Changing trends in the decision-making preferences of women with early breast cancer.
BACKGROUND
Previous studies have indicated a predominance of passive decision-making styles among women with early-stage breast cancer in the UK offered a choice between breast-conserving surgery (BCS) and mastectomy. The aim of this study was to determine current decision-making styles and establish their association with operation choice and breast unit mastectomy rate.


METHODS
A questionnaire survey was conducted among women from three specialist breast units representing high, medium and low case mix-adjusted mastectomy rates.


RESULTS
Of 697 consecutive patients, 356 (51.1 per cent) completed the questionnaire, a mean of 6.9 (range 1.3-48.6) weeks after surgery. Some 262 women (73.6 per cent) underwent BCS and 94 (26.4 per cent) had a mastectomy. Some 218 patients (61.2 per cent) achieved their preferred decision-making style. The proportions of women achieving an active decision-making style were high, particularly for those choosing mastectomy (83 versus 58.0 per cent for BCS; P < 0.001) and in the high mastectomy rate unit (79.6 versus 53 and 52.2 per cent for medium and low rate units respectively; P < 0.001).


CONCLUSIONS
More women chose an active decision-making style than in previous UK studies. The provision of greater treatment selection autonomy to women suitable for BCS may not reduce mastectomy rates.
Caldon
L J M
LJ
Academic Unit of Surgical Oncology, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, UK. l.caldon@sheffield.ac.uk
Walters
S J
SJ
Reed
M W R
MW
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology* / Q000601:surgery; D003657:Decision Making; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000523:psychology; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction