This presentation is part of: Oral Concurrent Session A - Patient and Physician Behavior/Preferences 1
WOMEN'S DECISION MAKING ROLES REGARDING PROPHYLACTIC MASTECTOMY
Larissa Nekhlyudov, MD, MPH, Harvard Medical School/Harvard Pilgrim Health Care, Department of Ambulatory Care and Prevention, Boston, MA and Ann M. Geiger, PhD, Southern California Kaiser Permanente, Research & Evaluation Department, Pasadena, CA.
PURPOSE: Contralateral prophylactic mastectomy (CPM) is the removal of a non-affected breast in a woman with unilateral breast cancer and is an option for women considering methods to prevent future risk of breast cancer. Yet little is known about a woman’s role in decision making regarding CPM and its effect on long term outcomes. METHODS: We mailed surveys to 766 women aged 18-80 with contralateral prophylactic mastectomy performed at one of six health maintenance organizations between 1979 and 1999. The survey included measures of decision making control, satisfaction, concern about breast cancer, and depressive disorders (CES-D). RESULTS: We received 562 surveys (response rate 73%); 502 analyzable surveys from women without recurrent breast cancer are included in this analysis. Respondents’ mean age was 61 years and duration since the procedure was 10 years. Most women (97%) reported active roles in decision making regarding CPM but their extent of involvement varied; 42% reported making the final decision themselves (ALONE), 39% made the final decision after considering the doctor’s opinion (OPINION), and 15% shared the decision making responsibility with their providers (SHARED). Women with the greatest involvement (ALONE) were more likely to have college education compared to those with OPINION and SHARED roles (51%, 45%, 19% respectively, p<0.0001) but were similar by race, age, breast cancer risk factors and concern about breast cancer. While most women were satisfied with CPM within six months of the procedure, those reporting ALONE and OPINION roles were more likely to be satisfied than those with SHARED roles (83%, 88%, 72% respectively, p=0.04, adjusted for education). Decision making roles did not predict long-term satisfaction, change in concern about breast cancer or current depressive disorders. CONCLUSIONS: Among women with active decision making roles, those with higher education reported greater involvement in decision making regarding CPM and short term satisfaction following the procedure. Women with lower education may need additional support to assume more active roles to achieve similar short term outcomes though the level of involvement does not appear to have long term implications.
