Department of Surgery, Selkirk Regional Health Centre, Selkirk, MB, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Ann Surg Oncol. 2019 Oct;26(11):3489-3494. doi: 10.1245/s10434-019-07432-6. Epub 2019 Jun 11.
Contralateral prophylactic mastectomy (CPM) is increasing despite a recent statement from The American Society of Breast Surgeons discouraging average-risk women with unilateral breast cancer (BC) from undergoing CPM. The objective of our study was to conduct a needs assessment of BC health practitioners to gather information about their opinions, attitudes, and experiences surrounding CPM.
The Ottawa Decision Support Framework was the theoretical framework for the development of the interview guide. Semistructured interviews were conducted until data saturation with a convenience sample of 16 BC practitioners (Ontario, Canada), including oncologic and reconstructive surgeons, medical oncologists, and nurse navigators.
Nearly all practitioners identified the discussion regarding CPM as patient-initiated. The majority of practitioners (13/16) described their role as supporting the patient in the decision-making process. Practitioners described educating patients on the lack of survival benefit and in general discouraging CPM. Practitioners agreed that most patients demonstrate decisional conflict (11/16) as a barrier to decision-making, and it is a challenge to realign patients' understanding and expectations. Almost all practitioners (15/16) identified a need for information materials to help educate patients on the risks and benefits of CPM and to help realign expectations.
Practitioners have identified CPM in average-risk women with unilateral BC as a patient-driven phenomenon that is on the rise, despite highlighting the increased risk of complications and lack of survival benefit. Our practitioner needs assessment identifies the need for a dynamic decision aid to help guide the shared decision-making process for practitioners and patients.
尽管美国乳腺外科学会最近发表声明，不鼓励单侧乳腺癌（BC）的平均风险女性接受对侧预防性乳房切除术（CPM），但 CPM 的实施仍在增加。本研究的目的是对 BC 健康从业者进行需求评估，以收集有关他们对 CPM 的意见、态度和经验的信息。
渥太华决策支持框架是制定访谈指南的理论框架。对 16 名 BC 从业者（加拿大安大略省）进行了半结构式访谈，直至数据饱和，这些从业者包括肿瘤学和重建外科医生、肿瘤内科医生和护士导航员。
几乎所有从业者都认为 CPM 的讨论是由患者发起的。大多数从业者（13/16）将其角色描述为支持患者做出决策过程。从业者描述了对患者进行缺乏生存获益的教育，并普遍劝阻 CPM。从业者一致认为，大多数患者表现出决策冲突（11/16）作为决策的障碍，并难以调整患者的理解和期望。几乎所有从业者（15/16）都认为需要信息材料来帮助教育患者 CPM 的风险和益处，并帮助调整期望。
从业者已经确定了单侧 BC 的平均风险女性中的 CPM 是一种患者驱动的现象，尽管强调了并发症风险增加和缺乏生存获益，但 CPM 的实施仍在增加。我们的从业者需求评估确定了需要一个动态决策辅助工具，以帮助指导从业者和患者的共同决策过程。
