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  • br then allowing the patient to make the final

    2020-03-24

    
    then allowing the patient to make the final decision based on their own values and preferences.
    To explore preferred physicianepatient communication, the survey queried, “How would you have liked to discuss the decision to remove one or both breasts with your doctor?” The answer choices for the above question were “I would prefer that my doctor give me a single recommendation”; “I would prefer that I am able to make the decision myself”; and “I would prefer that my doctor make sure I understand both options without recommending a single decision, and then let me make the decision.” Patients were also asked what their doctor recommended: “What was your doctor’s initial recommendation regarding removing one breast versus both?” Answer options included: “My doctor recommended to remove just one breast”; “My doctor recommended to remove both breasts”; and “My doctor made sure I understood both options without recommending a single decision, and then let me make the decision.”
    Patient satisfaction with their surgical decision was measured using the validated Satisfaction with Decision (SWD) scale, a validated instrument that measures multiple dimensions of satisfaction with health care decisions on a 5-point scale (higher score denoting increased satisfaction).18 Nonparametric statistical analyses were performed on SPSS version 24 (IBM; Armonk, NY). This study was reviewed and approved by the Human Investigations Committee of Yale University, and all patients included in this Artesunate study provided an informed consent to participate in the study.
    Results
    Patient population
    One hundred nine patients were approached for this study; 101 of whom consented to and completed the study survey (92.7%). These patients formed the cohort of interest. Among respondents, the median patient age at the time of surgery was 49 (range 29-82 y), and the median time of survey from surgery was 13.8 mo (range 0.3-192.1 mo). Fifty-five patients chose to undergo CPM (54.5%). Compared to patients who declined the survey, patients who completed the survey ten-ded to be younger at the time of surgery (median age 49 versus 62.5, P ¼ 0.022). The proportions of patients who selected CPM, however, were similar between the responder and nonre-sponder cohorts (54.5% versus 37.5%, P ¼ 0.470). Compared to patients who selected UM, patients who selected CPM tended to be younger than UM patients (median age 46 versus 58.5 y, P < 0.001). Otherwise, the sociodemographic and clinico-pathologic features of the patients in the two groups were similar (Table 1).
    Effect of physician recommendations on decision-making
    Of the cohort of 101 patients, 33 (33%) reported being recom-mended UM, six (6%) reported being recommended CPM, and 61 patients (61%) stated that their doctor employed SDM, that is, made no strong initial recommendation either way; there was one patient who did not provide a response to the
    Table 1 e Patient characteristics.
    Median age (y)
    Disease stage
    Race
    Education*
    Insurance typey
    Incomez
    BRCA
    * One patient did not report on highest level of education. y One patient did not report on insurance type. z Three patients did not report on income level at the time of surgery. x These patients were either not tested or the test results were not documented in the EMR.
    question of how their doctor initially discussed with them the decision between CPM and UM.
    Of the 39 patients who received a recommendation for either CPM or UM from their doctors, 31 (79.5%) followed this decision (P ¼ 0.007). In particular, 26 (78.8%) of the 33 patients who reported that their doctor recommended UM followed this recommendation, and five (83.3%) of the six patients who stated their doctor recommended CPM chose to pursue CPM. Of note, surgeons were more likely to recommend CPM in patients who were younger (P ¼ 0.045) and/or have a BRCA mutation (P ¼ 0.002).