title: Can women with early-stage breast cancer make an informed decision for mastectomy?
abstract: OBJECTIVE
  The purpose of this study was to measure the degree to which informed women chose mastectomy, and to reveal their reasons for this choice.
  
  
  METHODS
  This was a prospective cohort study of patients radiographically and pathologically eligible for either mastectomy or breast-conserving surgery (BCS; n = 125). Participants completed questionnaires at three time points: baseline, after viewing a decision aid, and after a surgical consultation. Questionnaires assessed clinical history, preference for participation in decision making, information comprehension, values, decisional conflict, and preferred treatment.
  
  
  RESULTS
  Of 125 participants, 44 (35%) chose mastectomy. Most understood that BCS and mastectomy offer an equivalent survival benefit (98%) and that BCS has a slightly higher local recurrence risk (63%); most accurately identified the magnitude of ipsilateral local recurrence risk (91%). Values assigned to three treatment attributes/outcomes ("remove breast for peace of mind," "avoid radiation," and "keep breast") clearly discriminated between patients choosing mastectomy or BCS. High decisional conflict scores improved after both the decision aid and surgical consultation.
  
  
  CONCLUSIONS
  Although conventional wisdom may view BCS as the preferred treatment, a notable proportion of well informed women choose mastectomy. Whereas prior studies have linked objective factors to treatment choice, this study reveals subjective preferences that underlie decision making. The systematic use of a decision aid before the surgical consultation may help women make informed, values-based decisions, while clearly reducing decisional conflict.
authors.affiliation: Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA. e.dale.collins@hitchcock.org
authors.forename: E Dale
authors.initials: ED
authors.lastname: Collins
authors.forename: Caroline P
authors.initials: CP
authors.lastname: Moore
authors.forename: Kate F
authors.initials: KF
authors.lastname: Clay
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Kearing
authors.forename: Annette M
authors.initials: AM
authors.lastname: O'Connor
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Llewellyn-Thomas
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Barth
authors.forename: Karen R
authors.initials: KR
authors.lastname: Sepucha
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D002755:Choice Behavior; D015331:Cohort Studies; D003657:Decision Making; D004493:Education; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D010353:Patient Education as Topic; D010358:Patient Participation; D017060:Patient Satisfaction; D011446:Prospective Studies; D011795:Surveys and Questionnaires