title: Understanding surgery choices for breast cancer: how might the Theory of Planned Behaviour and the Common Sense Model contribute to decision support interventions?
abstract: OBJECTIVE
  To describe the evidence about factors influencing breast cancer patients' surgery choices and the implications for designing decision support in reference to an extended Theory of Planned Behaviour (TPB) and the Common Sense Model of Illness Representations (CSM).
  
  
  BACKGROUND
  A wide range of factors are known to influence the surgery choices of women diagnosed with early breast cancer facing the choice of mastectomy or breast conservation surgery with radiotherapy. However, research does not always reflect the complexities of decision making and is often atheoretical. A theoretical approach, as provided by the CSM and the TPB, could help to identify and tailor support by focusing on patients' representations of their breast cancer and predicting surgery choices.
  
  
  METHODS
  Literature search and narrative synthesis of data.
  
  
  RESULTS
  Twenty-six studies reported women's surgery choices to be influenced by perceived clinical outcomes of surgery, appearance and body image, treatment concerns, involvement in decision making and preferences of clinicians. These factors can be mapped onto the key constructs of both the TPB and CSM and used to inform the design and development of decision support interventions to ensure accurate information is provided in areas most important to patients.
  
  
  CONCLUSIONS
  The TPB and CSM have the potential to inform the design of decision support for breast cancer patients, with accurate and clear information that avoids leading patients to make decisions they may come to regret. Further research is needed examining how the components of the extended TPB and CSM account for patients' surgery choices.
authors.affiliation: Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, Wales, UK. sivells2@cardiff.ac.uk
authors.forename: Stephanie
authors.initials: S
authors.lastname: Sivell
authors.forename: Adrian
authors.initials: A
authors.lastname: Edwards
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
authors.forename: Antony S R
authors.initials: AS
authors.lastname: Manstead
mesh_terms: D001828:Body Image; D001943:Breast Neoplasms / Q000601:surgery*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D010353:Patient Education as Topic / Q000379:methods; D010358:Patient Participation / Q000379:methods* / Q000523:psychology*; D057240:Patient Preference; D018570:Risk Assessment; D016896:Treatment Outcome