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Squires JE, Stacey D, Coughlin M, Greenough M, Roberts A, Dorrance K, Clemons M, Caudrelier JM, Graham ID, Zhang J, Varin MD, Arnaout A. Patient decision aid for contralateral prophylactic mastectomy for use in the consultation: a feasibility study. Curr Oncol 2019; 26:137-148. [PMID: 31043816 PMCID: PMC6476460 DOI: 10.3747/co.26.4689] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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.
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Affiliation(s)
- J E Squires
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON
| | - D Stacey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON
| | - M Coughlin
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
| | - M Greenough
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON
| | - A Roberts
- Breast Surgical Oncology Unit, The Ottawa Hospital, Ottawa, ON
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON
| | - K Dorrance
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
| | - M Clemons
- Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON
- Department of Medicine, University of Ottawa, Ottawa, ON
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON
| | - J M Caudrelier
- Department of Radiation Medicine, The Ottawa Hospital, Ottawa, ON
| | - I D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON
| | - J Zhang
- Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, ON
- Department of Plastic Surgery, The Ottawa Hospital, Ottawa, ON
| | - M Demery Varin
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON
| | - A Arnaout
- Breast Surgical Oncology Unit, The Ottawa Hospital, Ottawa, ON
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON
- Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON
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Parker PA, Peterson SK, Shen Y, Bedrosian I, Black DM, Thompson AM, Nelson JC, DeSnyder SM, Cook RL, Hunt KK, Volk RJ, Cantor SB, Dong W, Brewster AM. Prospective Study of Psychosocial Outcomes of Having Contralateral Prophylactic Mastectomy Among Women With Nonhereditary Breast Cancer. J Clin Oncol 2018; 36:2630-2638. [PMID: 30044695 DOI: 10.1200/jco.2018.78.6442] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose The incidence of contralateral prophylactic mastectomy (CPM) has continued to increase. We prospectively examined psychosocial outcomes before and up to 18 months after surgery in women who did or did not have CPM. Methods Women with unilateral, nonhereditary breast cancer completed questionnaires before and 1, 6, 12, and 18 months after surgery. Primary psychosocial measures were cancer worry and cancer-specific distress. Secondary measures were body image, quality of life (QOL), decisional satisfaction, and decisional regret. Results A total of 288 women (mean age, 56 years; 58% non-Hispanic white) provided questionnaire data, of whom 50 underwent CPM. Before surgery, women who subsequently received CPM had higher cancer distress ( P = .04), cancer worry ( P < .001), and body image concerns ( P < .001) than women who did not have CPM. In a multivariable repeated measures model adjusted for time, age, race/ethnicity, and stage, CPM was associated with more body image distress ( P < .001) and poorer QOL ( P = .02). There was a significant interaction between time point and CPM group for cancer worry ( Pinteraction < .001), suggesting that CPM patients had higher presurgery cancer worry, but their postsurgery worry decreased over time and was similar to the worry of patients who did not have CPM. QOL was similar between CPM groups before surgery but declined 1 month after surgery and remained lower than patients who did not have CPM after surgery ( Pinteraction = .05). Conclusion These results may facilitate informed discussions between women and their physicians regarding CPM. Fear and worry may be foremost concerns at the time surgical decisions are made, when women may not anticipate the adverse future effect of CPM on body image and QOL.
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Affiliation(s)
- Patricia A Parker
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Susan K Peterson
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Yu Shen
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Isabelle Bedrosian
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Dalliah M Black
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Alastair M Thompson
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Jonathan C Nelson
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Sarah M DeSnyder
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Robert L Cook
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Kelly K Hunt
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Robert J Volk
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Scott B Cantor
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Wenli Dong
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
| | - Abenaa M Brewster
- Patricia A. Parker, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Susan K. Peterson, Yu Shen, Isabelle Bedrosian, Dalliah M. Black, Alastair M. Thompson, Sarah M. DeSnyder, Kelly K. Hunt, Robert J. Volk, Scott B. Cantor, Wenli Dong, and Abenaa M. Brewster, The University of Texas MD Anderson Cancer Center; and Jonathan C. Nelson and Robert L. Cook, Kelsey-Seybold Clinic, Houston, TX
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