Purpose: To assess the quality of breast cancer patients’ decisions about surgery by measuring their knowledge and the degree to which their treatment decisions reflect their goals.
Method: A convenience sample of breast cancer survivors who had undergone treatment in the past 3 years completed a mailed survey, as part of a larger study to validate decision quality instruments. The survey contained questions on facts about breast cancer surgery and questions about personal goals and concerns related to surgery. Characteristics associated with knowledge were identified using chi-squared analysis. Goals/concerns associated with mastectomy were identified with multivariate logistic regression. A model for predicting reconstruction was developed, incorporating demographic and clinical variables, whether the provider mentioned reconstruction, and goals/concerns that were significant on bivariate analysis. The model was used to assess concordance between treatment and preferences. Concordance was defined as model predicted probability >0.50.
Result: 456 patients completed the survey (response rate 59%). The mean overall knowledge score was 52% (SD 22.4). 56% of women knew that breast conservation and mastectomy have equivalent survival. 46% of women knew that risk of recurrence is slightly higher with breast conservation. 70% of women understood that breast conservation is more likely to require another operation. Women who had breast conservation had higher knowledge than women who had mastectomy (55.0 vs. 47.1, p=0.0003). Younger age at diagnosis (58.1 vs. 48.3, p<0.0001), a college degree (55.5 vs. 42.8, p=0.014), and being married (54.1 vs. 48.0, p<0.0001) were also associated with higher knowledge scores. The goals “remove your entire breast to gain peace of mind” (OR 1.701, CI 1.486, 1.946) and “avoid having radiation” (OR 1.278, CI 1.142, 1.431) were associated with mastectomy. The goal “keep your breast” was associated with breast conservation (OR 0.765, CI 0.680, 0.860). 91% of patients had treatment that was concordant with preferences.
Conclusion: Women with breast cancer have significant deficits in knowledge about important facts related to breast cancer surgery, including facts about survival and recurrence. Most women undergo treatment that is concordant with their preferences. Providers should consider patients’ feelings about removing the breast for peace of mind, avoiding radiation, and keeping the breast, in order to maximize the quality of treatment decisions.
Candidate for the Lee B. Lusted Student Prize Competition