Thursday, August 3, 2006 (Reuters Health)—Approximately 40% of women say they "feel uncomfortable" when asked to make a decision between breast-conserving surgery and radical mastectomy for breast cancer, according to results of a Canadian study of breast cancer patient who were all candidates for breast-conserving surgery.

"Patient-centered care," where the patient is involved more or less, depending upon the physician, in decision-making is becoming more common, but these study findings suggest that the majority of patients don't want this approach.

Dr. Wally J. Temple and associates at the University of Calgary in Alberta, Canada, conducted a prospective study of 157 women with a first diagnosis of localized unilateral breast cancer between 1992 and 1995. Of the total number, 71.3% anticipated having breast-conserving surgery and 28.7% expected a modified radical mastectomy.

The two main factors that influenced women's treatment choices were doctor's advice and the possibility for a complete cure.

Approximately 60% of women were satisfied with the degree that they participated in decision-making. However, only 13.6% received as much information as they wanted.

More than 25% of women participated in the decision more than they wanted to, while 12% had a smaller role in decision-making than they wanted.

"We suggest that the surgeon's interpretation of 'patient-centered care' made 40% of our patients uncomfortable," Dr. Temple writes in the July 20th Journal of Clinical Oncology. "This might adversely affect some women's satisfaction with care."

"There is a gap between the women's preferences and actual experiences for the provision of information and participation in treatment; and this gap seems to be worse for information than for participation," Dr. Temple's group reports. Surgeons could profit from education to decrease bias in assisting women in making a decision, which should improve the number of women choosing breast-conserving surgery if they are candidates, the authors conclude.

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