Navigating Breast Cancer Treatment Through Shared Decision-Making

In an interview with Harold "Hal" J Burstein, MD, PhD, clinician and clinical investigator at Dana-Farber Cancer Institute and Brigham and Women's Hospital in the breast oncology center, he discussed shared-decision making methods for patients with breast cancer. Burstein emphasized the importance in fostering patient-physician relationships to build trust and ultimately, gain a better understanding of the treatments they are undergoing.

This transcript was lightly edited for clarity.

Transcript

In your perspective, why is shared-decision making valuable to patient-physician relationships? What tools or methods do you find most effective in facilitating shared decision-making for patients with breast cancer?

For oncologists, I think most people would say that shared decision-making is at the core of the work that we do with our patients, and is a vital part of being their provider. In the treatment of people who have cancer, there are some very, very important treatments, but almost all of them come with major side effects. Whether it's surgery, radiation treatment, chemotherapy, targeted therapies, or hormonal manipulations, this is true for breast cancer and for every cancer that we see.

When you're talking about treatments that have major side effects, it's really important that people both understand why they might be recommended to have these treatments, what those side effects are, and to agree that the trade offs are worthwhile. That's a process that once you start a treatment, you continue to work through because people will have side effects to the ongoing therapy.

This is a slightly different example of a shared decision-making than in the screening situation, where you're talking about whether or not people should have a test.

It's true whether you're measuring the cholesterol level to see if you should be on a statin, it's true, whether you're checking your hemoglobin A1C to see if you have prediabetes, it's true if you're talking about whether or not a woman should have a mammogram.

Again, it's a very important discussion so that they understand how the process works-what the rationale is for the study, or the test, and what some of the trade offs might be in terms of inconvenience, extra biopsies, stress/distress, that are there obviously concerning whenever you do a medical test.

On the one hand, this is a cornerstone of the work. On the other hand, it's a completely familiar process for both primary care teams and for oncology teams to undergo.