Treatment of early stage breast cancer: do surgeons and patients agree regarding whether treatment alternatives were discussed?

Abstract

Informing patients of available treatment alternatives is an important element of informed consent. We examined and compared patients' and their surgeons' reports of discussing treatment alternatives for early stage breast cancer. We surveyed early stage breast cancer patients in two states (Minnesota and Massachusetts) about discussions of breast cancer treatments. We also surveyed their surgeons. We compared how often patients' and surgeons' reports about discussions of treatment alternatives agreed, and we used generalized estimating equations to identify factors related to patients' reports that alternatives were not discussed when their surgeons reported that they were discussed. Among 1154 women eligible for both breast-conserving surgery and mastectomy, only 71% reported that their surgeon discussed both treatments. Surgeons of 730 women returned surveys and reported discussing both treatments with 82% of the patients. One-third of the time, patients and surgeons disagreed about whether both treatments were discussed; with patients more often reporting that both treatments were not discussed when surgeons reported they were. In adjusted analyses, compared to better-educated patients, less-educated patients more often reported that their surgeons did not discuss both treatments when their surgeons reported that they did (compared to non-high school graduates, odds ratio (OR) 0.44, 95% confidence interval (CI) 0.22-0.87 for high school graduates; OR 0.51; 95% CI 0.27-0.96 for women with at least some college education; and OR 0.50; 95% CI 0.20-1.24 for women with any post-graduate work). Patients' and surgeons' reports of treatments discussed often disagree. Interventions to assure that surgeons present and patients fully comprehend treatment options may help to improve the decision-making process, particularly for less well-educated women.