Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
J Surg Res. 2019 Oct;242:129-135. doi: 10.1016/j.jss.2019.04.037. Epub 2019 May 7.
We sought to determine how patient-physician communication affects patients' decision-making when choosing between contralateral prophylactic mastectomy (CPM) and unilateral mastectomy (UM).
atients with breast cancer who underwent mastectomy at our institution were approached with a survey regarding patient-physician communication in CPM.
Of 101 patients who completed the survey, 55 underwent CPM (54.5%). Thirty-three patients (33%) stated that their physician recommended UM, six (6%) stated their physician recommended CPM, and 61 (61%) stated they engaged in active participation in decision-making. Most patients whose doctors recommended UM chose UM (78.8%); similarly, 83.3% of those whose doctors recommended CPM chose CPM. Of 39 patients whose doctors recommended a particular surgical option, eight (20.5%) did not follow their doctor's advice. These patients were equally as satisfied with their decisions as those who followed their doctor's advice (P = 0.441). Patients engaging in active participation in decision-making tended to choose CPM (68.3% versus 30.8%, P < 0.001). Patients who did not engage in active participation were similarly satisfied with their decision as those who did (P = 0.286). Twelve patients (12%) stated they preferred their doctor to provide a recommendation, seven (7%) preferred to make the decision on their own, and 81 (81%) preferred to actively participate in their decision-making with the physician.
Patients tend to follow physicians' recommendation of UM or CPM; patients engaging in SDM tend to choose CPM. Most patients prefer to engage in active participation in decision-making with their physician but were equally satisfied with their surgical decision whether they engaged in active participation or not.
我们旨在探讨医患沟通如何影响患者在选择对侧预防性乳房切除术（CPM）与单侧乳房切除术（UM）时的决策。
在我院接受乳房切除术的乳腺癌患者接受了一项关于 CPM 中医患沟通的调查。
在完成调查的 101 名患者中，55 名患者接受了 CPM（54.5%）。33 名患者（33%）表示医生建议进行 UM，6 名患者（6%）表示医生建议进行 CPM，61 名患者（61%）表示他们积极参与了决策过程。大多数医生建议进行 UM 的患者选择了 UM（78.8%）；同样，83.3%的医生建议进行 CPM 的患者选择了 CPM。在 39 名医生建议特定手术方案的患者中，有 8 名（20.5%）未遵循医生的建议。这些患者对自己的决策与听从医生建议的患者一样满意（P=0.441）。积极参与决策的患者更倾向于选择 CPM（68.3%比 30.8%，P<0.001）。未积极参与决策的患者与积极参与决策的患者满意度相当（P=0.286）。12 名患者（12%）表示他们希望医生提供建议，7 名患者（7%）希望自己做决定，81 名患者（81%）希望与医生一起积极参与自己的决策。
患者倾向于遵循医生对 UM 或 CPM 的建议；积极参与 SDM 的患者更倾向于选择 CPM。大多数患者希望与医生积极参与决策，但无论是否积极参与，他们对手术决策的满意度相当。
