Majority of Women With Breast Cancer Surgery Did Not Feel Fully Informed of Treatment Options

The majority of women who underwent breast cancer operations reported not feeling fully informed of their treatment options, but the use of Web-based decision aids can help patients become informed, according to results of 2 new studies published in the Journal of the American College of Surgeons.

Breast cancer is the second most prevalent type of cancer in women in the United States, with over 230,000 diagnosed annually. For many breast cancer patients, choosing a treatment option is daunting. The first of the pair of studies sought to determine how patients receive their information to identify opportunities for improvement.

"Women diagnosed with breast cancer often describe the process of treatment decision making as bewildering and worrisome," wrote the authors. "Patients who do not feel completely informed about their surgical options may make choices that are suboptimal or regretted later."

The authors of the study conducted a nationwide survey between June 13, 2016, and June 24, 2016, among women who reported being surgically treated by lumpectomy only, mastectomy only, or both procedures for the treatment of breast cancer. Of the 487 women, 215 had a lumpectomy only, 140 had a mastectomy only, and 132 underwent both procedures.

Results showed that only 47% of lumpectomy patients, 67% of mastectomy patients, and 28% of both-surgeries patients said they felt completely informed about their treatment options prior to their surgeries. One-third of lumpectomy and mastectomy patients and one-fifth of both-surgeries patients indicated that making a quick decision for treatment was more important than researching all of their options. The majority of all 3 groups said they wished they had more time to explore different treatment options.

For sources of information, 66% of lumpectomy patients, 64% of mastectomy patients, and 76% of both-surgeries patients said that once their breast cancer surgeon recommended a surgery, they did not feel the need to research other options.

"This survey shows that a large portion of American women who had surgery for breast cancer did not feel completely informed about their treatment options," wrote the authors. "All healthcare providers should strive to create the ideal cancer care system where patients have an awareness of all treatment options and the risks and benefits associated with each."

According to the authors, efforts should include:

• Proactively planning on how to better inform patients about their treatment options
• Reassuring patients that they have sufficient time to become informed
• Providing a variety of other sources of vetted information, decision aids, and referrals to comprehensive care providers
• Scheduling follow-up consultations until the patient is completely informed

Also examining how patients received information about their treatment options, a second research team found that decision aids were more effective in informing patients than standard cancer information websites.

Between April 2016 and June 2016, the authors randomized women with stage 0 to stage III breast cancer, who were considering an operation within the University of Wisconsin breast program, to receive a link to selected standard websites, such as the National Cancer Institute, versus Web-based decision aids. According to the authors, the decision aid utilizes static, didactic information written for an eighth-grade reading level and clinical video vignettes. After receiving the links and reviewing the information, patients filled out a questionnaire in the clinic prior to their first surgical consultation. Using a breast cancer decision quality instrument, the authors measured patient knowledge.

Results showed that patients who received a link to the decision aid showed higher overall knowledge compared to patients who received links to standard websites. These patients were also more likely to know that waiting a few weeks to make a treatment decision would not affect survival (72% versus 54%).

"Although patients found receipt of any pre-consultation information helpful, the decision aid resulted in improved knowledge over standard websites and effectively conveyed that there is time to make a breast cancer surgery decision," concluded the authors. "Decreasing the urgency patients feel may improve the quality of patient-surgeon interactions and lead to more informed decision-making."