26 December 2017
A study recently published in the Journal of the American College of Surgeons evaluated patient perceptions regarding knowledge about their breast cancer surgery. An online survey was distributed via email to patients who had participated in previous online surveys and had agreed to be contacted again. Enrollment quotas were set for geographic area, insurance status, and income level to try to achieve a varied sample population. In the analyzed sample, 215 patients underwent lumpectomy, 140 underwent mastectomy, and 132 reported that they had undergone both procedures.
The study showed that only 47% of patients who underwent a lumpectomy and 67% who underwent a mastectomy felt fully informed about their treatment choice. About 30% of patients who underwent lumpectomy or mastectomy and about 20% of those who underwent both procedures felt that making a quick treatment decision was more important than thoroughly researching all of the options. The majority of patients reported that they “somewhat” or “strongly” felt that more time would be helpful to make their decision.
60% of patients who underwent lumpectomy obtained a 2nd surgical opinion. 45% of mastectomy and 87% of patients who underwent both procedures obtained a 2nd surgical opinion. Over 50% of women reported receiving additional information from other physicians, websites, and family / friends. A little over 30% of patients sought out information from online blogs and discussion groups.
The study has several limitations, the most important being that a variable amount of time might have elapsed from the time of the patient’s surgery to the time of the survey, and responses may have been influenced by “recall bias”. In addition, the patient population was primarily Caucasian and college-educated. However, this study along with other research clearly shows that we have a long way to go in terms of better informing our patients about their surgical options for breast cancer treatment. This study also shows that patients still feel a sense of urgency to make quick decisions about their treatment.
Physicians are under increasing pressure to see more patients, which limits the amount of time available for each consultation. However, physicians have a responsibility to ensure that patients receive a balanced discussion of their options and need to make themselves available to answer questions. Patients should not feel pressured to make quick decisions, and 2nd opinions can be helpful prior to making a final decision. The authors conclude that “Patients who are completely informed of all their treatment options will make higher-quality shared decisions about treatment and will experience better long-term survivorship outcomes” and I couldn’t agree more.