Association of shared decision-making with type of breast cancer surgery: a cross-sectional study
1 Division of Cancer Control, Research Institute for National Cancer Control and Evaluation, National Cancer Center, Goyang, Gyeonggi, Korea
2 Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
3 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
4 Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
5 Department of Surgery, Yonsei University Medical Center, Seoul, Korea
6 Branch of Breast Cancer, Research Institute, National Cancer Center, Goyang, Gyeonggi, Korea
BMC Health Services Research 2010, 10:48 doi:10.1186/1472-6963-10-48Published: 23 February 2010
Although some studies examined the association between shared decision-making (SDM) and type of breast cancer surgery received, it is little known how treatment decisions might be shaped by the information provided by physicians. The purpose of this study was to identify the associations between shared decision making (SDM) and surgical treatment received.
Questionnaires on SDM were administered to 1,893 women undergoing primary curative surgery for newly diagnosed stage 0-II localized breast cancer at five hospitals in Korea. Questions included being informed on treatment options and the patient's own opinion in decision-making.
Patients more likely to undergo mastectomy were those whose opinions were respected in treatment decisions (adjusted odds ratio, aOR), 1.40; 95% confidence interval (CI), 1.14-1.72) and who were informed on chemotherapy (aOR, 2.57; CI, 2.20-3.01) or hormone therapy (aOR, 2.03; CI, 1.77-2.32). In contrast, patients less likely to undergo mastectomy were those who were more informed on breast surgery options (aOR, 0.34; CI, 0.27-0.42). In patients diagnosed with stage 0-IIa cancer, clinical factors and the provision of information on treatment by the doctor were associated with treatment decisions. In patients diagnosed with stage IIb cancer, the patient's opinion was more respected in treatment decisions.
Our population-based study suggested that women's treatment decisions might be shaped by the information provided by physicians, and that women might request different information from their physicians based on their preferred treatment options. These results might need to be confirmed in other studies of treatment decisions.