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Mastectomy or Lumpectomy? Helping Women Make Informed Choices

From the Supportive Cancer Care Research Unit and Departments of Medicine, Clinical Epidemiology and Biostatistics, and Surgery, McMaster University, Hamilton; Hamilton Regional Cancer Centre, Hamilton; Henderson Division, Hamilton Health Sciences Corporation, Hamilton; Ottawa Civic Hospital, Ottawa; Brantford General Hospital, Brantford; Department of Surgery, University of Toronto, Toronto; St. Catharines General Hospital, St. Catharines; and Guelph General Hospital, Guelph, Ontario, Canada.

Address reprint requests to Timothy J. Whelan, BM, BCh, MSc, c/o Hamilton Regional Cancer Centre, 699 Concession St, Hamilton, ON L8V 5C2 Canada; email tim_whelan{at}hrcc.on.ca

PURPOSE: To develop an instrument to help clinicians inform their patients about surgical treatment options for the treatment of breast cancer and to evaluate the impact of the instrument on the clinical encounter.

METHODS: We developed an instrument, called the Decision Board, to present information regarding the benefits and risks of breast-conserving therapy (lumpectomy plus radiation therapy) and mastectomy to women with early-stage breast cancer to enable them to express a preference for the type of surgery. Seven surgeons from different communities in Ontario administered the instrument to women with newly diagnosed clinical stage I or II breast cancer over an 18-month period. Patients and surgeons were interviewed regarding acceptability of the instrument. The rates of breast-conserving surgery performed by surgeons before and after the introduction of the instrument were compared.

RESULTS: The Decision Board was administered to 175 patients; 98% reported that the Decision Board was easy to understand, and 81% indicated that it helped them make a decision. The average score on a true/false test of comprehension was 11.8 of 14 (84%) (range, 6 to 14). Surgeons found the Decision Board to be helpful in presenting information to patients in 91% of consultations. The rate of breast-conserving surgery decreased when the Decision Board was introduced (88% v 73%, P = .001)

CONCLUSION: The Decision Board is a simple method to improve communication and facilitate shared decision making. It was well accepted by patients and surgeons and easily applied in the community.

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