotomized as “low” (≤3 correct) versus “high” (≥4 correct), was assessed immediately after the visit by a 5 item survey. There were 97 DA patients (response rate 62.2 %) and 114 usual care (UC) patients (response rate 71.3 %).

Results

Patient demographic factors were similar between the two groups. Twenty-one (21.7 %) patients in the DA group underwent CPM compared with 18 (15.8 %) in the UC group (p = 0.22). Mean and median knowledge levels were significantly higher in the DA group compared with the UC group for patients of all ages, tumor stage, race, family history, anxiety levels, worry about CBC, and surgery type. Eighty-six (78.9 %) of UC versus 35 (37.9 %) DA patients had low knowledge. Of patients who underwent CPM, 15 (83.3 %) in the UC cohort versus 5 (25.0 %) of DA patients had “low” knowledge.

Conclusions

Knowledge was higher in the DA group. The UC group had approximately three times the number of patients of the DA group who were at risk for making a poorly informed decision to have CPM. Future studies should assess the impact of increased knowledge on overall CPM rates.

Available only for authorised users

King TA, Sakr R, Patil S, Gurevich I, Stempel M, Sampson M, et al. Clinical management factors contribute to the decision for contralateral prophylactic mastectomy. J Clin Oncol. 2011;29(16):2158–64. doi:10.1200/JCO.2010.29.4041 CrossRefPubMed

Yao K, Stewart AK, Winchester DJ, Winchester DP. Trends in contralateral prophylactic mastectomy for unilateral cancer: a report from the National Cancer Data Base, 1998-2007. Ann Surg Oncol. 2010;17(10):2554–62. doi:10.1245/s10434-010-1091-3 CrossRefPubMed

Tuttle TM, Jarosek S, Habermann EB, Arrington A, Abraham A, Morris TJ, et al. Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ. J Clin Oncol. 2009;27(9):1362–7. doi:10.1200/JCO.2008.20.1681 CrossRefPubMed

Tuttle TM, Habermann EB, Grund EH, Morris TJ, Virnig BA. Increasing use of contralateral prophylactic mastectomy for breast cancer patients: a trend toward more aggressive surgical treatment. J Clin Oncol. 2007;25(33):5203–9. doi:10.1200/JCO.2007.12.3141 CrossRefPubMed

Katipamula R, Degnim AC, Hoskin T, Boughey JC, Loprinzi C, Grant CS, et al. Trends in mastectomy rates at the Mayo Clinic Rochester: effect of surgical year and preoperative magnetic resonance imaging. J Clin Oncol. 2009;27(25):4082–8. doi:10.1200/JCO.2008.19.4225 CrossRefPubMedPubMedCentral

Sorbero ME, Dick AW, Beckjord EB, Ahrendt G. Diagnostic breast magnetic resonance imaging and contralateral prophylactic mastectomy. Ann Surg Oncol. 2009;16(6):1597–605. doi:10.1245/s10434-009-0362-3 CrossRefPubMed

Wang F, Amara D, Peled AW, Sbitany H, Foster RD, Ewing CA, et al. Negative genetic testing does not deter contralateral prophylactic mastectomy in younger patients with greater family histories of breast cancer. Ann Surg Oncol. 2015;22(10):3338–45. doi:10.1245/s10434-015-4745-3 CrossRefPubMed

Hawley ST JR, Morrow M, Katz SJ. Correlates of contralateral prophylactic mastectomy in a population based sample. J Clin Oncol. 2011;29: 6010.CrossRef

Rosenberg SM, Tracy MS, Meyer ME, Sepucha K, Gelber S, Hirshfield-Bartek J, et al. Perceptions, knowledge, and satisfaction with contralateral prophylactic mastectomy among young women with breast cancer: a cross-sectional survey. Ann Intern Med. 2013;159(6):373–81. doi:10.7326/0003-4819-159-6-201309170-00003 CrossRefPubMedPubMedCentral

10.

Soran A, Ibrahim A, Kanbour M, McGuire K, Balci FL, Polat AK, et al. Decision making and factors influencing long-term satisfaction with prophylactic mastectomy in women with breast cancer. Am J Clin Oncol. 2015;38(2):179–83. doi:10.1097/COC.0b013e318292f8a7 CrossRefPubMed

11.

Han E, Johnson N, Glissmeyer M, Wagie T, Carey B, DelaMelena T, et al. Increasing incidence of bilateral mastectomies: the patient perspective. Am J Surg. 2011;201(5):615–8. doi:10.1016/j.amjsurg.2011.01.018 CrossRefPubMed

12.

Covelli AM, Baxter NN, Fitch MI, McCready DR, Wright FC. ‘Taking control of cancer’: understanding women’s choice for mastectomy. Ann Surg Oncol. 2015;22(2):383–91. doi:10.1245/s10434-014-4033-7 CrossRefPubMed

13.

Fagerlin A, Lakhani I, Lantz PM, Janz NK, Morrow M, Schwartz K, et al. An informed decision? Breast cancer patients and their knowledge about treatment. Patient Educ Counsel. 2006;64(1-3):303–12. doi:10.1016/j.pec.2006.03.010 CrossRef

14.

Abbott A, Rueth N, Pappas-Varco S, Kuntz K, Kerr E, Tuttle T. Perceptions of contralateral breast cancer: an overestimation of risk. Ann Surg Oncol. 2011;18(11):3129–36. doi:10.1245/s10434-011-1914-x CrossRefPubMed

15.

Portschy PR, Kuntz KM, Tuttle TM. Survival outcomes after contralateral prophylactic mastectomy: a decision analysis. J Natl Cancer Inst. 2014;106(8). doi:10.1093/jnci/dju160.CrossRefPubMed

16.

Kruper L, Kauffmann RM, Smith DD, Nelson RA. Survival analysis of contralateral prophylactic mastectomy: a question of selection bias. Ann Surg Oncol. 2014;21(11):3448–56. doi:10.1245/s10434-014-3930-0 CrossRefPubMed

17.

Lostumbo L, Carbine N, Wallace J, Ezzo J. Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev. 2004(4):CD002748. doi:10.1002/14651858.CD002748.pub2

18.

Sepucha KR, Belkora JK, Chang Y, Cosenza C, Levin CA, Moy B, et al. Measuring decision quality: psychometric evaluation of a new instrument for breast cancer surgery. BMC Med Inform Decision Making. 2012;12:51. doi:10.1186/1472-6947-12-51 CrossRef

19.

Belkora JK, Loth MK, Volz S, Rugo HS. Implementing decision and communication aids to facilitate patient-centered care in breast cancer: a case study. Patient Educ Counsel. 2009;77(3): 360–8. doi:10.1016/j.pec.2009.09.012 CrossRef

20.

Belkora J. 2016. www.scoped.com.

21.

Whelan T, Levine M, Willan A, Gafni A, Sanders K, Mirsky D, et al. Effect of a decision aid on knowledge and treatment decision making for breast cancer surgery: a randomized trial. JAMA. 2004;292(4):435–41. doi:10.1001/jama.292.4.435 CrossRefPubMed

22.

Goel V, Sawka CA, Thiel EC, Gort EH, O’Connor AM. Randomized trial of a patient decision aid for choice of surgical treatment for breast cancer. Med Decision Making. 2001;21(1):1–6CrossRef

23.

Street RL, Jr., Voigt B, Geyer C, Jr., Manning T, Swanson GP. Increasing patient involvement in choosing treatment for early breast cancer. Cancer. 1995;76(11):2275–85CrossRefPubMed

24.

Frost MH, Schaid DJ, Sellers TA, Slezak JM, Arnold PG, Woods JE, et al. Long-term satisfaction and psychological and social function following bilateral prophylactic mastectomy. JAMA. 2000;284(3):319–24CrossRefPubMed

25.

Geiger AM, West CN, Nekhlyudov L, Herrinton LJ, Liu IL, Altschuler A, et al. Contentment with quality of life among breast cancer survivors with and without contralateral prophylactic mastectomy. J Clin Oncol. 2006;24(9):1350–6. doi:10.1200/JCO.2005.01.9901 CrossRefPubMed

26.

Musiello T, Bornhammar E, Saunders C. Breast surgeons’ perceptions and attitudes towards contralateral prophylactic mastectomy. ANZ J Surg. 2013;83(7–8):527–32. doi:10.1111/j.1445-2197.2012.06209.x CrossRefPubMed

27.

Collins ED, Moore CP, Clay KF, Kearing SA, O’Connor AM, Llewellyn-Thomas HA, et al. Can women with early-stage breast cancer make an informed decision for mastectomy? J Clin Oncol.2009;27(4):519–25. doi:10.1200/JCO.2008.16.6215 CrossRefPubMed

Title: Impact of an In-visit Decision Aid on Patient Knowledge about Contralateral Prophylactic Mastectomy: A Pilot Study
Authors: Katharine Yao, MD
Jeff Belkora, PhD
Isabelle Bedrosian, MD
Shoshana Rosenberg, PhD
Mark Sisco, MD
Ermilo Barrera, MD
Alexandra Kyrillios, BS
Jon Tilburt, MD
Chihsiung Wang, PhD
Sarah Rabbitt, RN
Catherine Pesce, MD
Sandra Simovic, BS
David J. Winchester, MD
Karen Sepucha, PhD
Publication date: 01-01-2017
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 1/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-016-5556-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Impact of an In-visit Decision Aid on Patient Knowledge about Contralateral Prophylactic Mastectomy: A Pilot Study

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2017

Primary Extremity Soft Tissue Sarcomas: Does Local Control Impact Survival?

Guidelines for Guidelines: An Assessment of the American Society of Breast Surgeons Contralateral Prophylactic Mastectomy Consensus Statement

“Adjuvant” Hyperthermic Intraperitoneal Chemotherapy: A Call to Action

Reexcision Surgery for Breast Cancer: An Analysis of the American Society of Breast Surgeons (ASBrS) MasterySM Database Following the SSO-ASTRO “No Ink on Tumor” Guidelines

Low-grade Appendiceal Mucinous Neoplasm of Uncertain Malignant Potential (LAMN-UMP): Prognostic Factors and Implications for Treatment and Follow-up

Impact of the Introduction of Calcimimetics on Timing of Parathyroidectomy in Secondary and Tertiary Hyperparathyroidism