Annals of Surgical Oncology

, Volume 26, Issue 13, pp 4372–4380 | Cite as

An In-Visit Decision Aid for Surgeons to Address Decision Making for Bilateral Mastectomy for Newly Diagnosed Breast Cancer Patients

  • Katharine YaoEmail author
  • Jeff Belkora
  • Clara Lee
  • Kristine Kuchta
  • Catherine Pesce
  • Katherine Kopkash
  • Sarah Rabbitt
  • Ermilo Barrera
  • Sandra Simovic
  • Karen Sepucha
Breast Oncology



Few decision aids for newly diagnosed breast cancer patients are used by surgeons during their consultations with patients.


From 2017 to 2019, an online interactive breast cancer in-visit decision aid (BIDA) was used on 63 patients and 57 patients underwent usual care (UC). We compared knowledge, decision involvement, anxiety and distress (HADS scale), quality of life (PROMIS), fear of recurrence, body image, and patient values between BIDA and UC before surgery. A knowledge score of ≥ 57% was considered “high knowledge.”


A total of 188 patients were enrolled of which 120 (63.8%) completed all study procedures. Patient demographic characteristics and anxiety and quality of life (QOL) at baseline were similar between patients in BIDA and UC cohorts. After seeing the surgeon, patients in the BIDA group had higher composite knowledge scores compared with UC patients [n = 55 (87.3%) vs. n = 39 (68.4%) respectively, p = 0.012]. Patients in the BIDA cohort reported being asked more often their surgical preference (p = 0.013) and discussing bilateral mastectomy (BM) as an option (p = 0.048). There was a trend of less patients in the BIDA cohort undergoing BM then in the UC cohort [10 (15.9%) vs. 14 (24.6%), p = 0.49]. Anxiety and distress, QOL, fear of recurrence, and body image were not significantly different between BIDA and UC cohorts.


A decision aid used by surgeons during their consultation was associated with higher knowledge levels, patients reporting more discussion about BM, and a trend of lower BMs. A larger study with more patients is needed to confirm this finding.



None to report.


The authors declare no conflicts of interest and no disclosures.

Supplementary material

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Supplementary material 1 (PDF 5353 kb)
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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Katharine Yao
    • 1
    • 6
    Email author
  • Jeff Belkora
    • 2
  • Clara Lee
    • 3
  • Kristine Kuchta
    • 4
  • Catherine Pesce
    • 1
    • 6
  • Katherine Kopkash
    • 1
    • 6
  • Sarah Rabbitt
    • 1
  • Ermilo Barrera
    • 1
    • 6
  • Sandra Simovic
    • 1
  • Karen Sepucha
    • 5
  1. 1.Division of Surgical Oncology, Department of SurgeryNorthShore University HealthSystemEvanstonUSA
  2. 2.University of California San Francisco School of MedicineSan FranciscoUSA
  3. 3.Division of Plastic Surgery, Department of SurgeryOhio State University Medical CenterColumbusUSA
  4. 4.Biostatistical CoreNorthShore University HealthSystem Research InstituteEvanstonUSA
  5. 5.Health Decision Sciences CenterMassachusetts General HospitalBostonUSA
  6. 6.Pritzker School of MedicineUniversity of ChicagoEvanstonUSA

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