title: Is there shared decision making when the provider makes a recommendation?
abstract: OBJECTIVE
  To compare the amount of shared decision making in breast cancer surgery interactions when providers do and do not make a treatment recommendation.
  
  
  METHODS
  We surveyed breast cancer survivors who were eligible for mastectomy and lumpectomy. Patients reported whether the provider made a recommendation and the recommendation given. They completed items about their interaction including discussion of options, pros, cons, and treatment preference. A total involvement score was calculated with higher scores indicating more shared decision making.
  
  
  RESULTS
  Most patients (85%) reported that their provider made a recommendation. Patients who did not receive a recommendation had higher involvement scores compared to those who did (52% vs. 39.1%, p=0.004). Type of recommendation was associated with involvement. Patients given different recommendations had the highest total involvement scores followed by those who received mastectomy and lumpectomy recommendations (65.5% vs. 42.5% vs. 33.2%, respectively, p<0.001).
  
  
  CONCLUSIONS
  Providers were less likely to present a balanced view of the options when they gave a recommendation for surgery. Patients who received a recommendation for lumpectomy had the lowest involvement score.
  
  
  CONCLUSIONS
  Providers need to discuss both mastectomy and lumpectomy and elicit patients' goals and treatment preferences regardless of whether or not a recommendation is given.
authors.affiliation: Department of General Medicine, Massachusetts General Hospital, Boston, MA 02114, USA. mfrongillo@partners.org
authors.forename: Marissa
authors.initials: M
authors.lastname: Frongillo
authors.forename: Sandra
authors.initials: S
authors.lastname: Feibelmann
authors.forename: Jeff
authors.initials: J
authors.lastname: Belkora
authors.forename: Clara
authors.initials: C
authors.lastname: Lee
authors.forename: Karen
authors.initials: K
authors.lastname: Sepucha
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology / Q000601:surgery*; D003142:Communication; D003657:Decision Making; D037001:Directive Counseling; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008408:Mastectomy / Q000523:psychology; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data; D016896:Treatment Outcome