Is there shared decision making when the provider makes a recommendation?

• Published in: Patient education and counseling Vol. 90; no. 1; pp. 69 - 73
• Main Authors: Frongillo, Marissa, Feibelmann, Sandra, Belkora, Jeff, Lee, Clara, Sepucha, Karen
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.01.2013
• Subjects: Adult; Aged; Attitudes; Breast cancer; Breast cancer treatment decisions; Breast Neoplasms - psychology; Breast Neoplasms - surgery; Collaborative decision making; Communication; Decision Making; Decision quality; Directive Counseling; Female; Health Care Surveys; Humans; Internal Medicine; Mastectomy; Mastectomy - psychology; Middle Aged; Nursing; Patient involvement; Patient Participation; Physician-Patient Relations; Practice Patterns, Physicians; Provider recommendation; Quality of Health Care; Shared decision making; Socioeconomic Factors; Surgery; Survivors; Survivors - psychology; Survivors - statistics & numerical data; Treatment Outcome; Decision quality; Shared decision making; Breast cancer treatment decisions; Patient involvement; Provider recommendation
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2012.08.016

Abstract Objective To compare the amount of shared decision making in breast cancer surgery interactions when providers do and do not make a treatment recommendation. Methods We surveyed breast cancer survivors who were eligible for mastectomy and lumpectomy. Patients reported whether the provider made a recommendation and the recommendation given. They completed items about their interaction including discussion of options, pros, cons, and treatment preference. A total involvement score was calculated with higher scores indicating more shared decision making. Results Most patients (85%) reported that their provider made a recommendation. Patients who did not receive a recommendation had higher involvement scores compared to those who did (52% vs. 39.1%, p = 0.004). Type of recommendation was associated with involvement. Patients given different recommendations had the highest total involvement scores followed by those who received mastectomy and lumpectomy recommendations (65.5% vs. 42.5% vs. 33.2%, respectively, p < 0.001). Conclusion Providers were less likely to present a balanced view of the options when they gave a recommendation for surgery. Patients who received a recommendation for lumpectomy had the lowest involvement score. Practice implications Providers need to discuss both mastectomy and lumpectomy and elicit patients’ goals and treatment preferences regardless of whether or not a recommendation is given.