Shared Decision Making, Decision Support and Breast Conservation Therapy
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Shared Decision Making, Decision Support and Breast Conservation Therapy explores how breast cancer patients interpret decisions around making decisions about mastectomy vs. lumpectomy.
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Shared Decision Making, Decision Support and Breast Conservation Therapy
- 1. Shared Decision Making, Decision Support and Breast Conserving Therapy Matthew S. Katz, MD Radiation Oncology Associates, PA Saints Medical Center Lowell, MA April 27, 2009
- 4. What I learned in medical school
- 18. Hack et al, Psychooncology 2006 Desired role changes over time Baseline Preferred Role Active Collaborative Passive Total Role Preference at 3 years A 33 18 21 36% C 19 22 43 42% P 3 2 41 22% 27% 21% 52%
- 31. Decisional Aids and BCS Walgee et al, JCO 2007
- 32. Increased BCS with DA Walgee et al, JCO 2007
- 33. DA Enhances Patient Knowledge Walgee et al, JCO 2007
- 34. Decision Board from JAMA Whelan et al, JAMA 2004
- 45. Not all statistical models give consistent results Mitchell et al, J Urol 2005
- 49. IBTR! Results
- 56. Collins et al, JCO 2009 Treatment Choice Before DA After DA After Consult Mastectomy 22% 31% 35% Breast Conserving Surgery 34% 31% 65% Uncertain 43% 38% --
- 57. What factors influence decision for surgery? Collins et al, JCO 2009
Hinweis der Redaktion
- 48% role congruence 61% of initially passive patients preferred collaborative or active role 3 years later Only 5% desiring collaborative/active role wished for a passive role
- Survey of 604 Australian MDs (51% treat breast cancer patients) * Of note, only 19% of surveyed MDs elicited patient’s values/preferences
- Consistent with findings in other studies Another large population-based study found that 75% of women choosing mastectomy had concerns regarding radiation Minimize risk of breast recurrence should be taken with grain of salt since only 69% correctly identified difference in LRR in M vs. BCT
- In theory multidisciplinary clinics help bring all the specialists together to come up with a joint plan. However, it may not always work best for the patient