Conservation surgery for breast cancer as the preferred choice: a prospective analysis.
OBJECTIVE
To describe the proportion of women who anticipate having breast-conserving surgery (BCS) versus modified radical mastectomy (MRM), the factors they considered when making treatment choices, the degree to which they perceived they had participated in and had control of the treatment decision, and to explore factors associated with type of planned surgery.


METHODS
Prospective cohort study conducted among patients attending a tertiary care hospital in Alberta, Canada from 1992 to 1995. Participants had a first diagnosis of localized unilateral breast cancer, and were, in the opinions of their surgeons, candidates for either BCS or MRM.


RESULTS
Of 157 participants, 71.3% anticipated having BCS and 28.7% anticipated MRM. Referents perceived to play an important role in decision making included self, doctor, and significant other. The two top-ranked items perceived to have influenced treatment choice were doctor's advice and possibility of complete cure. Most women (60%) participated in treatment choice to the degree that they preferred, but only 13.6% received their preferred amount of information. The type of planned surgery was predicted by surgeon, contribution of doctor to choice of treatment, importance of breasts to sexuality, self-efficacy, and concerns about cancer recurrence from a multivariable logistic regression model.


CONCLUSIONS
Both patient and surgeon factors are important predictors of type of planned surgery. There is a gap between women's preferences and actual experiences with regard to information provided and patient participation in treatment choices, with women's desire for more information about their treatment being most prevalent.
Temple
Walley J
WJ
Department of Oncology and Surgery, The University of Calgary, Alberta, Canada.
Russell
Margaret L
ML
Parsons
Louise L
LL
Huber
Sylvia M
SM
Jones
Charlotte A
CA
Bankes
Jane
J
Eliasziw
Michael
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000523:psychology* / Q000601:surgery*; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D005783:Gender Identity; D006801:Humans; D016015:Logistic Models; D015411:Mastectomy, Modified Radical; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D010820:Physicians / Q000523:psychology; D011446:Prospective Studies; D011795:Surveys and Questionnaires