From policy to patients and back: surgical treatment decision making for patients with breast cancer.
Persistent use of mastectomy for breast cancer has motivated concerns about overtreatment by surgeons and lack of patient involvement in decisions. However, recent studies suggest that patients perceive substantial involvement and that some patients prefer more invasive surgery, while other research suggests that surgical treatment choices might be poorly informed. Decision-making quality can be improved by increasing patients' knowledge about treatments' risks and benefits and by optimizing their involvement. The mastectomy story underscores the limitations of utilization measures as quality indicators. Strategies to improve patient outcomes should focus on tools to improve the quality of decision making and innovations in multispecialty practice.
Katz
Steven J
SJ
Department of Medicine, University of Michigan Health System, Ann Arbor, USA. skatz@med.umich.edu
Hawley
Sarah T
ST
D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000601:surgery*; D003657:Decision Making; D019317:Evidence-Based Medicine / Q000379:methods; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008408:Mastectomy; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D010358:Patient Participation / Q000379:methods*; D017410:Practice Guidelines as Topic