title: Correlates of patient satisfaction and provider trust after breast-conserving surgery.
abstract: BACKGROUND
  Although breast-conserving therapy (BCS) is considered the standard of care for early-stage breast cancer, up to 20% of patients are dissatisfied. The effect of treatment-related factors on patient satisfaction with their healthcare experiences is unclear.
  
  
  METHODS
  All BCS patients at the University of Michigan Medical Center who were treated between January 2002 and May 2006 were surveyed (n=714; response rate, 79.5%). Patients were queried regarding 4 aspects of their decision for surgery: satisfaction with the decision, decision regret, decisional conflict, and trust in surgeons. Independent variables included the number of re-excisions, the occurrence of postoperative complications, and postoperative breast appearance, which was assessed by using the Breast Cancer Treatment and Outcomes scale. Multiple logistic regression was used to assess the effect of the independent variables on each outcome controlling for demographic and clinical characteristics.
  
  
  RESULTS
  Breast asymmetry after BCS was correlated significantly with patient satisfaction with their treatment experiences and patient distrust in surgeons. Women who reported pronounced asymmetry were significantly less likely to be satisfied with the decision for surgery compared with women who reported minimal asymmetry (odds ratio [OR], 0.43; 95% confidence interval [95% CI], 0.21-0.89). Women with pronounced asymmetry were less likely to be certain about their surgical decision (OR, 0.36; 95% CI, 0.21-0.60) and to believe that they were prepared to make the decision for surgery (OR, 0.25; 95% CI, 0.14-0.43). Increasing breast asymmetry was associated with higher surgeon distrust scores (2.14 vs 2.30 vs 2.35; P= .04) and with the occurrence of postoperative complications (distrust score: 2.23 vs 2.35; P= .03). Reoperation after BCS was not associated with patient satisfaction or trust in providers.
  
  
  CONCLUSIONS
  Esthetic result after BCS was associated more profoundly with aspects of satisfaction than either surgical therapy or the occurrence of postoperative complications. The current findings indicated that surgeons who care for patients with breast cancer should identify the women at an increased risk for breast asymmetry preoperatively to effectively address their expectations of treatment outcomes.
authors.affiliation: Section of General Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109, USA. filip@med.umich.edu
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Waljee
authors.forename: Emily S
authors.initials: ES
authors.lastname: Hu
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Newman
authors.forename: Amy K
authors.initials: AK
authors.lastname: Alderman
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000523:psychology / Q000601:surgery*; D003220:Conflict, Psychological; D003657:Decision Making; D004644:Emotions; D004954:Esthetics; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008408:Mastectomy; D015412:Mastectomy, Segmental / Q000009:adverse effects / Q000523:psychology; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011183:Postoperative Complications; D012086:Reoperation; D016896:Treatment Outcome; D035502:Trust