title: Why do hospital mastectomy rates vary? Differences in the decision-making experiences of women with breast cancer.
abstract: BACKGROUND
  Hospital mastectomy rates vary. This study explores the relationship between mastectomy rates and breast cancer patients' consultation and decision-making experiences with specialist clinicians.
  
  
  METHODS
  Qualitative semi-structured interviews were conducted with 65 patients from three purposively selected breast units from a single UK region. Patients provided with a choice of breast cancer surgery (breast conservation therapy (BCT) or mastectomy) were purposively recruited from high, medium and low case-mix-adjusted mastectomy rate units.
  
  
  RESULTS
  Low mastectomy rate unit patients' consultation and decision-making experiences were markedly different to those of the medium and high mastectomy rate breast units. Treatment variation was associated with patients' perception of the most reassuring and least disruptive treatment; the content and style of information provision (equipoise or directed); level of patient participation in decision making; the time and process of decision making and patient autonomy in decision making. The provision of more comprehensive less directive information and greater autonomy, time and support of independent decision making were associated with a lower uptake of BCT.
  
  
  CONCLUSIONS
  Variation in hospital mastectomy rates was associated with differences in the consultation and decision-making experiences of breast cancer patients. Higher mastectomy rates were associated with the facilitation of more informed autonomous patient decision making.
authors.affiliation: Department of Oncology, University of Sheffield, School of Medicine and Biomedical Sciences, Beech Hill Road, Sheffield S10 2RX, UK. l.caldon@sheffield.ac.uk
authors.forename: L J M
authors.initials: LJ
authors.lastname: Caldon
authors.forename: K A
authors.initials: KA
authors.lastname: Collins
authors.forename: D J
authors.initials: DJ
authors.lastname: Wilde
authors.forename: S H
authors.initials: SH
authors.lastname: Ahmedzai
authors.forename: T W
authors.initials: TW
authors.lastname: Noble
authors.forename: A
authors.initials: A
authors.lastname: Stotter
authors.forename: D M
authors.initials: DM
authors.lastname: Sibbering
authors.forename: S
authors.initials: S
authors.lastname: Holt
authors.forename: M W R
authors.initials: MW
authors.lastname: Reed
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D003657:Decision Making; D005260:Female; D006761:Hospitals; D006801:Humans; D008408:Mastectomy / Q000706:statistics & numerical data*; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D012017:Referral and Consultation