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Practitioner Opinion on Contralateral Prophylactic Mastectomy: How Do We Steer a Patient-Driven Discussion?

  • Angela E. Schellenberg
  • Amanda Stypulkowski
  • Erin Cordeiro
  • Claire M. B. Holloway
  • Andrea Eisen
  • Adena S. ScheerEmail author
Breast Oncology

Abstract

Background

Contralateral prophylactic mastectomy (CPM) is increasing despite a recent statement from The American Society of Breast Surgeons discouraging average-risk women with unilateral breast cancer (BC) from undergoing CPM. The objective of our study was to conduct a needs assessment of BC health practitioners to gather information about their opinions, attitudes, and experiences surrounding CPM.

Methods

The Ottawa Decision Support Framework was the theoretical framework for the development of the interview guide. Semistructured interviews were conducted until data saturation with a convenience sample of 16 BC practitioners (Ontario, Canada), including oncologic and reconstructive surgeons, medical oncologists, and nurse navigators.

Results

Nearly all practitioners identified the discussion regarding CPM as patient-initiated. The majority of practitioners (13/16) described their role as supporting the patient in the decision-making process. Practitioners described educating patients on the lack of survival benefit and in general discouraging CPM. Practitioners agreed that most patients demonstrate decisional conflict (11/16) as a barrier to decision-making, and it is a challenge to realign patients’ understanding and expectations. Almost all practitioners (15/16) identified a need for information materials to help educate patients on the risks and benefits of CPM and to help realign expectations.

Conclusions

Practitioners have identified CPM in average-risk women with unilateral BC as a patient-driven phenomenon that is on the rise, despite highlighting the increased risk of complications and lack of survival benefit. Our practitioner needs assessment identifies the need for a dynamic decision aid to help guide the shared decision-making process for practitioners and patients.

Notes

Funding

This study was funded by a grant from CancerCare Ontario and the Ontario Institute for Cancer Research.

Disclosures

None declared.

Supplementary material

10434_2019_7432_MOESM1_ESM.docx (25 kb)
Supplementary material 1 (DOCX 24 kb)

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  1. 1.Department of SurgerySelkirk Regional Health CentreSelkirkCanada
  2. 2.Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonCanada
  3. 3.Department of SurgeryThe Ottawa HospitalOttawaCanada
  4. 4.Department of Surgical OncologySunnybrook Health Sciences CentreTorontoCanada
  5. 5.Department of Medical OncologySunnybrook Health Sciences CentreTorontoCanada
  6. 6.Department of SurgerySt. Michael’s HospitalTorontoCanada
  7. 7.CIBC Breast CentreSt. Michael’s HospitalTorontoCanada

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