Opportunities for personalised follow-up care among patients with breast cancer: A scoping review to identify preference-sensitive decisions.

Kelly M De Ligt,Sabine Siesling,Linetta B Koppert,Laurentine S.E Van Egdom,Janine A Van Til

doi:10.1111/ecc.13092

Abstract

IntroductionCurrent follow‐up arrangements for breast cancer do not optimally meet the needs of individual patients. We therefore reviewed the evidence on preferences and patient involvement in decisions about breast cancer follow‐up to explore the potential for personalised care.MethodsStudies published between 2008 and 2017 were extracted from MEDLINE, PsycINFO and EMBASE. We then identified decision categories related to content and form of follow‐up. Criteria for preference sensitiveness and patient involvement were compiled and applied to determine the extent to which decisions were sensitive to patient preferences and patients were involved.ResultsForty‐one studies were included in the full‐text analysis. Four decision categories were identified: “surveillance for recurrent/secondary breast cancer; consultations for physical and psychosocial effects; recurrence‐risk reduction by anti‐hormonal treatment; and improving quality of life after breast cancer.” There was little evidence that physicians treated decisions about anti‐hormonal treatment, menopausal symptoms, and follow‐up consultations as sensitive to patient preferences. Decisions about breast reconstruction were considered as very sensitive to patient preferences, and patients were usually involved.ConclusionPatients are currently not involved in all decisions that affect them during follow‐up, indicating a need for improvements. Personalised follow‐up care could improve resource allocation and the value of care for patients.

Highlights

Current follow‐up arrangements for breast cancer do not optimally meet the needs of individual patients
Three research questions were posed: (a) “what decisions are made during follow‐up about content or form of follow‐up care for breast cancer survivors?” (b) “to what extent are these decisions sensitive to patient preferences?” and (c) “to what extent and how are pa‐ tients with breast cancer involved in making these decisions?” The literature was searched separately for each question, between 18th July and 25th September 2017, in the MEDLINE, PsycINFO and EMBASE da‐ tabases (Table 1)
We identified many decisions that needed to be made during follow‐up, including those related to surveillance imaging, follow‐up consultations, anti‐hormonal treatment, treatment‐induced menopausal symptoms and lifestyle changes

Summary

Introduction

Current follow‐up arrangements for breast cancer do not optimally meet the needs of individual patients. We reviewed the evidence on pref‐ erences and patient involvement in decisions about breast cancer follow‐up to ex‐ plore the potential for personalised care. Methods: Studies published between 2008 and 2017 were extracted from MEDLINE, PsycINFO and EMBASE. We identified decision categories related to content and form of follow‐up. Four decision categories were identified: “surveillance for recurrent/secondary breast cancer; consultations for physical and psychosocial effects; recurrence‐risk reduction by anti‐hormonal treatment; and improving quality of life after breast cancer.”. There was little evidence that physicians treated decisions about anti‐hormonal treatment, menopausal symptoms, and follow‐up consultations as sensitive to patient prefer‐ ences. Conclusion: Patients are currently not involved in all decisions that affect them dur‐ ing follow‐up, indicating a need for improvements. Personalised follow‐up care could improve resource allocation and the value of care for patients

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Conclusion