br Overall patients with breast cancer in our cohort over
Overall, patients with breast cancer in our cohort over-whelmingly reported preferring being able to actively partici-pate in decision-making with their doctor over following a doctor’s recommendation or making the decision alone (81%, 12%, and 7%). Although there have been a limited number of studies examining specifically preferences for decision-making in the context of selecting between CPM and UM among UBC patients, the concept of active and shared decision-making has been well studied across medicine. Indeed, in a meta-analysis of 115 studies investigating patient decision role preferences, Chewning et al. reported that the majority of patients in 63% of studies preferred shared decision-making. This seems to be a growing trend as more studies published after 2000 reported a preference for shared decision-making compared to older studies.28
Our study adds to the limited data evaluating patientephysician communication in decision-making regarding CPM. Our work, however, should be interpreted in light of some limitations. To begin with, as with all retro-spective survey studies, our study was subject to recall bias, with patients being a median of 13.8 mo out from surgery at the time of survey. However, there are data suggesting that the significance of an event (e.g., the decision to remove one breast or two) may mitigate some recall bias.29 Hence, although certainly a limitation of the study, we feel that the recall of how such a significant decision was made may not be as seriously hampered as recall of other more trivial events.
Furthermore, given that this Cucurbitacin I was a survey, we asked pa-tients about their perception of their interaction with their surgeon and how this impacted their decision-making. We were not present during the initial conversation between the patient and physician surrounding mastectomy decision. Although we therefore could not objectively assess whether the physician clearly engaged the patient in understanding the options, presenting data in an unbiased fashion and providing patients with an opportunity to engage in active decision-making, we feel that understanding patients’ per-ceptions of what occurred during the consultation is critical as it is on that basis, which may or may not reflect what objec-tively occurred, that their decisions are made.
Our survey included questions from the validated SWD scale as well as author-generated questions regarding patient decision-making experiences. Although the author-generated questions were not a validated instrument, they asked the
simple question of whether the decision they made was pri-marily done by them, by their surgeon, or was formulated after having a conversation with their surgeon as to the ad-vantages and disadvantages of each option and then bringing to the decision their own values and judgment.
Clearly, decision-making involves a number of factors, and another limitation of our study is that not all possible factors that could have influenced that decision were collected. Still, insofar as we could discern the impact of socioeconomic and clinicopathologic factors on this decision, we did so.
Finally, our study was conducted at a single large academic institution in the Northeast, and thus our patient population may not have been representative of the general population of the United States. Notably, a sizable proportion of the popu-lation included in this study were college educated and had annual incomes over $100,000. We did not, however, find that education level or income were associated with engaging in active participation in decision-making. Nevertheless, the association between income, education, and health literacy may be associated with different conceptualizations of decision-making involvement.30 A larger study focusing on health literacy in the CPM versus UM populations may help elucidate such associations specifically for CPM decision-making.