Decisional conflict among breast cancer patients considering contralateral prophylactic mastectomy.
Sharon Manne, Barbara Smith, Anna Mitarotondo and 3 others
PMID 30553577WHAT IT FOUND
Average overall decisional conflict was 26.7 on a 0 to 100 scale, and uncertainty was 37.8, among breast cancer patients considering removing the unaffected breast.
Knowledge was low, and less physician discussion was tied to more conflict and less preparedness.
Key findings
01On the paper's 0 to 100 decisional conflict scale, total conflict averaged 26.7, and the uncertainty subscale averaged 37.8.
02Average CPM knowledge was 46.6% correct, and 61.3% of women answered fewer than half the items correctly.
03When factors were considered together, higher confidence in managing future worry and surveillance, more reasons for CPM, and more discussion with the physician were associated with less conflict.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was mostly non-Hispanic white, well-educated, insured, and recruited at two Northeastern US cancer centers with advanced breast and reconstructive surgery access, so it may not apply to more diverse patients. This was a baseline survey before randomization, not a test of a decision support aid, so it shows associations at one time point rather than whether an intervention changes conflict or preparedness. The study did not follow patients to see what surgery they chose, so it cannot link conflict or preparedness to actual CPM uptake. Several measures were created for the study, including CPM knowledge and reasons for CPM, and the knowledge scale had low reliability (Cronbach's alpha .53). The content of physician-patient discussions was not assessed, nor were surgeon recommendations or other provider factors. Participants consented to a trial of an online decision support tool, so they may differ from patients who are less interested in decision support.
Declared interests
The authors declared no conflict of interest.
The easy way to misread this
Do not conclude that increasing CPM knowledge will reduce decisional conflict. Knowledge was not significantly associated with decisional conflict or preparedness, and this survey did not test an intervention.