Newly diagnosed breast cancer patients are vulnerable. In the context of this vulnerability, they are asked to engage with their surgeon in a complex decision making process that requires weighing risks and benefits between surgical options that are equivalent in survival and recurrence, but different in long-term impacts on quality of life (QOL). The level of engagement in decision making that patients prefer varies and recognition of this variation is a key component of patient centered delivery of care. A major barrier to negotiating the patient?s preferred role (role negotiation) and helping them achieve concordance between their preferred role and their achieved role (role concordance) is a lack of a standards for implementing this clinical practice pattern and a lack of evidence that this type of intervention matters. While prior research has shown the variability in preferred role and the low rate of role concordance, to our knowledge there has yet to be a study published in any patient population that attempts to improve role concordance and then examines the effects on decisional and health outcomes. The Patient Preference Scale assesses what role patients prefer while the Patient Perception Scale assesses what role patients? perceive to have achieved. Using these scales allows an examination of concordance between preferred and achieved roles. Thus, the goal of this project is to test the effects of the Patient Preference Scale as the basis for a clinical intervention for role negotiation in breast cancer surgery decisions and the Patient Perception Scale to measure role concordance. We propose a mixed methods, interventional study with historical controls performed in a breast cancer surgery clinic at a comprehensive cancer center. In the first half of the study, providers will be blind to the patient?s preferred role. In the second half, providers will be made aware of the preferred role prior to the encounter and will have a brief conversation with the patient about their desired role in the decision making process. Clinical encounters will be audiotaped, transcribed, and scored for patient involvement. We hypothesize that this intervention will result in better role concordance. In addition, role concordance will be associated with improved short-term and longer-term improvements in outcomes of the following parameters: a) satisfaction with decision process b) breast specific QOL, and c) decision regret.
With a projected 231,840 new diagnoses of breast cancer in 2015, this project aims to improve the decision making process during the cancer treatment course among these patients. This will impact the clinical care of these patients as awareness of the consequences of cancer treatment and potential overtreatment increases.
