Jansen J, Serafimovska A, Glassey R, Zdenkowski N, Saunders C, Porter D, Butow P
Department of Family Medicine, School Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences (FHML), Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, University of Sydney, Australia.
Patient Educ Couns. 2022 Jan;105(1):74-80. doi: 10.1016/j.pec.2021.04.033. Epub 2021 May 4.
Despite little survival benefit and potential for harm, contralateral prophylactic mastectomy (CPM) rates are increasing amongst early-stage breast cancer patients at low contralateral breast cancer risk. We developed a CPM decision aid (DA) and conducted a pilot implementation.
Surgeons and oncologists recruited eligible patients considering CPM. Consenting patients received the DA, completed a questionnaire and participated in a semi-structured interview. Clinicians were interviewed at study close.
Eleven clinicians and 31 patients participated. Three themes emerged: perceived utility and impact of the DA, disagreement regarding timing of delivery and target population, and implementation strategies. Both women and clinicians found the DA valuable, indicating it confirmed rather than changed preferences. Women (all of whom raised CPM themselves), preferred offering the DA early in treatment discussions whilst clinicians favoured targeting women who enquired about CPM.
A DA about CPM is feasible and acceptable, but questions remain about the role of DAs in these types of decisions where one option has limited medical benefit.
Some women have a high need to make an informed choice about CPM. Tools to support this could include a DA with a clear recommendation against CPM and an explanation why.
尽管对侧预防性乳房切除术（CPM）几乎没有生存益处且存在潜在危害，但在对侧乳腺癌风险较低的早期乳腺癌患者中，该手术的实施率却在上升。我们开发了一种CPM决策辅助工具（DA）并进行了试点实施。
外科医生和肿瘤学家招募了考虑进行CPM的符合条件的患者。同意参与的患者接受了该决策辅助工具，完成了一份问卷并参加了一次半结构化访谈。在研究结束时对临床医生进行了访谈。
11名临床医生和31名患者参与其中。出现了三个主题：对决策辅助工具的感知效用和影响、关于提供时机和目标人群的分歧以及实施策略。女性和临床医生都认为该决策辅助工具很有价值，表明它证实而非改变了偏好。女性（她们都是自行提出CPM的）倾向于在治疗讨论早期提供该决策辅助工具，而临床医生则倾向于针对那些询问CPM的女性。
关于CPM的决策辅助工具是可行且可接受的，但对于决策辅助工具在这些一种选择的医疗益处有限的决策类型中的作用，仍存在疑问。
一些女性非常需要对CPM做出明智的选择。支持这一点的工具可以包括一个明确建议反对CPM并解释原因的决策辅助工具。
