Patient Decision Aid for Contralateral Prophylactic Mastectomy for Use in the Consultation: A Feasibility Study

Abstract

Background Rates of contralateral prophylactic mastectomy (cpm) continue to rise internationally despite evidence-based guidance strongly discouraging its use in most women with unilateral breast cancer. The purpose of the present study was to develop and assess the feasibility of a knowledge translation tool [a patient decision aid (da)] designed to enhance evidence-informed shared decision-making about cpm.Methods A consultation da was developed using the Ottawa Patient Decision Aid Development eTraining in consultation with clinicians and knowledge translation experts. The final da was then assessed for feasibility with health care professionals and patients across Canada. The assessment involved a survey completed online (health care professionals) or by telephone (patients). Survey data were analyzed using descriptive statistics for closed-ended questions and qualitative content analysis for open-ended questions.Results The 51 participants who completed the survey included 39 health care professionals and 12 patients. The da was acceptable; 88% of participants viewed it as having the right amount of information or slightly more or less information than they would like. Almost all participants (98%) felt that the da would prepare patients to make better decisions. The aid was perceived to be usable, with 73% of participants stating that they would be willing to use or share the da.Conclusions The cpm patient da developed for the present study was viewed by health care professionals and patients across Canada to be acceptable and usable during the clinical consultation. It holds promise as a knowledge translation tool to be used by clinicians in consultation with women who have unilateral breast cancer to enhance evidence-informed and shared decision-making with respect to undergoing cpm.

Contralateral prophylactic mastectomy: A narrative review of the evidence and acceptability

“…A large systematic review found that patient decision aids were associated with more accurate risk perceptions and improved decisional conflict scores [ 98 ]. In CPM decision-making, decision aids were acceptable and feasible to patients and healthcare professionals and associated with higher levels of knowledge [ 14 , 99 , 100 ]. An online interactive breast cancer in-visit decision aid (BIDA) has been used successfully by patients during breast surgery decision-making; under ‘Evaluation’, this tool showed published estimates using pictograms of 100 women for outcomes such as the risk of getting a new cancer in the other breast stratified by the three procedures—lumpectomy, unilateral mastectomy, and bilateral mastectomy—to compare those options [ 14 , 101 ].…”

Systematic Development of Patient Decision Aids: An Update from the IPDAS Collaboration

“…We included a final sample of 54 articles in the comparison of analyst and author ratings (Appendix Figure 1). Appendix Table 1 contains a list of the articles included in the final sample, 26-91 .…”

Exploring Reasons for Overuse of Contralateral Prophylactic Mastectomy in Canada

“…Women in our study, whether they underwent cpm or not, believed that bilateral mastectomy would improve reconstruction outcomes 34 . One way to address fear, anxiety, and esthetic concerns on the part of patients is to develop educational materials such as patient decision aids that accurately inform patients about the risks of contralateral bca and of future recurrence, the lack of a survival benefit for cpm, the psychosocial ramifications of cpm, and the outcomes of reconstruction, including its risks and benefits 35 . Other strategies to address the core theme of fear and anxiety among women with bca, which centres on cancer recurrence in the contralateral breast, could involve the use of social and other media to educate the public about the actual risks and options.…”