FCCC LOGO Faculty Publications
Opatt D , Morrow M , Hawley S , Schwartz K , Janz NK , Katz SJ
Conflicts in decision-making for breast cancer surgery
Annals of Surgical Oncology. 2007 Sep;14(9) :2463-2469
PMID: ISI:000249400600009   
Back to previous list
Background: Little is known about the interaction among surgeons, patients, and other physicians in selecting breast cancer surgery. Methods: We contacted attending surgeons (n = 456) of a population-based sample of 2645 breast cancer patients diagnosed in Detroit and Los Angeles from December 2001 to January 2003. Eighty percent completed a written survey with clinical scenarios. Results: The mean surgeon age was 50 years, 50% practiced in a community hospital, and breast cancer averaged 31% of practice volume. The mean number of years in practice was 17.2. Female surgeons made up 14.4% of the sample and 35% of the high-volume surgeons. Conflict with patients and other providers was reported by 58% and 32% of surgeons, respectively. When the patient preferred mastectomy and the surgeon favored BCS, conflict was reported by 49.9% of surgeons. Compared with low-volume surgeons, high-volume surgeons were significantly more likely to report conflict in this scenario (44% vs 62%; P = .047). When another provider preferred mastectomy and the respondent surgeon favored BCS, conflict was reported by 34% of surgeons and was more common for high-volume surgeons (P < .001). In a logistic regression model, surgeon volume and practice setting were strongly associated with conflict in this scenario. Conclusion: High-volume surgeons and those in cancer centers more frequently endorse current clinical guidelines that favor BCS over mastectomy, resulting in greater conflict with patients. These findings support patient reports that patient choice is a key factor in continued mastectomy use.
ISI Document Delivery No.: 209PN Times Cited: 0 Cited Reference Count: 25 Cited References: ANEMA MG, 1995, J CONTIN ED NURS, V26, P109 ARRIAGADA R, 1996, J CLIN ONCOL, V14, P1558 BACK A, 2006, ONCOLOGY-NY, V20, P67 BAXTER NN, 2004, J NATL CANCER I, V96, P443 CLAUSON J, 2002, CANCER, V94, P889 DILLMAN D, 1978, MAIL TELEPHONE SURVE ERNSTER VL, 1996, JAMA-J AM MED ASSOC, V275, P913 FAGERLIN A, 2006, PATIENT EDUC COUNS, V64, P303 FARROW DC, 1992, NEW ENGL J MED, V326, P1097 FISHER B, 2002, NEW ENGL J MED, V347, P1233 GUADAGNOLI E, 1998, J CLIN ONCOL, V16, P101 KATZ SJ, 2005, CANCER, V104, P1854 KATZ SJ, 2005, J CLIN ONCOL, V23, P3001 KATZ SJ, 2005, J CLIN ONCOL, V23, P5526 LANTZ PM, 2002, HEALTH SERV RES, V37, P417 LANTZ PM, 2005, HEALTH SERV RES, V40, P745 MASTAGLIA B, 2001, J ADV NURS, V35, P836 MORROW M, 2001, J CLIN ONCOL, V19, P2254 MORROW M, 2005, CANCER, V104, P2340 NATTINGER AB, 1992, NEW ENGL J MED, V326, P1102 POGGI MM, 2003, CANCER, V98, P697 VERONESI U, 2002, NEW ENGL J MED, V347, P1227 WENNBERG JE, 2002, BRIT MED J, V325, P961 WHELAN T, 2004, JAMA-J AM MED ASSOC, V292, P435 WHITE J, 2003, CANCER, V97, P893