CALDON, LJM, COLLINS, K, WILDE, DJ, AHMEDZAI, SH, NOBLE, TW, STOTTER, A, SIBBERING, DM, HOLT, S and REED, MWR (2011). Why do hospital mastectomy rates vary? Differences in the decision-making experiences of women with breast cancer. British journal of cancer, 104 (10), 1551-1557.
Abstract
BACKGROUND: Hospital mastectomy rates vary. This study explores the relationship between mastectomy rates and breast cancer
patients’ consultation and decision-making experiences with specialist clinicians.
METHODS: Qualitative semi-structured interviews were conducted with 65 patients from three purposively selected breast units from
a single UK region. Patients provided with a choice of breast cancer surgery (breast conservation therapy (BCT) or mastectomy)
were purposively recruited from high, medium and low case-mix-adjusted mastectomy rate units.
RESULTS: Low mastectomy rate unit patients’ consultation and decision-making experiences were markedly different to those of the
medium and high mastectomy rate breast units. Treatment variation was associated with patients’ perception of the most reassuring
and least disruptive treatment; the content and style of information provision (equipoise or directed); level of patient participation in
decision making; the time and process of decision making and patient autonomy in decision making. The provision of more
comprehensive less directive information and greater autonomy, time and support of independent decision making were associated
with a lower uptake of BCT.
CONCLUSION: Variation in hospital mastectomy rates was associated with differences in the consultation and decision-making
experiences of breast cancer patients. Higher mastectomy rates were associated with the facilitation of more informed autonomous
patient decision making.
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