PMID- 28407998 OWN - NLM STAT- MEDLINE DA - 20170414 DCOM- 20170424 LR - 20170507 IS - 1524-4733 (Electronic) IS - 1098-3015 (Linking) VI - 20 IP - 4 DP - 2017 Apr TI - A Cost-Effectiveness Evaluation of Germline BRCA1 and BRCA2 Testing in UK Women with Ovarian Cancer. PG - 567-576 LID - S1098-3015(17)30064-5 [pii] LID - 10.1016/j.jval.2017.01.004 [doi] AB - OBJECTIVES: To evaluate the long-term cost-effectiveness of germline BRCA1 and BRCA2 (collectively termed "BRCA") testing in women with epithelial ovarian cancer, and testing for the relevant mutation in first- and second-degree relatives of BRCA mutation-positive individuals, compared with no testing. Female BRCA mutation-positive relatives of patients with ovarian cancer could undergo risk-reducing mastectomy and/or bilateral salpingo-oophorectomy. METHODS: A cost-effectiveness model was developed that included the risks of breast and ovarian cancer; the costs, utilities, and effects of risk-reducing surgery on cancer rates; and the costs, utilities, and mortality rates associated with cancer. RESULTS: BRCA testing of all women with epithelial ovarian cancer each year is cost-effective at a UK willingness-to-pay threshold of pound20,000/quality-adjusted life-year (QALY) compared with no testing, with an incremental cost-effectiveness ratio of pound4,339/QALY. The result was primarily driven by fewer cases of breast cancer (142) and ovarian cancer (141) and associated reductions in mortality (77 fewer deaths) in relatives over the subsequent 50 years. Sensitivity analyses showed that the results were robust to variations in the input parameters. Probabilistic sensitivity analysis showed that the probability of germline BRCA mutation testing being cost-effective at a threshold of pound20,000/QALY was 99.9%. CONCLUSIONS: Implementing germline BRCA testing in all patients with ovarian cancer would be cost-effective in the United Kingdom. The consequent reduction in future cases of breast and ovarian cancer in relatives of mutation-positive individuals would ease the burden of cancer treatments in subsequent years and result in significantly better outcomes and reduced mortality rates for these individuals. CI - Copyright (c) 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved. FAU - Eccleston, Anthony AU - Eccleston A AD - DRG Abacus, Bicester, Oxfordshire, UK. FAU - Bentley, Anthony AU - Bentley A AD - DRG Abacus, Bicester, Oxfordshire, UK. FAU - Dyer, Matthew AU - Dyer M AD - AstraZeneca UK Ltd., Luton, Bedfordshire, UK. Electronic address: matthew.dyer@astrazeneca.com. FAU - Strydom, Ann AU - Strydom A AD - Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK. FAU - Vereecken, Wim AU - Vereecken W AD - AstraZeneca UK Ltd., Luton, Bedfordshire, UK. FAU - George, Angela AU - George A AD - Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK; Cancer Genetics Unit, The Royal Marsden NHS Foundation Trust, London, UK. FAU - Rahman, Nazneen AU - Rahman N AD - Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK; Cancer Genetics Unit, The Royal Marsden NHS Foundation Trust, London, UK. LA - eng PT - Journal Article DEP - 20170303 PL - United States TA - Value Health JT - Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research JID - 100883818 RN - 0 (BRCA1 Protein) RN - 0 (BRCA1 protein, human) RN - 0 (BRCA2 Protein) RN - 0 (BRCA2 protein, human) RN - 0 (Biomarkers, Tumor) RN - Ovarian epithelial cancer SB - IM MH - Adult MH - Aged MH - BRCA1 Protein/*genetics MH - BRCA2 Protein/*genetics MH - Biomarkers, Tumor/*genetics MH - Breast Neoplasms/diagnosis/economics/*genetics/therapy MH - Computer Simulation MH - Cost-Benefit Analysis MH - DNA Mutational Analysis/*economics MH - Decision Support Techniques MH - Early Detection of Cancer/*economics/methods MH - Female MH - Genetic Predisposition to Disease MH - Genetic Testing/*economics/methods MH - *Germ-Line Mutation MH - *Health Care Costs MH - Heredity MH - Humans MH - Middle Aged MH - Models, Economic MH - Neoplasms, Glandular and Epithelial/diagnosis/economics/*genetics/therapy MH - Ovarian Neoplasms/diagnosis/economics/*genetics/therapy MH - Pedigree MH - Phenotype MH - Predictive Value of Tests MH - Prognosis MH - Quality-Adjusted Life Years MH - Reproducibility of Results MH - Risk Assessment MH - Risk Factors MH - Time Factors MH - United Kingdom PMC - PMC5406158 OTO - NOTNLM OT - BRCA gene testing OT - breast cancer OT - cost-effectiveness OT - ovarian cancer EDAT- 2017/04/15 06:00 MHDA- 2017/04/25 06:00 CRDT- 2017/04/15 06:00 PHST- 2016/06/16 [received] PHST- 2017/01/03 [revised] PHST- 2017/01/11 [accepted] AID - S1098-3015(17)30064-5 [pii] AID - 10.1016/j.jval.2017.01.004 [doi] PST - ppublish SO - Value Health. 2017 Apr;20(4):567-576. doi: 10.1016/j.jval.2017.01.004. Epub 2017 Mar 3. PMID- 28407996 OWN - NLM STAT- MEDLINE DA - 20170414 DCOM- 20170424 LR - 20170424 IS - 1524-4733 (Electronic) IS - 1098-3015 (Linking) VI - 20 IP - 4 DP - 2017 Apr TI - A Multigene Test Could Cost-Effectively Help Extend Life Expectancy for Women at Risk of Hereditary Breast Cancer. PG - 547-555 LID - S1098-3015(17)30066-9 [pii] LID - 10.1016/j.jval.2017.01.006 [doi] AB - BACKGROUND: The National Comprehensive Cancer Network recommends that women who carry gene variants that confer substantial risk for breast cancer consider risk-reduction strategies, that is, enhanced surveillance (breast magnetic resonance imaging and mammography) or prophylactic surgery. Pathogenic variants can be detected in women with a family history of breast or ovarian cancer syndromes by multigene panel testing. OBJECTIVES: To investigate whether using a seven-gene test to identify women who should consider risk-reduction strategies could cost-effectively increase life expectancy. METHODS: We estimated effectiveness and lifetime costs from a payer perspective for two strategies in two hypothetical cohorts of women (40-year-old and 50-year-old cohorts) who meet the National Comprehensive Cancer Network-defined family history criteria for multigene testing. The two strategies were the usual test strategy for variants in BRCA1 and BRCA2 and the seven-gene test strategy for variants in BRCA1, BRCA2, TP53, PTEN, CDH1, STK11, and PALB2. Women found to have a pathogenic variant were assumed to undergo either prophylactic surgery or enhanced surveillance. RESULTS: The incremental cost-effectiveness ratio for the seven-gene test strategy compared with the BRCA1/2 test strategy was $42,067 per life-year gained or $69,920 per quality-adjusted life-year gained for the 50-year-old cohort and $23,734 per life-year gained or $48,328 per quality-adjusted life-year gained for the 40-year-old cohort. In probabilistic sensitivity analysis, the seven-gene test strategy cost less than $100,000 per life-year gained in 95.7% of the trials for the 50-year-old cohort. CONCLUSIONS: Testing seven breast cancer-associated genes, followed by risk-reduction management, could cost-effectively improve life expectancy for women at risk of hereditary breast cancer. CI - Copyright (c) 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved. FAU - Li, Yonghong AU - Li Y AD - Quest Diagnostics, San Juan Capistrano, CA, USA. Electronic address: yonghong.x.li2@questdiagnostics.com. FAU - Arellano, Andre R AU - Arellano AR AD - Quest Diagnostics, San Juan Capistrano, CA, USA. FAU - Bare, Lance A AU - Bare LA AD - Quest Diagnostics, San Juan Capistrano, CA, USA. FAU - Bender, Richard A AU - Bender RA AD - Quest Diagnostics, San Juan Capistrano, CA, USA. FAU - Strom, Charles M AU - Strom CM AD - Quest Diagnostics, San Juan Capistrano, CA, USA. FAU - Devlin, James J AU - Devlin JJ AD - Quest Diagnostics, San Juan Capistrano, CA, USA. LA - eng PT - Comparative Study PT - Journal Article DEP - 20170223 PL - United States TA - Value Health JT - Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research JID - 100883818 RN - 0 (Biomarkers, Tumor) SB - IM MH - Adult MH - Age Factors MH - Aged MH - Aged, 80 and over MH - Biomarkers, Tumor/*genetics MH - Breast Neoplasms/economics/*genetics/therapy MH - Cost-Benefit Analysis MH - Decision Support Techniques MH - Early Detection of Cancer/*economics/methods MH - Female MH - Gene Expression Profiling/*economics MH - Genetic Predisposition to Disease MH - Genetic Testing/*economics MH - *Health Care Costs MH - Heredity MH - Humans MH - *Life Expectancy MH - Magnetic Resonance Imaging/economics MH - Mammography/economics MH - Mastectomy/economics MH - Middle Aged MH - Models, Economic MH - Patient Selection MH - Phenotype MH - Predictive Value of Tests MH - Prognosis MH - *Quality-Adjusted Life Years MH - Risk Assessment MH - Risk Factors MH - Watchful Waiting/economics OTO - NOTNLM OT - *BRCA OT - *breast cancer OT - *cost-effectiveness OT - *multigene panel testing EDAT- 2017/04/15 06:00 MHDA- 2017/04/25 06:00 CRDT- 2017/04/15 06:00 PHST- 2016/03/14 [received] PHST- 2016/12/08 [revised] PHST- 2017/01/13 [accepted] AID - S1098-3015(17)30066-9 [pii] AID - 10.1016/j.jval.2017.01.006 [doi] PST - ppublish SO - Value Health. 2017 Apr;20(4):547-555. doi: 10.1016/j.jval.2017.01.006. Epub 2017 Feb 23. PMID- 28402085 OWN - NLM STAT- In-Process DA - 20170412 LR - 20170502 IS - 1469-493X (Electronic) IS - 1361-6137 (Linking) VI - 4 DP - 2017 Apr 12 TI - Decision aids for people facing health treatment or screening decisions. PG - CD001431 LID - 10.1002/14651858.CD001431.pub5 [doi] AB - BACKGROUND: Decision aids are interventions that support patients by making their decisions explicit, providing information about options and associated benefits/harms, and helping clarify congruence between decisions and personal values. OBJECTIVES: To assess the effects of decision aids in people facing treatment or screening decisions. SEARCH METHODS: Updated search (2012 to April 2015) in CENTRAL; MEDLINE; Embase; PsycINFO; and grey literature; includes CINAHL to September 2008. SELECTION CRITERIA: We included published randomized controlled trials comparing decision aids to usual care and/or alternative interventions. For this update, we excluded studies comparing detailed versus simple decision aids. DATA COLLECTION AND ANALYSIS: Two reviewers independently screened citations for inclusion, extracted data, and assessed risk of bias. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made and the decision-making process.Secondary outcomes were behavioural, health, and health system effects.We pooled results using mean differences (MDs) and risk ratios (RRs), applying a random-effects model. We conducted a subgroup analysis of studies that used the patient decision aid to prepare for the consultation and of those that used it in the consultation. We used GRADE to assess the strength of the evidence. MAIN RESULTS: We included 105 studies involving 31,043 participants. This update added 18 studies and removed 28 previously included studies comparing detailed versus simple decision aids. During the 'Risk of bias' assessment, we rated two items (selective reporting and blinding of participants/personnel) as mostly unclear due to inadequate reporting. Twelve of 105 studies were at high risk of bias.With regard to the attributes of the choice made, decision aids increased participants' knowledge (MD 13.27/100; 95% confidence interval (CI) 11.32 to 15.23; 52 studies; N = 13,316; high-quality evidence), accuracy of risk perceptions (RR 2.10; 95% CI 1.66 to 2.66; 17 studies; N = 5096; moderate-quality evidence), and congruency between informed values and care choices (RR 2.06; 95% CI 1.46 to 2.91; 10 studies; N = 4626; low-quality evidence) compared to usual care.Regarding attributes related to the decision-making process and compared to usual care, decision aids decreased decisional conflict related to feeling uninformed (MD -9.28/100; 95% CI -12.20 to -6.36; 27 studies; N = 5707; high-quality evidence), indecision about personal values (MD -8.81/100; 95% CI -11.99 to -5.63; 23 studies; N = 5068; high-quality evidence), and the proportion of people who were passive in decision making (RR 0.68; 95% CI 0.55 to 0.83; 16 studies; N = 3180; moderate-quality evidence).Decision aids reduced the proportion of undecided participants and appeared to have a positive effect on patient-clinician communication. Moreover, those exposed to a decision aid were either equally or more satisfied with their decision, the decision-making process, and/or the preparation for decision making compared to usual care.Decision aids also reduced the number of people choosing major elective invasive surgery in favour of more conservative options (RR 0.86; 95% CI 0.75 to 1.00; 18 studies; N = 3844), but this reduction reached statistical significance only after removing the study on prophylactic mastectomy for breast cancer gene carriers (RR 0.84; 95% CI 0.73 to 0.97; 17 studies; N = 3108). Compared to usual care, decision aids reduced the number of people choosing prostate-specific antigen screening (RR 0.88; 95% CI 0.80 to 0.98; 10 studies; N = 3996) and increased those choosing to start new medications for diabetes (RR 1.65; 95% CI 1.06 to 2.56; 4 studies; N = 447). For other testing and screening choices, mostly there were no differences between decision aids and usual care.The median effect of decision aids on length of consultation was 2.6 minutes longer (24 versus 21; 7.5% increase). The costs of the decision aid group were lower in two studies and similar to usual care in four studies. People receiving decision aids do not appear to differ from those receiving usual care in terms of anxiety, general health outcomes, and condition-specific health outcomes. Studies did not report adverse events associated with the use of decision aids.In subgroup analysis, we compared results for decision aids used in preparation for the consultation versus during the consultation, finding similar improvements in pooled analysis for knowledge and accurate risk perception. For other outcomes, we could not conduct formal subgroup analyses because there were too few studies in each subgroup. AUTHORS' CONCLUSIONS: Compared to usual care across a wide variety of decision contexts, people exposed to decision aids feel more knowledgeable, better informed, and clearer about their values, and they probably have a more active role in decision making and more accurate risk perceptions. There is growing evidence that decision aids may improve values-congruent choices. There are no adverse effects on health outcomes or satisfaction. New for this updated is evidence indicating improved knowledge and accurate risk perceptions when decision aids are used either within or in preparation for the consultation. Further research is needed on the effects on adherence with the chosen option, cost-effectiveness, and use with lower literacy populations. FAU - Stacey, Dawn AU - Stacey D AD - School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada. AD - Centre for Practice Changing Research, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, Canada, K1H 8L6. FAU - Legare, France AU - Legare F AD - Population Health and Optimal Health Practices Research Axis, CHU de Quebec Research Center, Universite Laval, 10 Rue de l'Espinay, D6-727, Quebec City, QC, Canada, G1L 3L5. FAU - Lewis, Krystina AU - Lewis K AD - School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada. FAU - Barry, Michael J AU - Barry MJ AD - Informed Medical Decisions Foundation, Boston, MA, USA. FAU - Bennett, Carol L AU - Bennett CL AD - Clinical Epidemiology Program, Ottawa Hospital Research Institute, Administrative Services Building, Room 2-013, 1053 Carling Avenue, Ottawa, ON, Canada, K1Y 4E9. FAU - Eden, Karen B AU - Eden KB AD - Department of Medical Informatics and Clinical Epidemiology, Oregon Health Sciences University, BICC 535, 3181 S.W. Sam Jackson Park Road, Portland, Oregon, USA, 97239-3098. FAU - Holmes-Rovner, Margaret AU - Holmes-Rovner M AD - Center for Ethics and Humanities in the Life Sciences, Michigan State University College of Human Medicine, East Fee Road, 956 Fee Road Rm C203, East Lansing, Michigan, USA, 48824-1316. FAU - Llewellyn-Thomas, Hilary AU - Llewellyn-Thomas H AD - The Dartmouth Center for Health Policy & Clinical Practice, The Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire, USA, 03755. FAU - Lyddiatt, Anne AU - Lyddiatt A AD - No affiliation, 28 Greenwood Road, Ingersoll, ON, Canada, N5C 3N1. FAU - Thomson, Richard AU - Thomson R AD - Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK, NE2 4AX. FAU - Trevena, Lyndal AU - Trevena L AD - The University of Sydney, Room 322, Edward Ford Building (A27), Sydney, NSW, Australia, 2006. LA - eng PT - Journal Article PT - Review DEP - 20170412 PL - England TA - Cochrane Database Syst Rev JT - The Cochrane database of systematic reviews JID - 100909747 EDAT- 2017/04/13 06:00 MHDA- 2017/04/13 06:00 CRDT- 2017/04/13 06:00 AID - 10.1002/14651858.CD001431.pub5 [doi] PST - epublish SO - Cochrane Database Syst Rev. 2017 Apr 12;4:CD001431. doi: 10.1002/14651858.CD001431.pub5. PMID- 28350657 OWN - NLM STAT- MEDLINE DA - 20170328 DCOM- 20170601 LR - 20170601 IS - 1529-4242 (Electronic) IS - 0032-1052 (Linking) VI - 139 IP - 4 DP - 2017 Apr TI - Normative Data for Interpreting the BREAST-Q: Augmentation. PG - 846-853 LID - 10.1097/PRS.0000000000003186 [doi] AB - BACKGROUND: The BREAST-Q is a rigorously developed, well-validated, patient-reported outcome instrument with a module designed for evaluating breast augmentation outcomes. However, there are no published normative BREAST-Q scores, limiting interpretation. METHODS: Normative data were generated for the BREAST-Q Augmentation module by means of the Army of Women, an online community of women (with and without breast cancer) engaged in breast-cancer related research. Members were recruited by means of e-mail; women aged 18 years or older without a history of breast cancer or breast surgery were invited to participate. Descriptive statistics and a linear multivariate regression were performed. A separate analysis compared normative scores to findings from previously published BREAST-Q augmentation studies. RESULTS: The preoperative BREAST-Q Augmentation module was completed by 1211 women. Mean age was 54 +/- 24 years, the mean body mass index was 27 +/- 6 kg/m, and 39 percent (n = 467) had a bra cup size of D or greater. Mean scores were as follows: Satisfaction with Breasts, 54 +/- 19; Psychosocial Well-being, 66 +/- 20; Sexual Well-being, 49 +/- 20; and Physical Well-being, 86 +/- 15. Women with a body mass index of 30 kg/m or greater and bra cup size of D or greater had lower scores. In comparison with Army of Women scores, published BREAST-Q augmentation scores were lower before and higher after surgery for all scales except Physical Well-being. CONCLUSIONS: The Army of Women normative data represent breast-related satisfaction and well-being in women not actively seeking breast augmentation. These data may be used as normative comparison values for those seeking and undergoing surgery as we did, demonstrating the value of breast augmentation in this patient population. FAU - Mundy, Lily R AU - Mundy LR AD - Durham, N.C.; Lebanon, N.H.; Hamilton, Ontario, Canada; and New York, N.Y. From the Division of Plastic and Reconstructive Surgery, Duke University; the Section of Plastic Surgery, Dartmouth Hitchcock Medical Center; McMaster University; and the Plastic and Reconstructive Service, Memorial Sloan Kettering Cancer Center. FAU - Homa, Karen AU - Homa K FAU - Klassen, Anne F AU - Klassen AF FAU - Pusic, Andrea L AU - Pusic AL FAU - Kerrigan, Carolyn L AU - Kerrigan CL LA - eng GR - P30 CA008748/CA/NCI NIH HHS/United States PT - Journal Article PL - United States TA - Plast Reconstr Surg JT - Plastic and reconstructive surgery JID - 1306050 SB - AIM SB - IM MH - Data Interpretation, Statistical MH - Female MH - Humans MH - Mammaplasty/*standards MH - Middle Aged MH - *Patient Reported Outcome Measures PMC - PMC5373485 MID - NIHMS830003 EDAT- 2017/03/30 06:00 MHDA- 2017/06/02 06:00 CRDT- 2017/03/29 06:00 PMCR- 2018/04/01 AID - 10.1097/PRS.0000000000003186 [doi] AID - 00006534-201704000-00013 [pii] PST - ppublish SO - Plast Reconstr Surg. 2017 Apr;139(4):846-853. doi: 10.1097/PRS.0000000000003186. PMID- 28349337 OWN - NLM STAT- Publisher DA - 20170328 LR - 20170328 IS - 1534-4681 (Electronic) IS - 1068-9265 (Linking) DP - 2017 Mar 27 TI - Erratum to: Impact of an In-visit Decision Aid on Patient Knowledge about Contralateral Prophylactic Mastectomy: A Pilot Study. LID - 10.1245/s10434-017-5850-2 [doi] FAU - Yao, Katharine AU - Yao K AD - Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. kyao@northshore.org. FAU - Belkora, Jeff AU - Belkora J AD - University of California San Francisco School of Medicine, San Francisco, CA, USA. FAU - Bedrosian, Isabelle AU - Bedrosian I AD - Department of Surgery, MD Anderson Cancer Center, Houston, TX, USA. FAU - Rosenberg, Shoshana AU - Rosenberg S AD - Dana Farber Cancer Institute, Boston, MA, USA. FAU - Sisco, Mark AU - Sisco M AD - Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. FAU - Barrera, Ermilo AU - Barrera E AD - Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. FAU - Kyrillos, Alexandra AU - Kyrillos A AD - Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. FAU - Tilburt, Jon AU - Tilburt J AD - Mayo Clinic, Rochester, MN, USA. FAU - Wang, Chihsiung AU - Wang C AD - Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, IL, USA. FAU - Rabbitt, Sarah AU - Rabbitt S AD - Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. FAU - Pesce, Catherine AU - Pesce C AD - Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. FAU - Simovic, Sandra AU - Simovic S AD - Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. FAU - Winchester, David J AU - Winchester DJ AD - Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. FAU - Sepucha, Karen AU - Sepucha K AD - Massachusetts General Hospital, Health Decision Sciences Center, Boston, MA, USA. LA - eng PT - Published Erratum DEP - 20170327 PL - United States TA - Ann Surg Oncol JT - Annals of surgical oncology JID - 9420840 EFR - Ann Surg Oncol. 2017 Jan;24(1):91-99. PMID: 27654108 EDAT- 2017/03/30 06:00 MHDA- 2017/03/30 06:00 CRDT- 2017/03/29 06:00 AID - 10.1245/s10434-017-5850-2 [doi] AID - 10.1245/s10434-017-5850-2 [pii] PST - aheadofprint SO - Ann Surg Oncol. 2017 Mar 27. doi: 10.1245/s10434-017-5850-2. PMID- 28327125 OWN - NLM STAT- In-Process DA - 20170322 LR - 20170403 IS - 1472-6947 (Electronic) IS - 1472-6947 (Linking) VI - 17 IP - 1 DP - 2017 Mar 21 TI - Facilitating informed decisions about breast cancer screening: development and evaluation of a web-based decision aid for women in their 40s. PG - 29 LID - 10.1186/s12911-017-0423-7 [doi] AB - BACKGROUND: Expert groups and national guidelines recommend individualized decision making about screening mammography for women in their 40s at low-to-average risk of breast cancer. We created Breast Screening Decisions (BSD), a personalized, web-based decision aid, to help women decide when to start and how often to have routine screening mammograms. We evaluated BSD in a large, prospective pilot trial of women and their clinicians. METHODS: Women ages 40-49 were invited to use BSD before a scheduled preventive care visit. One month post-visit, users were asked about decisional conflict, knowledge, perceptions and worry about breast cancer and screening. They were also asked whether they had a screening mammogram since their visit, scheduled an appointment for a screening mammogram, or if they were planning to schedule an appointment within the next six months. Women who responded "no" to each of these successive questions were considered to have no plan for a screening mammogram within the next 6 months, unless they explicitly stated that they were unsure about screening mammography. Clinicians were surveyed regarding mammography discussions and perceived patient knowledge and anxiety. RESULTS: Of 1,100 women invited to use BSD, 253 accessed the website, and 168 were eligible to participate in the pilot study. One-fifth had a family history of breast cancer, and at least 76% had any prior mammogram. At follow-up, 88% of BSD users reported discussing mammography at their visit, and 77% said they had a screening mammogram since the visit or that they made or were planning to make a screening mammogram appointment. The average decisional conflict score was 22.5, within the threshold for implementing decisions. Decisional conflict scores were lowest in women who said that they had or planned to have a mammogram (mean 21.4, 95% CI 18.3-24.6), higher in those who did not (mean 24.8, 95% CI 19.2-30.5), and highest in those who were unsure (mean 31.5, 95% CI 13.9-49.1). Most BSD users expressed accurate perceptions of their breast cancer risk and the benefits and limitations of screening. CONCLUSIONS: A web-based decision aid may support informed, individualized decisions about screening mammography and facilitate discussions about screening between women in their 40s and their clinicians. FAU - Elkin, Elena B AU - Elkin EB AD - Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. elkine@mskcc.org. FAU - Pocus, Valerie H AU - Pocus VH AD - Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. FAU - Mushlin, Alvin I AU - Mushlin AI AD - Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA. FAU - Cigler, Tessa AU - Cigler T AD - Department of Medicine, Weill Cornell Medical College, New York, NY, USA. FAU - Atoria, Coral L AU - Atoria CL AD - Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. FAU - Polaneczky, Margaret M AU - Polaneczky MM AD - Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA. LA - eng GR - P30 CA008748/CA/NCI NIH HHS/United States PT - Journal Article DEP - 20170321 PL - England TA - BMC Med Inform Decis Mak JT - BMC medical informatics and decision making JID - 101088682 PMC - PMC5359988 OTO - NOTNLM OT - Breast cancer OT - Decision aid OT - Mammogram OT - Screening OT - Shared decision making EDAT- 2017/03/23 06:00 MHDA- 2017/03/23 06:00 CRDT- 2017/03/23 06:00 PHST- 2016/06/14 [received] PHST- 2017/02/23 [accepted] AID - 10.1186/s12911-017-0423-7 [doi] AID - 10.1186/s12911-017-0423-7 [pii] PST - epublish SO - BMC Med Inform Decis Mak. 2017 Mar 21;17(1):29. doi: 10.1186/s12911-017-0423-7. PMID- 28277290 OWN - NLM STAT- In-Process DA - 20170309 LR - 20170314 IS - 1873-5134 (Electronic) IS - 0738-3991 (Linking) VI - 100 IP - 3 DP - 2017 Mar TI - Effect of a decision aid with patient narratives in reducing decisional conflict in choice for surgery among early-stage breast cancer patients: A three-arm randomized controlled trial. PG - 550-562 LID - S0738-3991(16)30421-9 [pii] LID - 10.1016/j.pec.2016.09.011 [doi] AB - OBJECTIVE: We aimed to evaluate the effect of a decision aid (DA) with patient narratives on decisional conflict in surgery choice for Japanese women with early-stage breast cancer. METHODS: Two hundred ten women with early-stage breast cancer were randomly assigned to an intervention or control group. Groups 1 and 2 received standard information and a DA, with or without patient narratives, and Group 3 received standard information (control) before surgery choice. At baseline, post-intervention (Time 2), and 1 month after surgery (Time 3), we evaluated decisional conflict as the primary outcome using a decisional conflict scale (DCS). Sidak corrections for multiple comparisons in analysis of covariate were used to compare Time 2 and Time 3 DCS mean scores between each pair of groups. RESULTS: At Time 3, decisional conflict was significantly reduced for Group 1 vs control (P=0.021, Cohen's d =0.26) and Group 2 vs control (P=0.008, Cohen's d=0.40). CONCLUSION: The DAs with and without patient narratives are equivalently effective at reducing postoperative decisional conflict in Japanese women with early-stage breast cancer. PRACTICE IMPLICATIONS: The DAs with and without patient narratives can be used in clinical practice for women with early-stage breast cancer. CI - Copyright (c) 2016 Elsevier Ireland Ltd. All rights reserved. FAU - Osaka, Wakako AU - Osaka W AD - Department of Nursing Informatics, St. Luke's International University Graduate School of Nursing Science, Tokyo, Japan; School of Nursing, The Jikei University, Tokyo, Japan. Electronic address: osakawakako@gmail.com. FAU - Nakayama, Kazuhiro AU - Nakayama K AD - Department of Nursing Informatics, St. Luke's International University Graduate School of Nursing Science, Tokyo, Japan. Electronic address: nakayama@slcn.ac.jp. LA - eng PT - Journal Article DEP - 20160920 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 OTO - NOTNLM OT - Breast cancer OT - Decision Support Techniques OT - Decisional conflict OT - Patient decision aids OT - Patient narratives OT - Patient-Centered Care OT - Preference-sensitive decision EDAT- 2017/03/10 06:00 MHDA- 2017/03/10 06:00 CRDT- 2017/03/10 06:00 PHST- 2016/04/03 [received] PHST- 2016/09/15 [revised] PHST- 2016/09/20 [accepted] AID - S0738-3991(16)30421-9 [pii] AID - 10.1016/j.pec.2016.09.011 [doi] PST - ppublish SO - Patient Educ Couns. 2017 Mar;100(3):550-562. doi: 10.1016/j.pec.2016.09.011. Epub 2016 Sep 20. PMID- 28269836 OWN - NLM STAT- In-Process DA - 20170308 LR - 20170312 IS - 1942-597X (Electronic) IS - 1559-4076 (Linking) VI - 2016 DP - 2016 TI - Usability Testing of a Web-Based Decision Aid for Breast Cancer Risk Assessment Among Multi-Ethnic Women. PG - 411-420 AB - Chemoprevention with antiestrogens could decrease the incidence of invasive breast cancer but uptake has been low among high-risk women in the United States. We have designed a web-based patient-facing decision aid, called RealRisks, to inform high-risk women about the risks and benefits of chemoprevention and facilitate shared decision-making with their primary care provider. We conducted two rounds of usability testing to determine how subjects engaged with and understood the information in RealRisks. A total of 7 English-speaking and 4 Spanish-speaking subjects completed testing. Using surveys, think-aloud protocols, and subject recordings, we identified several themes relating to the usability of RealRisks, specifically in the content, ease of use, and navigability of the application. By conducting studies in two languages with a diverse multi-ethnic population, we were able to implement interface changes to make RealRisks accessible to users with varying health literacy and acculturation. FAU - Coe, Austin M AU - Coe AM AD - Columbia University, New York, NY. FAU - Ueng, William AU - Ueng W AD - Columbia University, New York, NY. FAU - Vargas, Jennifer M AU - Vargas JM AD - Columbia University, New York, NY. FAU - David, Raven AU - David R AD - Columbia University, New York, NY. FAU - Vanegas, Alejandro AU - Vanegas A AD - Columbia University, New York, NY. FAU - Infante, Katherine AU - Infante K AD - Columbia University, New York, NY. FAU - Trivedi, Meghna AU - Trivedi M AD - Columbia University, New York, NY. FAU - Yi, Haeseung AU - Yi H AD - Columbia University, New York, NY. FAU - Dimond, Jill AU - Dimond J AD - Sassafras Tech Collective, Ann Arbor, MI. FAU - Crew, Katherine D AU - Crew KD AD - Columbia University, New York, NY. FAU - Kukafka, Rita AU - Kukafka R AD - Columbia University, New York, NY. LA - eng PT - Journal Article DEP - 20170210 PL - United States TA - AMIA Annu Symp Proc JT - AMIA ... Annual Symposium proceedings. AMIA Symposium JID - 101209213 PMC - PMC5333260 EDAT- 2017/03/09 06:00 MHDA- 2017/03/09 06:00 CRDT- 2017/03/09 06:00 PST - epublish SO - AMIA Annu Symp Proc. 2017 Feb 10;2016:411-420. eCollection 2016. PMID- 28221673 OWN - NLM STAT- Publisher DA - 20170221 LR - 20170221 IS - 1097-0142 (Electronic) IS - 0008-543X (Linking) DP - 2017 Feb 21 TI - Breast cancer prevention strategies in lobular carcinoma in situ: A decision analysis. LID - 10.1002/cncr.30644 [doi] AB - BACKGROUND: Women diagnosed with lobular carcinoma in situ (LCIS) have a 3-fold to 10-fold increased risk of developing invasive breast cancer. The objective of this study was to evaluate the life expectancy (LE) and differences in survival offered by active surveillance, risk-reducing chemoprevention, and bilateral prophylactic mastectomy among women with LCIS. METHODS: A Markov simulation model was constructed to determine average LE and quality-adjusted LE (QALE) gains for hypothetical cohorts of women diagnosed with LCIS at various ages under alternative risk-reduction strategies. Probabilities for invasive breast cancer, breast cancer-specific mortality, other-cause mortality and the effectiveness of preventive strategies were derived from published studies and from the National Cancer Institute's Surveillance, Epidemiology, and End Results database. RESULTS: Assuming a breast cancer incidence from 1.02% to 1.37% per year under active surveillance, a woman aged 50 years diagnosed with LCIS would have a total LE of 32.78 years and would gain 0.13 years (1.6 months) in LE by adding chemoprevention and 0.25 years (3.0 months) in LE by adding bilateral prophylactic mastectomy. After quality adjustment, chemoprevention resulted in the greatest QALE for women ages 40 to 60 years at LCIS diagnosis, whereas surveillance remained the preferred strategy for optimizing QALE among women diagnosed at age 65 years and older. CONCLUSIONS: In this model, among women with a diagnosis of LCIS, breast cancer prevention strategies only modestly affected overall survival, whereas chemoprevention was modeled as the preferred management strategy for optimizing invasive disease-free survival while prolonging QALE form women younger than 65 years. Cancer 2017. (c) 2017 American Cancer Society. CI - (c) 2017 American Cancer Society. FAU - Wong, Stephanie M AU - Wong SM AD - Harvard School of Public Health, Boston, Massachusetts. AD - Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada. FAU - Stout, Natasha K AU - Stout NK AD - Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts. FAU - Punglia, Rinaa S AU - Punglia RS AD - Department of Radiation Oncology Brigham, and Women's Hospital/Dana-Farber Cancer Institute Harvard Medical School, Boston, Massachusetts. FAU - Prakash, Ipshita AU - Prakash I AD - Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada. FAU - Sagara, Yasuaki AU - Sagara Y AD - Department of Breast Oncology, Sagara Hospital, Hakuaikai Medical Corporation, Kagoshima, Japan. AD - Department of Surgery, Brigham and Women's Hospital/Dana-Farber Cancer Institute Harvard Medical School, Boston, Massachusetts. FAU - Golshan, Mehra AU - Golshan M AD - Department of Surgery, Brigham and Women's Hospital/Dana-Farber Cancer Institute Harvard Medical School, Boston, Massachusetts. LA - eng PT - Journal Article DEP - 20170221 PL - United States TA - Cancer JT - Cancer JID - 0374236 OTO - NOTNLM OT - breast neoplasms OT - cancer outcomes OT - decision analysis OT - prognosis OT - survival EDAT- 2017/02/22 06:00 MHDA- 2017/02/22 06:00 CRDT- 2017/02/22 06:00 PHST- 2016/12/03 [received] PHST- 2017/01/14 [revised] PHST- 2017/02/05 [accepted] AID - 10.1002/cncr.30644 [doi] PST - aheadofprint SO - Cancer. 2017 Feb 21. doi: 10.1002/cncr.30644. PMID- 28145105 OWN - NLM STAT- In-Process DA - 20170201 LR - 20170525 IS - 1365-2354 (Electronic) IS - 0961-5423 (Linking) VI - 26 IP - 3 DP - 2017 May TI - A qualitative study on a decision aid for breast cancer screening: Views from women and health professionals. LID - 10.1111/ecc.12660 [doi] AB - This qualitative study evaluates a decision aid that includes the benefits and harms of breast cancer screening and analyses women's perception of the information received and healthcare professionals' perceptions of the convenience of providing it. Seven focus groups of women aged 40-69 years (n = 39) and two groups of healthcare professionals (n = 23) were conducted in Catalonia and the Canary Islands. The focus groups consisted of guided discussions regarding decision-making about breast cancer screening, and acceptability and feasibility of the decision aid. A content analysis was performed. Women positively value receiving information regarding the benefits and harms of breast cancer screening. Several women had difficulties understanding some concepts, especially those regarding overdiagnosis. Women preferred to share the decisions on screening with healthcare professionals. The professionals noted the lack of inclusion of some harms and benefits in the decision aid, and proposed improving the clarity of the statistical information. The information on overdiagnosis generates confusion among women and controversy among professionals. Faced with the new information presented by the decision aid, the majority of women prefer shared decision-making; however, its feasibility might be limited by a lack of knowledge and attitudes of rejection from healthcare professionals. CI - (c) 2017 John Wiley & Sons Ltd. FAU - Toledo-Chavarri, A AU - Toledo-Chavarri A AD - Canary Islands Foundation of Health Research (FUNCANIS), Tenerife, Spain. AD - Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain. FAU - Rue, M AU - Rue M AD - Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain. AD - Basic Medical Sciences Department, University of Lleida-IRBLLEIDA, Lleida, Spain. AD - Research Group in Economic Analysis and Health (GRAES, 2014 SGR 978), Rovira i Virgili University (URV), Reus, Spain. FAU - Codern-Bove, N AU - Codern-Bove N AD - AreaQ, Evaluation and Qualitative Research, Barcelona, Spain. AD - Escola Universitaria d'Infermeria i Terapia Ocupacional (EUIT), Terrassa, Universitat Autonoma de Barcelona, Barcelona, Spain. FAU - Carles-Lavila, M AU - Carles-Lavila M AD - Research Group in Economic Analysis and Health (GRAES, 2014 SGR 978), Rovira i Virgili University (URV), Reus, Spain. AD - Department of Economics and CREIP, Rovira i Virgili University (URV), Tarragona, Spain. FAU - Perestelo-Perez, L AU - Perestelo-Perez L AD - Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain. AD - Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain. AD - Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain. FAU - Perez-Lacasta, M J AU - Perez-Lacasta MJ AD - Research Group in Economic Analysis and Health (GRAES, 2014 SGR 978), Rovira i Virgili University (URV), Reus, Spain. AD - Department of Economics and CREIP, Rovira i Virgili University (URV), Tarragona, Spain. FAU - Feijoo-Cid, M AU - Feijoo-Cid M AUID- ORCID: http://orcid.org/0000-0002-7010-373X AD - Department of Nursing, Faculty of Medicine, Universitat Autonoma de Barcelona, Bellaterra, Spain. AD - Researcher in Grups de Recerca d'America i Africa Llatines (GRAAL) (2014 SGR 1175), Barcelona, Spain. AD - Researcher Collaborator of the Infectious Diseases Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain. CN - InforMa Study Group LA - eng PT - Journal Article DEP - 20170201 PL - England TA - Eur J Cancer Care (Engl) JT - European journal of cancer care JID - 9301979 OTO - NOTNLM OT - breast cancer screening OT - decision aid OT - decision-making OT - patients' information IR - Cardona A FIR - Cardona, Angels IR - Codern N FIR - Codern, Nuria IR - Perestelo L FIR - Perestelo, Lilisbeth IR - Garcia M FIR - Garcia, Montse IR - Vidal C FIR - Vidal, Carmen IR - Buil S FIR - Buil, Sara IR - Martinez-Alonso M FIR - Martinez-Alonso, Montserrat IR - Ortega M FIR - Ortega, Marta IR - Pla S FIR - Pla, Sandra IR - Pons A FIR - Pons, Anna IR - Soler J FIR - Soler, Jorge IR - Vinyals C FIR - Vinyals, Clara IR - Vinyals L FIR - Vinyals, Laia IR - Carles M FIR - Carles, Misericordia IR - Pla R FIR - Pla, Roger IR - Buron A FIR - Buron, Andrea IR - Castells X FIR - Castells, Xavier IR - Romero A FIR - Romero, Anabel IR - Sala M FIR - Sala, Maria EDAT- 2017/02/02 06:00 MHDA- 2017/02/02 06:00 CRDT- 2017/02/02 06:00 PHST- 2016/12/22 [accepted] AID - 10.1111/ecc.12660 [doi] PST - ppublish SO - Eur J Cancer Care (Engl). 2017 May;26(3). doi: 10.1111/ecc.12660. Epub 2017 Feb 1. PMID- 28118228 OWN - NLM STAT- In-Process DA - 20170124 LR - 20170411 IS - 1536-3708 (Electronic) IS - 0148-7043 (Linking) VI - 78 IP - 5 Suppl 4 DP - 2017 May TI - Efficacy of a Procedure-Specific Education Module on Informed Consent in Plastic Surgery. PG - S225-S228 LID - 10.1097/SAP.0000000000000970 [doi] AB - INTRODUCTION: Truly informed consent is an elusive goal, seldom attained in medical or surgical practice. Patients often do not fully understand procedures and therapies they undergo or the associated sequelae. Historically, informed consent and patient education have been limited to physician discussions, sometimes with the addition of simple visual aids. More recently, there is a growing body of decision aids available, including interactive multimedia patient educational modules that review preoperative through postoperative care, risks, benefits, alternatives, different surgical options, as well as commonly asked questions. We hypothesized that the addition of a Web-based educational tool would positively impact attainment of informed consent and satisfaction in plastic surgery patients. METHODS: We performed a prospective randomized controlled study comparing patients who presented in consultation for breast reconstruction, breast reduction, and abdominoplasty. Patients received standard patient education along with a procedure-specific (study) or general patient safety (control) Web-based educational module. Informed consent was measured using a surgical-focused, modified version of the Shared Decision-making 25 index tool. Patient demographic information as well as surrogate markers of familiarity with technology were recorded preoperatively and postoperatively. Comparisons were made between study and control groups, procedure subgroups, and preoperative and postoperative time points. Demographic factors and consent variables were compared among experimental and procedure groups. RESULTS: Data were collected from 65 patients preoperatively and 48 patients postoperatively. Thirty patients competed both surveys. Overall, no differences in patient characteristics or familiarity with technology were observed between experimental groups. Demographic characteristics were also similar between groups. No meaningful differences were identified in comparisons between experimental groups on either cross-sectional or longitudinal analyses. Nearly all patient responses were consistent with being well informed and satisfied with the educational process. CONCLUSIONS: Overall, patients undergoing plastic surgery procedures are adequately informed and have a high degree of satisfaction regarding their patient education. The addition of a Web-based informed consent tool did not make a demonstrable difference in informed consent. FAU - Brandel, Michael G AU - Brandel MG AD - From the Division of Plastic Surgery, Department of Surgery, UC San Diego Medical Center, San Diego, CA. FAU - Reid, Christopher M AU - Reid CM FAU - Parmeshwar, Nisha AU - Parmeshwar N FAU - Dobke, Marek K AU - Dobke MK FAU - Gosman, Amanda A AU - Gosman AA LA - eng PT - Journal Article PL - United States TA - Ann Plast Surg JT - Annals of plastic surgery JID - 7805336 EDAT- 2017/01/25 06:00 MHDA- 2017/01/25 06:00 CRDT- 2017/01/25 06:00 AID - 10.1097/SAP.0000000000000970 [doi] PST - ppublish SO - Ann Plast Surg. 2017 May;78(5 Suppl 4):S225-S228. doi: 10.1097/SAP.0000000000000970. PMID- 27957772 OWN - NLM STAT- Publisher DA - 20161213 LR - 20170130 IS - 1099-1611 (Electronic) IS - 1057-9249 (Linking) DP - 2016 Dec 13 TI - Qualitatively understanding patients' and health professionals' experiences of the BRECONDA breast reconstruction decision aid. LID - 10.1002/pon.4346 [doi] AB - OBJECTIVE: Women diagnosed with breast cancer or ductal carcinoma in situ and those with a genetic susceptibility to developing this disease face the challenging decision of whether or not to undergo breast reconstruction following mastectomy. As part of a large randomized controlled trial, this qualitative study examined women's experiences of using the Breast RECONstruction Decision Aid (BRECONDA) and health professionals' feedback regarding the impact of this resource on patients' knowledge and decision making about breast reconstruction. METHOD: Semistructured interviews were conducted with women who accessed the BRECONDA intervention (N = 36) and with their healthcare providers (N = 6). All interviews were transcribed verbatim and subjected to thematic analysis by 3 independent coders. RESULTS: Participants reported an overall positive impression, with all interviewees endorsing this decision aid as a useful resource for women considering reconstructive surgery. Thematic analysis of patient interviews revealed 4 themes: overall impressions and aesthetics; personal relevance and utility; introducing BRECONDA; and advantages and suggested improvements. Analysis of health professionals' interviews also revealed 4 themes: need for BRECONDA, impact of BRECONDA, potential difficulties that may arise in using the decision aid, and recommending BRECONDA to patients. Patients indicated that they derived benefit from this resource at all stages of their decision-making process, with the greatest perceived benefit being for those early in their breast reconstruction journey. CONCLUSION: These findings support the use of BRECONDA as an adjunct to clinical consultation and other information sources. CI - Copyright (c) 2016 John Wiley & Sons, Ltd. FAU - Sherman, Kerry A AU - Sherman KA AUID- ORCID: http://orcid.org/0000-0001-7780-6668 AD - Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia. AD - Westmead Breast Cancer Institute, Westmead Hospital, University of Sydney, Sydney, Australia. FAU - Shaw, Laura-Kate AU - Shaw LK AD - Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia. FAU - Jorgensen, Lone AU - Jorgensen L AD - Clinic for Surgery and Oncology & Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark. FAU - Harcourt, Diana AU - Harcourt D AD - Centre for Appearance Research, Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK. FAU - Cameron, Linda AU - Cameron L AD - Psychological Sciences, University of California, Merced, CA, USA. AD - School of Psychology, The University of Auckland, Auckland, New Zealand. FAU - Boyages, John AU - Boyages J AUID- ORCID: http://orcid.org/0000-0003-3208-3966 AD - Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia. FAU - Elder, Elisabeth AU - Elder E AD - Westmead Breast Cancer Institute, Westmead Hospital, University of Sydney, Sydney, Australia. FAU - Kirk, Judy AU - Kirk J AD - Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney Medical School, University of Sydney, Sydney, Australia. AD - Centre for Cancer Research, The Westmead Institute for Medical Research, Sydney, Australia. FAU - Tucker, Katherine AU - Tucker K AD - Hereditary Cancer Clinic, Prince of Wales Hospital, Sydney, Australia. LA - eng PT - Journal Article DEP - 20161213 PL - England TA - Psychooncology JT - Psycho-oncology JID - 9214524 OTO - NOTNLM OT - BRCA OT - breast reconstruction OT - cancer OT - decision aid OT - oncology OT - user experience EDAT- 2016/12/14 06:00 MHDA- 2016/12/14 06:00 CRDT- 2016/12/14 06:00 PHST- 2016/08/25 [received] PHST- 2016/11/06 [revised] PHST- 2016/12/07 [accepted] AID - 10.1002/pon.4346 [doi] PST - aheadofprint SO - Psychooncology. 2016 Dec 13. doi: 10.1002/pon.4346. PMID- 27837638 OWN - NLM STAT- MEDLINE DA - 20161112 DCOM- 20170608 LR - 20170608 IS - 1107-0625 (Print) IS - 1107-0625 (Linking) VI - 21 IP - 5 DP - 2016 Sept-Oct TI - Development of a novel scoring system to potentially avoid completion axillary lymph node clearance after breast cancer excision and positive sentinel lymph node biopsy. PG - 1316-1319 FAU - Seretis, Charalampos AU - Seretis C AD - Department of General Surgery, Russells Hall Hospital, Dudley Group of Hospitals NHS Foundation Trust, Dudley, United Kingdom. FAU - Seretis, Fotios AU - Seretis F LA - eng PT - Journal Article PL - Greece TA - J BUON JT - Journal of B.U.ON. : official journal of the Balkan Union of Oncology JID - 100883428 SB - IM MH - Adult MH - Aged MH - Breast Neoplasms/pathology/*surgery MH - Carcinoma, Ductal, Breast/pathology/*surgery MH - *Decision Support Techniques MH - Female MH - Humans MH - *Lymph Node Excision/adverse effects MH - Lymphatic Metastasis MH - *Mastectomy/adverse effects MH - Middle Aged MH - Neoplasm Grading MH - Predictive Value of Tests MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Sentinel Lymph Node/pathology/*surgery MH - *Sentinel Lymph Node Biopsy MH - Treatment Outcome MH - Tumor Burden EDAT- 2016/11/13 06:00 MHDA- 2017/06/09 06:00 CRDT- 2016/11/13 06:00 PST - ppublish SO - J BUON. 2016 Sept-Oct;21(5):1316-1319. PMID- 27803595 OWN - NLM STAT- In-Data-Review DA - 20161102 LR - 20170220 IS - 1198-0052 (Print) IS - 1198-0052 (Linking) VI - 23 IP - 5 DP - 2016 Oct TI - Reoperation costs in attempted breast-conserving surgery: a decision analysis. PG - 314-321 AB - BACKGROUND: Breast-conserving surgery (bcs) is the preferred surgical approach for most patients with early-stage breast cancer. Frequently, concerns arise about the pathologic margin status, resulting in an average reoperation rate of 23% in Canada. No consensus has been reached about the ideal reoperation rate, although 10% has been suggested as a target. Upon undergoing reoperation, many patients choose mastectomy and breast reconstruction, which add to the morbidity and cost of patient care. We attempted to identify the cost of reoperation after bcs, and the effect that a reduction in the reoperation rate could have on the B.C. health care system. METHODS: A decision tree was constructed to estimate the average cost per patient undergoing initial bcs with two reoperation frequency scenarios: 23% and 10%. The model included the direct medical costs from the perspective of the B.C. health care system for the most common surgical treatment options, including breast reconstruction and postoperative radiation therapy. RESULTS: Costs ranged from a low of $8,225 per patient with definitive bcs [95% confidence interval (ci): $8,061 to $8,383] to a high of $26,026 for reoperation with mastectomy and delayed reconstruction (95% ci: $23,991 to $28,122). If the reoperation rate could be reduced to 10%, the average saving would be $1,055 per patient undergoing attempted bcs (95% ci: $959 to $1,156). If the lower rate were to be achieved in British Columbia, it would translate into a savings of $1.9 million annually. SUMMARY: The implementation of initiatives to reduce reoperation after bcs could result in significant savings to the health care system, while potentially improving the quality of patient care. FAU - Pataky, R E AU - Pataky RE AD - Canadian Centre for Applied Research in Cancer Control, BC Cancer Agency, Vancouver. FAU - Baliski, C R AU - Baliski CR AD - Surgical Oncology, Sindi Ahluwalia Hawkins Centre for the Southern Interior, BC Cancer Agency, Kelowna, University of British Columbia, Vancouver, BC; Department of Surgery, University of British Columbia, Vancouver, BC. LA - eng PT - Journal Article DEP - 20161025 PL - Canada TA - Curr Oncol JT - Current oncology (Toronto, Ont.) JID - 9502503 PMC - PMC5081007 OTO - NOTNLM OT - Breast cancer OT - breast-conserving surgery OT - costs OT - mastectomy OT - quality of care EDAT- 2016/11/03 06:00 MHDA- 2016/11/03 06:00 CRDT- 2016/11/03 06:00 AID - 10.3747/co.23.2989 [doi] AID - conc-23-314 [pii] PST - ppublish SO - Curr Oncol. 2016 Oct;23(5):314-321. Epub 2016 Oct 25. PMID- 27550796 OWN - NLM STAT- MEDLINE DA - 20160912 DCOM- 20170403 LR - 20170403 IS - 1365-2168 (Electronic) IS - 0007-1323 (Linking) VI - 103 IP - 12 DP - 2016 Nov TI - National study of the impact of patient information and involvement in decision-making on immediate breast reconstruction rates. PG - 1640-1648 LID - 10.1002/bjs.10286 [doi] AB - BACKGROUND: Reconstructive alternatives should be discussed with women facing mastectomy for breast cancer. These include immediate and delayed reconstruction, which both have inherent advantages and disadvantages. Immediate reconstruction rates vary considerably in Swedish healthcare regions, and the aim of the study was to analyse reasons for this disparity. METHODS: All women who underwent mastectomy for primary breast cancer in Sweden in 2013 were included. Tumour data were retrieved from the Swedish National Breast Cancer Registry and from questionnaires regarding patient information and involvement in preoperative decision-making sent to women who were still alive in 2015. RESULTS: Of 2929 women who had undergone 2996 mastectomies, 2906 were still alive. The questionnaire response rate was 76.3 per cent. Immediate reconstruction rates varied regionally, between 3.0 and 26.4 per cent. Tumour characteristics impacted on reconstruction rates but did not explain regional differences. Patient participation in decision-making, availability of plastic surgery services and patient information, however, were independent predictors of immediate breast reconstruction, and varied significantly between regions. Even in younger patients with low-risk tumours, rates of patient information ranged between 34.3 and 83.3 per cent. CONCLUSION: Significant regional differences in immediate reconstruction rates were not explained by differences in tumour characteristics, but by disparities in patient information, availability of plastic surgery services and involvement in decision-making. CI - (c) 2016 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd. FAU - Frisell, A AU - Frisell A AD - Department of Emergency Medicine and Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden. FAU - Lagergren, J AU - Lagergren J AD - Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden. AD - Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden. FAU - de Boniface, J AU - de Boniface J AD - Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden. Jana.De-Boniface@ki.se. AD - Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden. Jana.De-Boniface@ki.se. LA - eng PT - Journal Article DEP - 20160823 PL - England TA - Br J Surg JT - The British journal of surgery JID - 0372553 SB - AIM SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/epidemiology/psychology/*surgery MH - Cross-Sectional Studies MH - Decision Making MH - Female MH - Humans MH - Mammaplasty/psychology/*statistics & numerical data MH - Mastectomy/psychology/statistics & numerical data MH - Middle Aged MH - *Patient Education as Topic MH - Patient Participation/*psychology MH - Registries MH - Retrospective Studies MH - Sweden/epidemiology MH - Young Adult PMC - PMC5095775 EDAT- 2016/11/02 06:00 MHDA- 2017/04/04 06:00 CRDT- 2016/08/24 06:00 PHST- 2016/03/10 [received] PHST- 2016/04/07 [revised] PHST- 2016/07/01 [accepted] AID - 10.1002/bjs.10286 [doi] PST - ppublish SO - Br J Surg. 2016 Nov;103(12):1640-1648. doi: 10.1002/bjs.10286. Epub 2016 Aug 23. PMID- 27782983 OWN - NLM STAT- MEDLINE DA - 20161026 DCOM- 20170517 LR - 20170517 IS - 1529-4242 (Electronic) IS - 0032-1052 (Linking) VI - 138 IP - 5 DP - 2016 Nov TI - Techniques and Perforator Selection in Single, Dominant DIEP Flap Breast Reconstruction: Algorithmic Approach to Maximize Efficiency and Safety. PG - 790e-803e AB - BACKGROUND: Perforator selection is critical to deep inferior epigastric perforator (DIEP) flap harvest. Commitment to a single perforator has the potential benefit of a simpler dissection, but may increase fat necrosis or perfusion-related complications compared with multiple perforator harvest. METHODS: A 3-year retrospective study was carried out of all patients who underwent DIEP flap breast reconstruction performed by the senior author (M.S.-C). Data were collected on patient demographics and surgical outcomes. RESULTS: One hundred eighty-three flaps were performed (105 patients) over 3 years. One hundred fifty-six bilateral (78 patients) and 24 unilateral flaps were included in the final study. Mean age was 47.8 +/- 8.4 years and mean body mass index was 29.1 +/- 5.3 kg/m. Seventy-five percent of flaps were based on single dominant perforators. Single perforators were used in 33.3 percent of flaps weighing over 1000 g, 80 and 74 percent of flaps weighing 500 to 1000 g and less than 500 g, respectively (p = 0.01). There were no differences in overall complications between single- versus multiple-perforator DIEP flaps. Neither body mass index nor flap weight posed additional risk to overall complications. Conversion to a muscle-sparing flap was 9.4 percent. CONCLUSIONS: The authors present an algorithm for perforator selection, stepwise approach to flap harvest, and considerations for intraoperative decision-making in DIEP flap reconstruction. Single-dominant perforator flaps can be safely performed, but inclusion of the largest perforator is critical to flap perfusion. Additional perforators must be weighed against the associated tradeoff with donor-site morbidity. The threshold for conversion to a muscle-sparing flap is reduced with increased clinical experience. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. FAU - Mohan, Anita T AU - Mohan AT AD - Rochester, Minn.; and London and Cambridge, UnitedKingdom From the Division of Plastic Surgery and the Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic; the Restoration of Appearance and Function Charitable Trust; and the Department of Surgery, University of Cambridge. FAU - Zhu, Lin AU - Zhu L FAU - Wang, Zhen AU - Wang Z FAU - Vijayasekaran, Aparna AU - Vijayasekaran A FAU - Saint-Cyr, Michel AU - Saint-Cyr M LA - eng PT - Journal Article PT - Video-Audio Media PL - United States TA - Plast Reconstr Surg JT - Plastic and reconstructive surgery JID - 1306050 SB - AIM SB - IM MH - Adult MH - Aged MH - Algorithms MH - Decision Support Techniques MH - Epigastric Arteries/*surgery MH - Female MH - Humans MH - Mammaplasty/*methods MH - Mastectomy MH - Middle Aged MH - Outcome Assessment (Health Care) MH - Patient Safety MH - Perforator Flap/*blood supply/surgery MH - Retrospective Studies EDAT- 2016/10/27 06:00 MHDA- 2017/05/18 06:00 CRDT- 2016/10/27 06:00 AID - 10.1097/PRS.0000000000002716 [doi] AID - 00006534-201611000-00003 [pii] PST - ppublish SO - Plast Reconstr Surg. 2016 Nov;138(5):790e-803e. PMID- 26780376 OWN - NLM STAT- In-Process DA - 20160118 LR - 20170224 IS - 1538-9804 (Electronic) IS - 0162-220X (Linking) VI - 36 IP - 6 DP - 2016 Nov/Dec TI - Attitudes and Decisional Conflict Regarding Breast Reconstruction Among Breast Cancer Patients. PG - 427-436 AB - BACKGROUND: The decision to undergo breast reconstruction (BR) surgery after mastectomy is made during stressful circumstances. Many women do not feel well prepared to make this decision. OBJECTIVE: Using the Ottawa Decision Support Framework, this study aims to describe women's reasons to choose or not choose BR, BR knowledge, decisional preparedness, and decisional conflict about BR. Possible demographic, medical, BR knowledge, and attitudinal correlates of decisional conflict about BR were also evaluated. METHODS: Participants were 55 women with early-stage breast cancer drawn from the baseline data of a pilot randomized trial evaluating the efficacy of a BR decision support aid for breast cancer patients considering BR. RESULTS: The most highly ranked reasons to choose BR were the desire for breasts to be equal in size, the desire to wake up from surgery with a breast in place, and perceived bother of a scar with no breast. The most highly ranked reasons not to choose BR were related to the surgical risks and complications. Regression analyses indicated that decisional conflict was associated with higher number of reasons not to choose BR and lower levels of decisional preparedness. CONCLUSIONS: The results suggest that breast cancer patients considering BR may benefit from decisional support. IMPLICATIONS FOR CLINICAL PRACTICE: Healthcare professionals may facilitate decision making by focusing on reasons for each patient's uncertainty and unaddressed concerns. All patients, even those who have consulted with a plastic surgeon and remain uncertain about their decision, may benefit from decision support from a health professional. FAU - Manne, Sharon L AU - Manne SL AD - Author Affiliations: Section of Population Science, Department of Medicine, Robert Wood Johnson Medical School, Rutgers, the Cancer Institute of New Jersey, New Brunswick (Drs Manne, Kirstein, Myers Virtue, and Devine and Mss Gajda, Frederick, and Darabos); Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania (Dr Topham); MD Anderson Cancer Center at Cooper Health Systems, Voorhees Township, New Jersey (Dr Brill); and Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania (Ms Sorice). FAU - Topham, Neal AU - Topham N FAU - Kirstein, Laurie AU - Kirstein L FAU - Virtue, Shannon Myers AU - Virtue SM FAU - Brill, Kristin AU - Brill K FAU - Devine, Katie A AU - Devine KA FAU - Gajda, Tina AU - Gajda T FAU - Frederick, Sara AU - Frederick S FAU - Darabos, Katie AU - Darabos K FAU - Sorice, Kristen AU - Sorice K LA - eng GR - R21 CA149531/CA/NCI NIH HHS/United States PT - Journal Article PL - United States TA - Cancer Nurs JT - Cancer nursing JID - 7805358 PMC - PMC4947023 MID - NIHMS728274 COI - The authors have no conflicts of interest to disclose. EDAT- 2016/10/26 06:00 MHDA- 2016/10/26 06:00 CRDT- 2016/01/19 06:00 PMCR- 2017/11/01 AID - 10.1097/NCC.0000000000000320 [doi] PST - ppublish SO - Cancer Nurs. 2016 Nov/Dec;36(6):427-436. PMID- 27673530 OWN - NLM STAT- MEDLINE DA - 20160928 DCOM- 20170505 LR - 20170505 IS - 1529-4242 (Electronic) IS - 0032-1052 (Linking) VI - 138 IP - 4 DP - 2016 Oct TI - Reducing Decisional Conflict and Enhancing Satisfaction with Information among Women Considering Breast Reconstruction following Mastectomy: Results from the BRECONDA Randomized Controlled Trial. PG - 592e-602e LID - 10.1097/PRS.0000000000002538 [doi] AB - BACKGROUND: Deciding whether or not to have breast reconstruction following breast cancer diagnosis is a complex decision process. This randomized controlled trial assessed the impact of an online decision aid [Breast RECONstruction Decision Aid (BRECONDA)] on breast reconstruction decision-making. METHODS: Women (n = 222) diagnosed with breast cancer or ductal carcinoma in situ, and eligible for reconstruction following mastectomy, completed an online baseline questionnaire. They were then assigned randomly to receive either standard online information about breast reconstruction (control) or standard information plus access to BRECONDA (intervention). Participants then completed questionnaires at 1 and 6 months after randomization. The primary outcome was participants' decisional conflict 1 month after exposure to the intervention. Secondary outcomes included decisional conflict at 6 months, satisfaction with information at 1 and 6 months, and 6-month decisional regret. RESULTS: Linear mixed-model analyses revealed that 1-month decisional conflict was significantly lower in the intervention group (27.18) compared with the control group (35.5). This difference was also sustained at the 6-month follow-up. Intervention participants reported greater satisfaction with information at 1- and 6-month follow-up, and there was a nonsignificant trend for lower decisional regret in the intervention group at 6-month follow-up. Intervention participants' ratings for BRECONDA demonstrated high user acceptability and overall satisfaction. CONCLUSIONS: Women who accessed BRECONDA benefited by experiencing significantly less decisional conflict and being more satisfied with information regarding the reconstruction decisional process than women receiving standard care alone. These findings support the efficacy of BRECONDA in helping women to arrive at their breast reconstruction decision. FAU - Sherman, Kerry A AU - Sherman KA AD - Sydney, Australia; Bristol, United Kingdom; and Merced, Calif. From the Centre for Emotional Health, Macquarie University; the Westmead Breast Cancer Institute, Westmead Hospital; the Macquarie University Cancer Institute, Australian School of Advanced Medicine, Macquarie University; The Poche Centre, Mater Hospital; the Centre for Appearance Research, University of West of England; and the University of California, Merced. FAU - Shaw, Laura-Kate E AU - Shaw LK FAU - Winch, Caleb J AU - Winch CJ FAU - Harcourt, Diana AU - Harcourt D FAU - Boyages, John AU - Boyages J FAU - Cameron, Linda D AU - Cameron LD FAU - Brown, Paul AU - Brown P FAU - Lam, Thomas AU - Lam T FAU - Elder, Elisabeth AU - Elder E FAU - French, James AU - French J FAU - Spillane, Andrew AU - Spillane A CN - BRECONDA Collaborative Research Group LA - eng PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PL - United States TA - Plast Reconstr Surg JT - Plastic and reconstructive surgery JID - 1306050 SB - AIM SB - IM MH - Adult MH - Aged MH - *Decision Making MH - *Decision Support Techniques MH - Female MH - Follow-Up Studies MH - Humans MH - Internet MH - Mammaplasty/*psychology MH - *Mastectomy MH - Middle Aged MH - Outcome Assessment (Health Care) MH - Patient Education as Topic MH - Patient Participation/*methods/psychology MH - Patient Satisfaction/*statistics & numerical data MH - Single-Blind Method EDAT- 2016/09/28 06:00 MHDA- 2017/05/06 06:00 CRDT- 2016/09/28 06:00 AID - 10.1097/PRS.0000000000002538 [doi] AID - 00006534-201610000-00007 [pii] PST - ppublish SO - Plast Reconstr Surg. 2016 Oct;138(4):592e-602e. doi: 10.1097/PRS.0000000000002538. PMID- 27654108 OWN - NLM STAT- In-Process DA - 20160922 LR - 20170328 IS - 1534-4681 (Electronic) IS - 1068-9265 (Linking) VI - 24 IP - 1 DP - 2017 Jan TI - Impact of an In-visit Decision Aid on Patient Knowledge about Contralateral Prophylactic Mastectomy: A Pilot Study. PG - 91-99 LID - 10.1245/s10434-016-5556-x [doi] AB - BACKGROUND: Studies have reported that breast cancer patients have limited understanding about the oncologic outcomes following contralateral prophylactic mastectomy (CPM). We hypothesized that an in-visit decision aid (DA) would be associated with higher patient knowledge about the anticipated short and long term outcomes of CPM. METHODS: We piloted a DA which used the SCOPED: (Situation, Choices, Objectives, People, Evaluation and Decision) framework. Knowledge, dichotomized as "low" (/=4 correct), was assessed immediately after the visit by a 5 item survey. There were 97 DA patients (response rate 62.2 %) and 114 usual care (UC) patients (response rate 71.3 %). RESULTS: Patient demographic factors were similar between the two groups. Twenty-one (21.7 %) patients in the DA group underwent CPM compared with 18 (15.8 %) in the UC group (p = 0.22). Mean and median knowledge levels were significantly higher in the DA group compared with the UC group for patients of all ages, tumor stage, race, family history, anxiety levels, worry about CBC, and surgery type. Eighty-six (78.9 %) of UC versus 35 (37.9 %) DA patients had low knowledge. Of patients who underwent CPM, 15 (83.3 %) in the UC cohort versus 5 (25.0 %) of DA patients had "low" knowledge. CONCLUSIONS: Knowledge was higher in the DA group. The UC group had approximately three times the number of patients of the DA group who were at risk for making a poorly informed decision to have CPM. Future studies should assess the impact of increased knowledge on overall CPM rates. FAU - Yao, Katharine AU - Yao K AD - Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. kyao@northshore.org. FAU - Belkora, Jeff AU - Belkora J AD - University of California San Francisco School of Medicine, San Francisco, CA, USA. FAU - Bedrosian, Isabelle AU - Bedrosian I AD - Department of Surgery, MD Anderson Cancer Center, Houston, TX, USA. FAU - Rosenberg, Shoshana AU - Rosenberg S AD - Dana Farber Cancer Institute, Boston, MA, USA. FAU - Sisco, Mark AU - Sisco M AD - Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. FAU - Barrera, Ermilo AU - Barrera E AD - Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. FAU - Kyrillios, Alexandra AU - Kyrillios A AD - Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. FAU - Tilburt, Jon AU - Tilburt J AD - Mayo Clinic, Rochester, MN, USA. FAU - Wang, Chihsiung AU - Wang C AD - Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, IL, USA. FAU - Rabbitt, Sarah AU - Rabbitt S AD - Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. FAU - Pesce, Catherine AU - Pesce C AD - Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. FAU - Simovic, Sandra AU - Simovic S AD - Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. FAU - Winchester, David J AU - Winchester DJ AD - Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. FAU - Sepucha, Karen AU - Sepucha K AD - Massachusetts General Hospital, Health Decision Sciences Center, Boston, MA, USA. LA - eng PT - Journal Article DEP - 20160921 PL - United States TA - Ann Surg Oncol JT - Annals of surgical oncology JID - 9420840 EIN - Ann Surg Oncol. 2017 Mar 27;:. PMID: 28349337 EDAT- 2016/09/23 06:00 MHDA- 2016/09/23 06:00 CRDT- 2016/09/23 06:00 PHST- 2016/07/19 [received] AID - 10.1245/s10434-016-5556-x [doi] AID - 10.1245/s10434-016-5556-x [pii] PST - ppublish SO - Ann Surg Oncol. 2017 Jan;24(1):91-99. doi: 10.1245/s10434-016-5556-x. Epub 2016 Sep 21. PMID- 27650678 OWN - NLM STAT- In-Process DA - 20160921 LR - 20170510 IS - 1465-542X (Electronic) IS - 1465-5411 (Linking) VI - 18 IP - 1 DP - 2016 Sep 20 TI - Outcomes of contralateral prophylactic mastectomy in relation to familial history: a decision analysis (BRCR-D-16-00033). PG - 93 LID - 10.1186/s13058-016-0752-y [doi] AB - BACKGROUND: Family history of breast cancer is associated with an increased risk of contralateral breast cancer (CBC) even in the absence of mutations in the breast cancer susceptibility genes BRCA1/2. We compared quality-adjusted survival after contralateral prophylactic mastectomy (CPM) with surveillance only (no CPM) among women with breast cancer incorporating the degree of family history. METHODS: We created a microsimulation model for women with first-degree, second-degree, and no family history treated for a stage I, II, or III estrogen receptor (ER)-positive or ER-negative breast cancer at the ages of 40, 50, 60, and 70. The model incorporated a 10-year posttreatment period for risk of developing CBC and/or dying of the primary cancer or CBC. For each patient profile, we used 100,000 microsimulation trials to estimate quality-adjusted life expectancy for the clinical strategies CPM and no CPM. RESULTS: CPM showed minimal improvement on quality-adjusted life expectancy among women age 50-60 with no or a unilateral first-degree or second-degree family history (decreasing from 0.31 to -0.06 quality-adjusted life-years (QALYs)) and was unfavorable for most subgroups of women age 70 with stage III breast cancer regardless of degree of family history (range -0.08 to -0.02 QALYs). Sensitivity analysis showed that the highest predicted benefit of CPM assuming 95 % risk reduction in CBC was 0.57 QALYs for a 40-year-old woman with stage I breast cancer who had a first-degree relative with bilateral breast cancer. CONCLUSIONS: Women age 40 with stage I breast cancer and a first-degree relative with bilateral breast cancer have a QALY benefit from CPM similar to that reported for BRCA1/2 mutation carriers. For most subgroups of women, CPM has a minimal to no effect on quality-adjusted life expectancy, irrespective of family history of breast cancer. FAU - Davies, Kalatu R AU - Davies KR AD - Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Unit 1444, P.O. Box 301402, Houston, TX, 77230-1402, USA. FAU - Brewster, Abenaa M AU - Brewster AM AD - Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. FAU - Bedrosian, Isabelle AU - Bedrosian I AD - Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. FAU - Parker, Patricia A AU - Parker PA AD - Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. FAU - Crosby, Melissa A AU - Crosby MA AD - Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. FAU - Peterson, Susan K AU - Peterson SK AD - Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. FAU - Shen, Yu AU - Shen Y AD - Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. FAU - Volk, Robert J AU - Volk RJ AD - Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Unit 1444, P.O. Box 301402, Houston, TX, 77230-1402, USA. FAU - Cantor, Scott B AU - Cantor SB AD - Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Unit 1444, P.O. Box 301402, Houston, TX, 77230-1402, USA. sbcantor@mdanderson.org. LA - eng GR - P30 CA008748/CA/NCI NIH HHS/United States GR - P30 CA016672/CA/NCI NIH HHS/United States PT - Journal Article DEP - 20160920 PL - England TA - Breast Cancer Res JT - Breast cancer research : BCR JID - 100927353 SB - IM PMC - PMC5028980 OID - NLM: PMC5028980 OTO - NOTNLM OT - Breast cancer OT - Contralateral breast cancer OT - Decision analysis OT - Prophylactic mastectomy EDAT- 2016/09/22 06:00 MHDA- 2016/09/22 06:00 CRDT- 2016/09/22 06:00 PHST- 2016/01/21 [received] PHST- 2016/08/11 [accepted] AID - 10.1186/s13058-016-0752-y [doi] AID - 10.1186/s13058-016-0752-y [pii] PST - epublish SO - Breast Cancer Res. 2016 Sep 20;18(1):93. doi: 10.1186/s13058-016-0752-y. PMID- 27476081 OWN - NLM STAT- MEDLINE DA - 20160907 DCOM- 20170314 LR - 20170314 IS - 1532-3080 (Electronic) IS - 0960-9776 (Linking) VI - 29 DP - 2016 Oct TI - Formal analysis of the surgical pathway and development of a new software tool to assist surgeons in the decision making in primary breast surgery. PG - 74-81 LID - 10.1016/j.breast.2016.06.004 [doi] LID - S0960-9776(16)30078-9 [pii] AB - BACKGROUND: The increased complexity of the decisional process in breast cancer surgery is well documented. With this study we aimed to create a software tool able to assist patients and surgeons in taking proper decisions. METHODOLOGY: We hypothesized that the endpoints of breast cancer surgery could be addressed combining a set of decisional drivers. We created a decision support system software tool (DSS) and an interactive decision tree. A formal analysis estimated the information gain derived from each feature in the process. We tested the DSS on 52 patients and we analyzed the concordance of decisions obtained by different users and between the DSS suggestions and the actual surgery. We also tested the ability of the system to prevent post breast conservation deformities. RESULTS: The information gain revealed that patients preferences are the root of our decision tree. An observed concordance respectively of 0.98 and 0.88 was reported when the DSS was used twice by an expert operator or by a newly trained operator vs. an expert one. The observed concordance between the DSS suggestion and the actual decision was 0.69. A significantly higher incidence of post breast conservation defects was reported among patients who did not follow the DSS decision (Type III of Fitoussi, N = 4; 33.3%, p = 0.004). CONCLUSION: The DSS decisions can be reproduced by operators with different experience. The concordance between suggestions and actual decision is quite low, however the DSS is able to prevent post- breast conservation deformities. CI - Copyright (c) 2016 Elsevier Ltd. All rights reserved. FAU - Catanuto, Giuseppe AU - Catanuto G AD - U.O. C. Senologia - Azienda Ospedaliera Cannizzaro, Via Messina 829, Catania, Italy; Scuola di Oncologia Chirurgica Ricostruttiva - Onlus, Milano, Italy. Electronic address: giuseppecatanuto@gmail.com. FAU - Pappalardo, Francesco AU - Pappalardo F AD - Universita degli Studi di Catania, Catania, Italy. FAU - Rocco, Nicola AU - Rocco N AD - Dipartimento di Medicina Clinica e Chirurgia, Universita di Napoli 'Federico II', Napoli, Italy. FAU - Leotta, Marco AU - Leotta M AD - Universita degli Studi di Catania, Catania, Italy. FAU - Ursino, Venera AU - Ursino V AD - U.O. C. Senologia - Azienda Ospedaliera Cannizzaro, Via Messina 829, Catania, Italy. FAU - Chiodini, Paolo AU - Chiodini P AD - Unita di Statistica Medica, Seconda Universita di Napoli, Napoli, Italy. FAU - Buggi, Federico AU - Buggi F AD - U.O.C. Senologia - Ospedale Morgagni-Pierantoni, Forli, Italy. FAU - Folli, Secondo AU - Folli S AD - U.O.C. Senologia - Ospedale Morgagni-Pierantoni, Forli, Italy. FAU - Catalano, Francesca AU - Catalano F AD - U.O. C. Senologia - Azienda Ospedaliera Cannizzaro, Via Messina 829, Catania, Italy. FAU - Nava, Maurizio B AU - Nava MB AD - Scuola di Oncologia Chirurgica Ricostruttiva - Onlus, Milano, Italy. LA - eng PT - Journal Article PT - Validation Studies DEP - 20160728 PL - Netherlands TA - Breast JT - Breast (Edinburgh, Scotland) JID - 9213011 SB - IM MH - Breast/pathology/surgery MH - Breast Neoplasms/psychology/*surgery MH - Decision Making MH - *Decision Making, Computer-Assisted MH - *Decision Support Techniques MH - Endpoint Determination/methods MH - Female MH - Humans MH - Mastectomy/*psychology MH - Middle Aged MH - Postoperative Complications/prevention & control MH - Reproducibility of Results MH - *Software MH - Surgeons/psychology OTO - NOTNLM OT - *Breast reconstructive surgery OT - *Cosmetic outcome OT - *Decision making in breast surgery OT - *Oncoplastic surgery OT - *Prevention of defects EDAT- 2016/08/01 06:00 MHDA- 2017/03/16 06:00 CRDT- 2016/08/01 06:00 PHST- 2016/02/19 [received] PHST- 2016/04/15 [revised] PHST- 2016/06/05 [accepted] AID - S0960-9776(16)30078-9 [pii] AID - 10.1016/j.breast.2016.06.004 [doi] PST - ppublish SO - Breast. 2016 Oct;29:74-81. doi: 10.1016/j.breast.2016.06.004. Epub 2016 Jul 28. PMID- 27464606 OWN - NLM STAT- In-Process DA - 20160826 LR - 20160826 IS - 1534-4681 (Electronic) IS - 1068-9265 (Linking) VI - 23 IP - 10 DP - 2016 Oct TI - Breast Conservation Therapy Versus Mastectomy: Shared Decision-Making Strategies and Overcoming Decisional Conflicts in Your Patients. PG - 3133-7 LID - 10.1245/s10434-016-5369-y [doi] AB - Although breast-conserving therapy is considered the preferred treatment for the majority of women with early-stage breast cancer, mastectomy rates in this group remain high. The patient, physician, and systems factors contributing to a decision for mastectomy are complicated. Understanding the individual patient's values and goals when making this decision is paramount to providing a shared decision-making process that will yield the desired outcome. The cornerstones of this discussion include education of the patient, access to decision-aid tools, and time to make an informed decision. However, it is also paramount for the physician to understand that a significant majority of women with an informed and complete understanding of their surgical choices will still prefer mastectomy. The rates of breast conservation versus mastectomy should not be considered a quality measure alone. Rather, the extent by which patients are informed, involved in decision-making, and undergoing treatments that reflect their goals is the true test of quality. Here we explore some of the factors that impact the patient preference for breast conservation versus mastectomy and how shared decision-making can be maximized for patient satisfaction. FAU - Margenthaler, Julie A AU - Margenthaler JA AD - Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA. margenthalerj@wudosis.wustl.edu. FAU - Ollila, David W AU - Ollila DW AD - Department of Surgery, University of North Carolina, Chapel Hill, NC, USA. LA - eng PT - Journal Article DEP - 20160727 PL - United States TA - Ann Surg Oncol JT - Annals of surgical oncology JID - 9420840 SB - IM EDAT- 2016/07/29 06:00 MHDA- 2016/07/29 06:00 CRDT- 2016/07/29 06:00 PHST- 2016/05/09 [received] AID - 10.1245/s10434-016-5369-y [doi] AID - 10.1245/s10434-016-5369-y [pii] PST - ppublish SO - Ann Surg Oncol. 2016 Oct;23(10):3133-7. doi: 10.1245/s10434-016-5369-y. Epub 2016 Jul 27. PMID- 27438052 OWN - NLM STAT- MEDLINE DA - 20160927 DCOM- 20170329 LR - 20170330 IS - 1488-2310 (Electronic) IS - 0008-428X (Linking) VI - 59 IP - 5 DP - 2016 Sep TI - Predicting which patients actually receive radiation following breast conserving therapy in Canadian populations. PG - 358-60 AB - SUMMARY: Canadian women with breast cancer may choose breast conserving therapy as their course of treatment, requiring both breast conserving surgery and adjuvant radiation therapy. However, more than 15% of Canadian women fail to receive the appropriate radiation therapy, putting them at increased risk for recurrence. Age, distance from their radiation therapy centre and stage of disease affect patients' likelihood of receiving prescribed radiation therapy. We propose a nomogram that allows physicians to predict which patients will and will not receive radiation. This nomogram, once validated, could be used to guide decision making when choosing between breast conserving therapy and mastectomy as the treatment course and thereby change the practice of breast cancer management. FAU - Guidolin, Keegan AU - Guidolin K AD - From the Schulich School of Medicine & Dentistry, Western University, London, Ont. (Guidolin, Lock, Brackstone); and the London Health Sciences Centre, London, Ont. (Lock, Richard, Boldt, Brackstone). FAU - Lock, Michael AU - Lock M AD - From the Schulich School of Medicine & Dentistry, Western University, London, Ont. (Guidolin, Lock, Brackstone); and the London Health Sciences Centre, London, Ont. (Lock, Richard, Boldt, Brackstone). FAU - Richard, Lucie AU - Richard L AD - From the Schulich School of Medicine & Dentistry, Western University, London, Ont. (Guidolin, Lock, Brackstone); and the London Health Sciences Centre, London, Ont. (Lock, Richard, Boldt, Brackstone). FAU - Boldt, Gabriel AU - Boldt G AD - From the Schulich School of Medicine & Dentistry, Western University, London, Ont. (Guidolin, Lock, Brackstone); and the London Health Sciences Centre, London, Ont. (Lock, Richard, Boldt, Brackstone). FAU - Brackstone, Muriel AU - Brackstone M AD - From the Schulich School of Medicine & Dentistry, Western University, London, Ont. (Guidolin, Lock, Brackstone); and the London Health Sciences Centre, London, Ont. (Lock, Richard, Boldt, Brackstone). LA - eng PT - Journal Article PL - Canada TA - Can J Surg JT - Canadian journal of surgery. Journal canadien de chirurgie JID - 0372715 SB - IM MH - Breast Neoplasms/radiotherapy/*surgery MH - Clinical Decision-Making/*methods MH - *Decision Support Techniques MH - Female MH - Humans MH - Mastectomy/*standards MH - Mastectomy, Segmental/*standards PMC - PMC5042724 EDAT- 2016/07/21 06:00 MHDA- 2017/03/31 06:00 CRDT- 2016/07/21 06:00 AID - 10.1503/cjs.000516 [pii] PST - ppublish SO - Can J Surg. 2016 Sep;59(5):358-60. PMID- 27318167 OWN - NLM STAT- MEDLINE DA - 20160712 DCOM- 20170313 LR - 20170313 IS - 1532-3080 (Electronic) IS - 0960-9776 (Linking) VI - 28 DP - 2016 Aug TI - Decision making, psychological wellbeing and psychosocial outcomes for high risk women who choose to undergo bilateral prophylactic mastectomy - A review of the literature. PG - 130-5 LID - 10.1016/j.breast.2016.05.012 [doi] LID - S0960-9776(16)30071-6 [pii] AB - A bilateral prophylactic, or preventative, mastectomy (BPM) for women at high risk of developing breast cancer (BC) can reduce their risk of developing the disease by up to 90% (relative risk reduction). An increasing number of women, including young women, are taking up this option. However, there is a dearth of information for younger women (under 40 years) choosing preventative mastectomy. In fact, no studies to date have specifically focused on younger women's experiences of a BPM and investigated their informational needs. The purpose of this review is to report on the current literature surrounding the psychological experience of a BPM and the informational needs for women at high risk of developing BC with a particular emphasis on younger women. Research has highlighted a range of psychological outcomes linked to preventative mastectomy, including positives such as reduced anxiety and negatives including impaired body image and sexuality. The literature strongly suggests women want more information surrounding BPM, particularly related to the after effects of the surgery, and the impact on their psychological wellbeing. Research method limitations and reporting has resulted in conflicting conclusions, making it difficult for women to be well informed. In particular, there has been little focus on the experiences and needs of younger women opting for BPM. Due to the unique needs of younger women and an increase in BPM rates for younger women, it is imperative that the needs of this group are addressed. Together these findings provide justification and recommendation for further research in this area. CI - Copyright (c) 2016 Elsevier Ltd. All rights reserved. FAU - Glassey, Rachael AU - Glassey R AD - School of Surgery, The University of Western Australia, M507, 35 Stirling Highway, Crawley, Perth, WA, Australia. Electronic address: rachael.glassey@research.uwa.edu.au. FAU - Ives, Angela AU - Ives A AD - School of Surgery, The University of Western Australia, M507, 35 Stirling Highway, Crawley, Perth, WA, Australia. FAU - Saunders, Christobel AU - Saunders C AD - School of Surgery, The University of Western Australia, M507, 35 Stirling Highway, Crawley, Perth, WA, Australia. FAU - Musiello, Toni AU - Musiello T AD - School of Surgery, The University of Western Australia, M507, 35 Stirling Highway, Crawley, Perth, WA, Australia. LA - eng PT - Journal Article PT - Review DEP - 20160615 PL - Netherlands TA - Breast JT - Breast (Edinburgh, Scotland) JID - 9213011 SB - IM MH - Age Factors MH - Anxiety/etiology MH - Body Image MH - Breast Neoplasms/*prevention & control/*psychology/surgery MH - *Decision Making MH - Female MH - Genes, BRCA1 MH - Genes, BRCA2 MH - Genetic Testing MH - Humans MH - Patient Education as Topic MH - Patient Satisfaction MH - Prophylactic Mastectomy/*psychology MH - Sexuality OTO - NOTNLM OT - Anxiety OT - Body image OT - Familial cancer OT - Prophylactic mastectomy OT - Psychological wellbeing OT - Young women EDAT- 2016/06/19 06:00 MHDA- 2017/03/14 06:00 CRDT- 2016/06/19 06:00 PHST- 2016/02/02 [received] PHST- 2016/05/23 [revised] PHST- 2016/05/26 [accepted] AID - S0960-9776(16)30071-6 [pii] AID - 10.1016/j.breast.2016.05.012 [doi] PST - ppublish SO - Breast. 2016 Aug;28:130-5. doi: 10.1016/j.breast.2016.05.012. Epub 2016 Jun 15. PMID- 27290619 OWN - NLM STAT- MEDLINE DA - 20160712 DCOM- 20170313 LR - 20170313 IS - 1532-3080 (Electronic) IS - 0960-9776 (Linking) VI - 28 DP - 2016 Aug TI - Contralateral prophylactic mastectomy (CPM): A systematic review of patient reported factors and psychological predictors influencing choice and satisfaction. PG - 107-20 LID - 10.1016/j.breast.2016.04.005 [doi] LID - S0960-9776(16)30035-2 [pii] AB - OBJECTIVE: Conduct a systematic review of quantitative and qualitative studies exploring patient reported factors and psychological variables influencing the decision to have contralateral prophylactic mastectomy (CPM), and satisfaction with CPM, in women with early stage breast cancer. METHODS: Studies were identified via databases: Medline, CINAHL, Embase and PsycINFO. Data were extracted by one author and crosschecked by two additional authors for accuracy. The quality of included articles was assessed using standardised criteria by three authors. RESULTS: Of the 1346 unique citations identified, 17 were studies that met the inclusion criteria. Studies included were primarily cross-sectional and retrospective. No study utilised a theoretical framework to guide research and few studies considered psychological predictors of CPM. Fear of breast cancer was the most commonly cited reason for CPM, followed by cosmetic reasons such as desire for symmetry. Overall, women appeared satisfied with CPM, however, adverse/diminished body image, poor cosmetic result, complications, diminished sense of sexuality, emotional issues and perceived lack of education regarding alternative surveillance/CPM efficacy were cited as reasons for dissatisfaction. CONCLUSION: Current literature has begun to identify patient-reported reasons for CPM; however, the relative importance of different factors and how these factors relate to the process underlying the decision to have CPM are unknown. Of women who considered CPM, limited information is available regarding differences between those who proceed with or ultimately decline CPM. CI - Copyright (c) 2016 Elsevier Ltd. All rights reserved. FAU - Ager, Brittany AU - Ager B AD - School of Psychology, The University of Sydney, Australia. Electronic address: bage4508@uni.sydney.edu.au. FAU - Butow, Phyllis AU - Butow P AD - Centre for Medical Psychology and Evidence Based Decision-Making, The University of Sydney, Australia; Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Australia. FAU - Jansen, Jesse AU - Jansen J AD - Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Australia; Sydney Medical School, The University of Sydney, Australia. FAU - Phillips, Kelly-Anne AU - Phillips KA AD - Division of Cancer Medicine, Peter MacCallum Cancer Centre, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia. FAU - Porter, David AU - Porter D AD - Dept of Medical Oncology, Auckland Hospital, Auckland, New Zealand; Faculty of Medical and Health Sciences, The University of Auckland, New Zealand. CN - CPM DA Advisory Group LA - eng PT - Journal Article PT - Review DEP - 20160609 PL - Netherlands TA - Breast JT - Breast (Edinburgh, Scotland) JID - 9213011 SB - IM MH - Body Image/psychology MH - Breast Neoplasms/*prevention & control/*psychology/surgery MH - *Choice Behavior MH - Emotions MH - Fear MH - Female MH - Humans MH - Patient Education as Topic MH - *Patient Satisfaction MH - Prophylactic Mastectomy/adverse effects/*psychology MH - Sexuality/psychology OTO - NOTNLM OT - Contralateral prophylactic mastectomy OT - Patient attitudes OT - Systematic review EDAT- 2016/06/13 06:00 MHDA- 2017/03/14 06:00 CRDT- 2016/06/13 06:00 PHST- 2015/09/17 [received] PHST- 2016/03/19 [revised] PHST- 2016/04/12 [accepted] AID - S0960-9776(16)30035-2 [pii] AID - 10.1016/j.breast.2016.04.005 [doi] PST - ppublish SO - Breast. 2016 Aug;28:107-20. doi: 10.1016/j.breast.2016.04.005. Epub 2016 Jun 9. PMID- 27278271 OWN - NLM STAT- In-Process DA - 20160922 LR - 20170220 IS - 1433-7339 (Electronic) IS - 0941-4355 (Linking) VI - 24 IP - 11 DP - 2016 Nov TI - Qualitative assessment of information and decision support needs for managing menopausal symptoms after breast cancer. PG - 4567-75 LID - 10.1007/s00520-016-3296-x [doi] AB - PURPOSE: For breast cancer (BrCa) survivors, premature menopause can result from conventional cancer treatment. Due to limited treatment options, survivors often turn to complementary therapies (CTs), but struggle to make informed decisions. In this study, we identified BrCa survivors' CT and general information and decision-making needs related to menopausal symptoms. METHODS: The needs assessment was informed by interpretive descriptive methodology. Focus groups with survivors (n = 22) and interviews with conventional (n = 12) and CT (n = 5) healthcare professionals (HCPs) were conducted at two Canadian urban cancer centers. Thematic, inductive analysis was conducted on the data. RESULTS: Menopausal symptoms have significant negative impact on BrCa survivors. Close to 70 % of the sample were currently using CTs, including mind-body therapies (45.5 %), natural health products (NHPs) and dietary therapies (31.8 %), and lifestyle interventions (36.4 %). However, BrCa survivors reported inadequate access to information on the safety and efficacy of CT options. Survivors also struggled in their efforts to discuss CT with HCPs, who had limited time and information to support women in their CT decisions. Concise and credible information about CTs was required by BrCa survivors to support them in making informed and safe decisions about using CTs for menopausal symptom management. CONCLUSIONS: High quality research is needed on the efficacy and safety of CTs in managing menopausal symptoms following BrCa treatment. Decision support strategies, such as patient decision aids (DAs), may help synthesize and translate evidence on CTs and promote shared decision-making between BrCa survivors and HCPs about the role of CTs in coping with menopause following cancer treatment. FAU - Balneaves, Lynda G AU - Balneaves LG AD - Centre for Integrative Medicine, Leslie Dan Faculty of Pharmacy, 144 College St., Room 737, Toronto, ON, M5S 3M2, Canada. lynda.balneaves@utoronto.ca. AD - Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. lynda.balneaves@utoronto.ca. FAU - Panagiotoglou, Dimitra AU - Panagiotoglou D AD - School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada. FAU - Brazier, Alison S A AU - Brazier AS AD - School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada. FAU - Lambert, Leah K AU - Lambert LK AD - School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada. FAU - Porcino, Antony AU - Porcino A AD - Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. FAU - Forbes, Margaret AU - Forbes M AD - Juravinski Cancer Centre, Hamilton, Ontario, Canada. FAU - Van Patten, Cheri AU - Van Patten C AD - British Columbia Cancer Agency, Vancouver, British Columbia, Canada. FAU - Truant, Tracy L O AU - Truant TL AD - School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada. FAU - Seely, Dugald AU - Seely D AD - Ottawa Integrative Cancer Centre, Ottawa, Ontario, Canada. FAU - Stacey, Dawn AU - Stacey D AD - School of Nursing, University of Ottawa, Ottawa, Ontario, Canada. LA - eng PT - Journal Article DEP - 20160608 PL - Germany TA - Support Care Cancer JT - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer JID - 9302957 SB - IM PMC - PMC5031723 OTO - NOTNLM OT - Breast cancer OT - Complementary therapy OT - Decision support OT - Information needs OT - Menopause EDAT- 2016/06/10 06:00 MHDA- 2016/06/10 06:00 CRDT- 2016/06/10 06:00 PHST- 2016/01/24 [received] PHST- 2016/05/30 [accepted] AID - 10.1007/s00520-016-3296-x [doi] AID - 10.1007/s00520-016-3296-x [pii] PST - ppublish SO - Support Care Cancer. 2016 Nov;24(11):4567-75. doi: 10.1007/s00520-016-3296-x. Epub 2016 Jun 8. PMID- 27251058 OWN - NLM STAT- In-Process DA - 20160917 LR - 20170224 IS - 1525-1497 (Electronic) IS - 0884-8734 (Linking) VI - 31 IP - 10 DP - 2016 Oct TI - Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice. PG - 1148-55 LID - 10.1007/s11606-016-3726-y [doi] AB - BACKGROUND: Despite substantial resources devoted to cancer screening nationally, the availability of clinical practice-based systems to support screening guidelines is not known. OBJECTIVE: To characterize the prevalence and correlates of practice-based systems to support breast and cervical cancer screening, with a focus on the patient-centered medical home (PCMH). DESIGN: Web and mail survey of primary care providers conducted in 2014. The survey assessed provider (gender, training) and facility (size, specialty training, physician report of National Committee for Quality Assurance (NCQA) PCMH recognition, and practice affiliation) characteristics. A hierarchical multivariate analysis clustered by clinical practice was conducted to evaluate characteristics associated with the adoption of practice-based systems and technology to support guideline-adherent screening. PARTICIPANTS: Primary care physicians in family medicine, general internal medicine, and obstetrics and gynecology, and nurse practitioners or physician assistants from four clinical care networks affiliated with PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium research centers. MAIN MEASURES: The prevalence of routine breast cancer risk assessment, electronic health record (EHR) decision support, comparative performance reports, and panel reports of patients due for routine screening and follow-up. KEY RESULTS: There were 385 participants (57.6 % of eligible). Forty-seven percent (47.0 %) of providers reported NCQA recognition as a PCMH. Less than half reported EHR decision support for breast (48.8 %) or cervical cancer (46.2 %) screening. A minority received comparative performance reports for breast (26.2 %) or cervical (19.7 %) cancer screening, automated reports of patients overdue for breast (18.7 %) or cervical (16.4 %) cancer screening, or follow-up of abnormal breast (18.1 %) or cervical (17.6 %) cancer screening tests. In multivariate analysis, reported NCQA recognition as a PCMH was associated with greater use of comparative performance reports of guideline-adherent breast (OR 3.23, 95 % CI 1.58-6.61) or cervical (OR 2.56, 95 % CI 1.32-4.96) cancer screening and automated reports of patients overdue for breast (OR 2.19, 95 % CI 1.15-41.7) or cervical (OR. 2.56, 95 % CI 1.26-5.26) cancer screening. CONCLUSIONS: Providers lack systems to support breast and cervical cancer screening. Practice transformation toward a PCMH may support the adoption of systems to achieve guideline-adherent cancer screening in primary care settings. FAU - Schapira, Marilyn M AU - Schapira MM AD - University of Pennsylvania and the Philadelphia VA Medical Center, 1110 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA. mschap@upenn.edu. FAU - Sprague, Brian L AU - Sprague BL AD - University of Vermont, Burlington, VT, USA. FAU - Klabunde, Carrie N AU - Klabunde CN AD - Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD, USA. FAU - Tosteson, Anna N A AU - Tosteson AN AD - Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA. FAU - Bitton, Asaf AU - Bitton A AD - Harvard Medical School, Boston, MA, USA. AD - Brigham and Women's Hospital, Boston, MA, USA. FAU - Chen, Jane S AU - Chen JS AD - Brigham and Women's Hospital, Boston, MA, USA. FAU - Beaber, Elisabeth F AU - Beaber EF AD - Fred Hutchinson Cancer Research Center, Seattle, WA, USA. FAU - Onega, Tracy AU - Onega T AD - Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA. FAU - MacLean, Charles D AU - MacLean CD AD - University of Vermont, Burlington, VT, USA. FAU - Harris, Kimberly AU - Harris K AD - Brigham and Women's Hospital, Boston, MA, USA. FAU - Howe, Kathleen AU - Howe K AD - University of Vermont, Burlington, VT, USA. FAU - Pearson, Loretta AU - Pearson L AD - Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA. FAU - Feldman, Sarah AU - Feldman S AD - Harvard Medical School, Boston, MA, USA. AD - Brigham and Women's Hospital, Boston, MA, USA. FAU - Brawarsky, Phyllis AU - Brawarsky P AD - Brigham and Women's Hospital, Boston, MA, USA. FAU - Haas, Jennifer S AU - Haas JS AD - Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital, Boston, MA, USA. CN - PROSPR consortium LA - eng GR - U54 CA163313/CA/NCI NIH HHS/United States GR - U54 CA163307/CA/NCI NIH HHS/United States GR - U54 CA163303/CA/NCI NIH HHS/United States GR - P30 CA023108/CA/NCI NIH HHS/United States GR - U01 CA163304/CA/NCI NIH HHS/United States PT - Journal Article DEP - 20160601 PL - United States TA - J Gen Intern Med JT - Journal of general internal medicine JID - 8605834 SB - IM PMC - PMC5023599 OID - NLM: PMC5023599 [Available on 10/01/17] OTO - NOTNLM OT - breast cancer screening OT - cervical cancer screening OT - patient-centered medical home COI - The authors declare that they do not have a conflict of interest. Funders This study was conducted as part of the National Cancer Institute-funded consortium, Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) (grant numbers U54 CA163307, U54CA 163313, U54 CA163303, U01CA163304). A list of PROSPR investigators and contributing research staff is provided at: http://healthcaredelivery.cancer.gov/prospr/ EDAT- 2016/06/03 06:00 MHDA- 2016/06/03 06:00 CRDT- 2016/06/03 06:00 PMCR- 2017/10/01 PHST- 2015/12/07 [received] PHST- 2016/04/22 [accepted] PHST- 2016/03/25 [revised] AID - 10.1007/s11606-016-3726-y [doi] AID - 10.1007/s11606-016-3726-y [pii] PST - ppublish SO - J Gen Intern Med. 2016 Oct;31(10):1148-55. doi: 10.1007/s11606-016-3726-y. Epub 2016 Jun 1. PMID- 27215718 OWN - NLM STAT- MEDLINE DA - 20160524 DCOM- 20170124 LR - 20170124 IS - 1555-9823 (Electronic) IS - 0003-1348 (Linking) VI - 82 IP - 5 DP - 2016 May TI - Decision-Making in Breast Cancer Surgery: Where Do Patients Go for Information? PG - 397-402 AB - Patient decision-making regarding breast cancer surgery is multifactorial, and patients derive information on surgical treatment options from a variety of sources which may have an impact on choice of surgery. We investigated the role of different information sources in patient decision-making regarding breast cancer surgery. Two hundred and sixty-eight patients with breast cancer, eligible for breast-conserving therapy were surveyed in the immediate preoperative period, and clinical data were also collected. This survey evaluated the scope and features of patient-driven research regarding their ultimate choice of surgical treatment. The two most common sources of information used by patients were written material from surgeons (199/268-74%) and the Internet (184/268-69%). There was a trend for women who chose bilateral mastectomy to use the Internet more frequently than those choosing unilateral mastectomy (P = 0.056). Number of surgeons consulted, genetic testing, and MRI were significant predictors of patient choice of mastectomy over breast-conserving therapy. Multivariate analysis showed that the number of surgeons consulted (P < 0.001) and genetic testing (P < 0.001) were independent predictors of choosing mastectomy, whereas MRI was not. In conclusions, understanding factors driving patient decision-making may promote more effective education for patients requiring breast cancer surgery. FAU - Schmidt, Hank AU - Schmidt H AD - Department of Surgery, Dubin Breast Center/Mount Sinai Medical Center, New York, New York, USA. FAU - Cohen, Almog AU - Cohen A FAU - Mandeli, John AU - Mandeli J FAU - Weltz, Christina AU - Weltz C FAU - Port, Elisa R AU - Port ER LA - eng PT - Journal Article PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/*diagnosis/*surgery MH - Cohort Studies MH - *Decision Making MH - Female MH - Health Information Exchange MH - Humans MH - Mastectomy/*methods MH - Medical Informatics/*organization & administration MH - Middle Aged MH - Patient Education as Topic/organization & administration MH - *Surveys and Questionnaires MH - United States EDAT- 2016/05/25 06:00 MHDA- 2017/01/25 06:00 CRDT- 2016/05/25 06:00 PST - ppublish SO - Am Surg. 2016 May;82(5):397-402. PMID- 27207563 OWN - NLM STAT- PubMed-not-MEDLINE DA - 20160521 DCOM- 20160521 LR - 20170220 IS - 1929-0748 (Print) IS - 1929-0748 (Linking) VI - 5 IP - 2 DP - 2016 May 20 TI - A Decision Aid for Women Considering Neoadjuvant Systemic Therapy for Operable Invasive Breast Cancer: Development and Protocol of a Phase II Evaluation Study (ANZ1301 DOMINO). PG - e88 LID - 10.2196/resprot.5641 [doi] AB - BACKGROUND: Neoadjuvant systemic therapy is offered to selected women with large and/or highly proliferative operable breast cancers. This option adds further complexity to an already complex breast cancer treatment decision tree. Patient decision aids are an established method of increasing patient involvement and knowledge while decreasing decisional conflict. There is currently no decision aid available for women considering neoadjuvant systemic therapy. OBJECTIVE: We aimed to develop a decision aid for women diagnosed with operable breast cancer and considered suitable for neoadjuvant systemic therapy, and the protocol for a multicenter pre-post study evaluating the acceptability and feasibility of the decision aid. METHODS: The decision aid was developed through literature review, expert advisory panel, adherence to the International Patient Decision Aid Standards, and iterative review. The protocol for evaluation of the decision aid consists of the following: eligible women will undertake a series of questionnaires prior to and after using the decision aid. The primary endpoint is decision aid acceptability to patients and investigators and the feasibility of use. Secondary endpoints include change in decisional conflict, participant knowledge, and information involvement preference. Feasibility is defined as the proportion of eligible participants who use the decision aid to help inform their treatment decision. RESULTS: This study has recruited 29 out of a planned 50 participants at four Australian sites. A 12-month recruitment period is expected with a further 12-months follow-up. CONCLUSIONS: The decision aid has the potential to allow patients with operable breast cancer, who have been offered neoadjuvant systemic therapy, decreased decisional conflict, and greater involvement in the decision. If this study finds that an online decision aid is feasible and acceptable, it will be made widely available for routine clinical practice. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12614001267640; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12614001267640&isBasic=T rue (Archived by WebCite at http://www.webcitation.org/6gh7BPZdG). FAU - Zdenkowski, Nicholas AU - Zdenkowski N AUID- ORCID: http://orcid.org/0000-0001-8738-8463 AD - Northern Clinical School, Faculty of Medicine, University of Sydney, North Sydney, Australia. nick.zdenkowski@newcastle.edu.au. FAU - Butow, Phyllis AU - Butow P AUID- ORCID: http://orcid.org/0000-0003-3562-6954 FAU - Hutchings, Elizabeth AU - Hutchings E AUID- ORCID: http://orcid.org/0000-0002-6030-954X FAU - Douglas, Charles AU - Douglas C AUID- ORCID: http://orcid.org/0000-0001-7952-068X FAU - Coll, Joseph R AU - Coll JR AUID- ORCID: http://orcid.org/0000-0002-8928-0656 FAU - Boyle, Frances M AU - Boyle FM AUID- ORCID: http://orcid.org/0000-0003-3798-1570 LA - eng PT - Journal Article DEP - 20160520 PL - Canada TA - JMIR Res Protoc JT - JMIR research protocols JID - 101599504 PMC - PMC4893151 OID - NLM: PMC4893151 OTO - NOTNLM OT - breast neoplasm OT - chemotherapy OT - decision aid OT - neoadjuvant OT - protocol EDAT- 2016/05/22 06:00 MHDA- 2016/05/22 06:01 CRDT- 2016/05/22 06:00 PHST- 2016/02/16 [received] PHST- 2016/03/30 [accepted] PHST- 2016/03/30 [revised] AID - v5i2e88 [pii] AID - 10.2196/resprot.5641 [doi] PST - epublish SO - JMIR Res Protoc. 2016 May 20;5(2):e88. doi: 10.2196/resprot.5641. PMID- 27070681 OWN - NLM STAT- MEDLINE DA - 20160415 DCOM- 20170106 LR - 20170107 IS - 1536-3708 (Electronic) IS - 0148-7043 (Linking) VI - 76 Suppl 3 DP - 2016 May TI - Effects of A Novel Decision Aid for Breast Reconstruction: A Randomized Prospective Trial. PG - S249-54 LID - 10.1097/SAP.0000000000000722 [doi] AB - INTRODUCTION: The choice to undergo mastectomy and breast reconstruction is a highly personal decision with profound psychosocial effects, and ultimately, the decision between implant- and autologous tissue-based reconstruction should be made based on a combination of factual information and the patient's personal values and preferences. Unfortunately, patients undergoing breast reconstruction surgery may experience decision regret. Decision aids promote patient involvement in decision making by not only providing standard information about options, but also emphasizing comparative risks, benefits, and alternatives, and most importantly by providing clarification exercises regarding personal values to guide patients toward an individualized decision. METHODS: We developed a novel decision aid to provide decision support and structured guidance for prosthetic, autologous, and combined prosthetic-autologous breast reconstruction surgery. New breast reconstruction patients of one surgeon at our institution were randomized by week to either receive the decision aid or standard preconsultation material. Immediately preceding their new patient consultation clinic visit, patients were asked to complete the validated Decisional Conflict Scale and the BREAST-Q Preoperative survey. After 3 to 5 months following breast mound reconstruction, patients were asked to complete the Decision Regret Scale, BREAST-Q Postoperative survey, and the Hospital Anxiety and Depression Scale. RESULTS: Patients who received the decision aid demonstrated a trend toward decreased preoperative decisional conflict (mean of 13.3 +/- 5.5, compared to 26.2 +/- 4.2; n = 8 per group, P = 0.069), with similar preoperative BREAST-Q scores. Most patients desired to know "everything" regarding their reconstruction surgery (75%), and to be "very involved" in the decisions in their care (81%), with remaining patients wanting to know "as much as I need to be prepared" and to be "somewhat involved." Postoperatively, patients who received the decision aid demonstrated significantly less decision regret (P < 0.001), although there was no significant difference in anxiety, depression, or quality of life-related outcomes as measured by the BREAST-Q. CONCLUSIONS: The use of decision aids in breast reconstruction surgery may help decrease decisional conflict and regret through promoting improved information sharing and shared decision making, which are highly important in this particular setting, patient population, and in our move toward greater patient-centered care. FAU - Luan, Anna AU - Luan A AD - From the *Division of Plastic Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA; and daggerDivision of Plastic and Reconstructive Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. FAU - Hui, Kenneth J AU - Hui KJ FAU - Remington, Austin C AU - Remington AC FAU - Liu, Xiangxia AU - Liu X FAU - Lee, Gordon K AU - Lee GK LA - eng PT - Journal Article PT - Randomized Controlled Trial PL - United States TA - Ann Plast Surg JT - Annals of plastic surgery JID - 7805336 SB - IM MH - Adult MH - *Decision Support Techniques MH - Female MH - Follow-Up Studies MH - Humans MH - Mammaplasty/methods/*psychology MH - Mastectomy/*psychology MH - Middle Aged MH - Outcome and Process Assessment (Health Care) MH - Patient Participation/*methods/psychology MH - Patient Satisfaction/*statistics & numerical data MH - Patient-Centered Care/*methods MH - Prospective Studies EDAT- 2016/04/14 06:00 MHDA- 2017/01/07 06:00 CRDT- 2016/04/13 06:00 AID - 10.1097/SAP.0000000000000722 [doi] PST - ppublish SO - Ann Plast Surg. 2016 May;76 Suppl 3:S249-54. doi: 10.1097/SAP.0000000000000722. PMID- 27066455 OWN - NLM STAT- PubMed-not-MEDLINE DA - 20160412 DCOM- 20160412 LR - 20170220 IS - 2234-943X (Print) IS - 2234-943X (Linking) VI - 6 DP - 2016 TI - Decision-Making in the Surgical Treatment of Breast Cancer: Factors Influencing Women's Choices for Mastectomy and Breast Conserving Surgery. PG - 74 LID - 10.3389/fonc.2016.00074 [doi] AB - One of the most difficult decisions a woman can be faced with when choosing breast cancer treatment is whether or not to undergo breast conserving surgery or mastectomy. The factors that influence these treatment decisions are complex and involve issues regarding access to health care, concerns for cancer recurrence, and the impact of surgery on body image and sexuality. Understanding these factors will help practitioners to improve patient education and to better guide patients through this decision-making process. Although significant scientific and societal advances have been made in improving women's choices for the breast cancer treatment, there are still deficits in the decision-making processes surrounding the surgical treatment of breast cancer. Further research is needed to define optimal patient education and shared decision-making practices in this area. FAU - Bellavance, Emily Catherine AU - Bellavance EC AD - Department of General and Oncologic Surgery, University of Maryland , Baltimore, MD , USA. FAU - Kesmodel, Susan Beth AU - Kesmodel SB AD - Department of General and Oncologic Surgery, University of Maryland , Baltimore, MD , USA. LA - eng PT - Journal Article PT - Review DEP - 20160329 PL - Switzerland TA - Front Oncol JT - Frontiers in oncology JID - 101568867 PMC - PMC4810034 OID - NLM: PMC4810034 OTO - NOTNLM OT - breast cancer OT - breast conserving surgery OT - contralateral prophylactic mastectomy OT - mastectomy OT - shared decision-making EDAT- 2016/04/12 06:00 MHDA- 2016/04/12 06:01 CRDT- 2016/04/12 06:00 PHST- 2016/01/11 [received] PHST- 2016/03/14 [accepted] AID - 10.3389/fonc.2016.00074 [doi] PST - epublish SO - Front Oncol. 2016 Mar 29;6:74. doi: 10.3389/fonc.2016.00074. eCollection 2016. PMID- 27017240 OWN - NLM STAT- MEDLINE DA - 20160328 DCOM- 20170104 LR - 20170105 IS - 1532-3080 (Electronic) IS - 0960-9776 (Linking) VI - 26 DP - 2016 Apr TI - A systematic review of decision aids for patients making a decision about treatment for early breast cancer. PG - 31-45 LID - 10.1016/j.breast.2015.12.007 [doi] LID - S0960-9776(15)00265-9 [pii] AB - Several complex treatment decisions may be offered to women with early stage breast cancer, about a range of treatments from different modalities including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids can facilitate shared decision-making and improve decision-related outcomes. We aimed to systematically identify, describe and appraise the literature on treatment decision aids for women with early breast cancer, synthesise the data and identify breast cancer decisions that lack a decision aid. A prospectively developed search strategy was applied to MEDLINE, the Cochrane databases, EMBASE, PsycINFO, Web of Science and abstract databases from major conferences. Data were extracted into a pre-piloted form. Quality and risk of bias were measured using Qualsyst criteria. Results were synthesised into narrative format. Thirty-three eligible articles were identified, evaluating 23 individual treatment decision aids, comprising 13 randomised controlled trial reports, seven non-randomised comparative studies, eight single-arm pre-post studies and five cross-sectional studies. The decisions addressed by these decision aids were: breast conserving surgery versus mastectomy (+/- reconstruction); use of chemotherapy and/or endocrine therapy; radiotherapy; and fertility preservation. Outcome measures were heterogeneous, precluding meta-analysis. Decisional conflict decreased, and knowledge and satisfaction increased, without any change in anxiety or depression, in most studies. No studies were identified that evaluated decision aids for neoadjuvant systemic therapy, or contralateral prophylactic mastectomy. Decision aids are available and improved decision-related outcomes for many breast cancer treatment decisions including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids for neoadjuvant systemic therapy and contralateral prophylactic mastectomy could not be found, and may be warranted. CI - Copyright (c) 2015 Elsevier Ltd. All rights reserved. FAU - Nicholas Zdenkowski AU - Nicholas Zdenkowski AD - Faculty of Medicine, University of Sydney, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia. Electronic address: nicholas.zdenkowski@anzbctg.org. FAU - Butow, Phyllis AU - Butow P AD - Psycho-oncology Co-operative Research Group (PoCoG) and Centre for Medical Psychology and Evidence-based Medicine (CeMPED), School of Psychology, University of Sydney, NSW, Australia. FAU - Tesson, Stephanie AU - Tesson S AD - Psycho-oncology Co-operative Research Group (PoCoG) and Centre for Medical Psychology and Evidence-based Medicine (CeMPED), School of Psychology, University of Sydney, NSW, Australia. FAU - Boyle, Frances AU - Boyle F AD - Faculty of Medicine, University of Sydney, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia; Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, Sydney, NSW, Australia. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20160108 PL - Netherlands TA - Breast JT - Breast (Edinburgh, Scotland) JID - 9213011 SB - IM MH - Breast Neoplasms/pathology/*psychology/*therapy MH - Cross-Sectional Studies MH - *Decision Making MH - *Decision Support Techniques MH - Drug Therapy/psychology MH - Early Detection of Cancer/*psychology MH - Female MH - Fertility Preservation/psychology MH - Humans MH - Mastectomy/psychology MH - Mastectomy, Segmental/psychology MH - Radiotherapy/psychology MH - Randomized Controlled Trials as Topic OTO - NOTNLM OT - Breast neoplasms OT - Chemotherapy OT - Decision aid OT - Decision making OT - Systematic review OT - Treatment EDAT- 2016/03/29 06:00 MHDA- 2017/01/05 06:00 CRDT- 2016/03/28 06:00 PHST- 2015/07/08 [received] PHST- 2015/12/12 [revised] PHST- 2015/12/15 [accepted] AID - S0960-9776(15)00265-9 [pii] AID - 10.1016/j.breast.2015.12.007 [doi] PST - ppublish SO - Breast. 2016 Apr;26:31-45. doi: 10.1016/j.breast.2015.12.007. Epub 2016 Jan 8. PMID- 26941952 OWN - NLM STAT- PubMed-not-MEDLINE DA - 20160304 DCOM- 20160304 LR - 20170221 IS - 2047-0525 (Print) IS - 2047-0525 (Linking) VI - 5 DP - 2016 TI - Anticipated regret in shared decision-making: a randomized experimental study. PG - 5 LID - 10.1186/s13741-016-0031-6 [doi] AB - BACKGROUND: Explicit consideration of anticipated regret is not part of the standard shared decision-making protocols. This pilot study aimed to compare decisions about a hypothetical surgery for breast cancer and examined whether regret is a consideration in treatment decisions. METHODS: In this randomized experimental study, 184 healthy female volunteers were randomized to receive a standard decision aid (control) or one with information on post-surgical regret (experimental). The main outcome measures were the proportion of subjects choosing lumpectomy vs. mastectomy and the proportion reporting that regret played a role in the decision made. We hypothesized that a greater proportion of the experimental group (regret-incorporated decision aid) would make a surgical treatment preference that favored the less regret-inducing option and that they would be more likely to consider regret in their decision-making process as compared to the control group. RESULTS: A significantly greater proportion of the experimental group subjects reported regret played a role in their decision-making process compared to the control counterparts (78 vs. 65 %; p = 0.039). Recipients of the regret-incorporated experimental decision aid had a threefold increased odds of choosing the less regret-inducing surgery (OR = 2.97; 95 % CI = 1.25, 7.09; p value = 0.014). CONCLUSIONS: In this hypothetical context, the incorporation of regret in a decision aid for preference-sensitive surgery impacted decision-making. This finding suggests that keying in on anticipated regret may be an important element of shared decision-making strategies. Our results make a strong argument for applying this design and pursuing further research in a surgical patient population. TRIAL REGISTRATION: Clinicaltrials.gov, NCT02563808. FAU - Speck, Rebecca M AU - Speck RM AD - Department of Anesthesiology and Critical Care, Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, 3400 Spruce Street, Dulles 6, Philadelphia, PA 19104 USA ; Evidera, 1417 4th Ave., Suite 510, Seattle, WA 98101 USA. FAU - Neuman, Mark D AU - Neuman MD AD - Department of Anesthesiology and Critical Care, Leonard Davis Institute, University of Pennsylvania, 3400 Spruce Street, Dulles 6, Philadelphia, PA 19104 USA. FAU - Resnick, Kimberly S AU - Resnick KS AD - Department of Psychiatry, University of Pennsylvania, 3535 Market St, Philadelphia, PA 19104 USA. FAU - Mellers, Barbara A AU - Mellers BA AD - Department of Psychology, Department of Marketing, University of Pennsylvania, 3720 Walnut St, Philadelphia, PA 19104 USA. FAU - Fleisher, Lee A AU - Fleisher LA AD - Department of Anesthesiology and Critical Care, Center for Pharmacoepidemiology Research and Training, Leonard Davis Institute, University of Pennsylvania, 3400 Spruce Street, Dulles 6, Philadelphia, PA 19104 USA. LA - eng SI - ClinicalTrials.gov/NCT02563808 PT - Journal Article DEP - 20160302 PL - England TA - Perioper Med (Lond) JT - Perioperative medicine (London, England) JID - 101609072 PMC - PMC4776353 OID - NLM: PMC4776353 OTO - NOTNLM OT - Anticipated regret OT - Breast cancer OT - Decision-making OT - Surgery EDAT- 2016/03/05 06:00 MHDA- 2016/03/05 06:01 CRDT- 2016/03/05 06:00 PHST- 2015/09/30 [received] PHST- 2016/02/17 [accepted] AID - 10.1186/s13741-016-0031-6 [doi] AID - 31 [pii] PST - epublish SO - Perioper Med (Lond). 2016 Mar 2;5:5. doi: 10.1186/s13741-016-0031-6. eCollection 2016. PMID- 26883201 OWN - NLM STAT- In-Process DA - 20160506 LR - 20170220 IS - 1949-2553 (Electronic) IS - 1949-2553 (Linking) VI - 7 IP - 11 DP - 2016 Mar 15 TI - Decision aid on breast cancer screening reduces attendance rate: results of a large-scale, randomized, controlled study by the DECIDEO group. PG - 12885-92 LID - 10.18632/oncotarget.7332 [doi] AB - Controversies regarding the benefits of breast cancer screening programs have led to the promotion of new strategies taking into account individual preferences, such as decision aid. The aim of this study was to assess the impact of a decision aid leaflet on the participation of women invited to participate in a national breast cancer screening program. This Randomized, multicentre, controlled trial. Women aged 50 to 74 years, were randomly assigned to receive either a decision aid or the usual invitation letter. Primary outcome was the participation rate 12 months after the invitation. 16 000 women were randomized and 15 844 included in the modified intention-to-treat analysis. The participation rate in the intervention group was 40.25% (3174/7885 women) compared with 42.13% (3353/7959) in the control group (p = 0.02). Previous attendance for screening (RR = 6.24; [95%IC: 5.75-6.77]; p < 0.0001) and medium household income (RR = 1.05; [95%IC: 1.01-1.09]; p = 0.0074) were independently associated with attendance for screening. This large-scale study demonstrates that the decision aid reduced the participation rate. The decision aid activate the decision making process of women toward non-attendance to screening. These results show the importance of promoting informed patient choices, especially when those choices cannot be anticipated. FAU - Bourmaud, Aurelie AU - Bourmaud A AD - Hygee Centre, Lucien Neuwirth Cancer Institut, CIC-EC Inserm 1408, Saint Priest en Jarez, France. AD - EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France. FAU - Soler-Michel, Patricia AU - Soler-Michel P AD - Ademas-69, Association pour le Depistage Organise des Cancers dans le Rhone, Lyon, France. FAU - Oriol, Mathieu AU - Oriol M AD - Hygee Centre, Lucien Neuwirth Cancer Institut, CIC-EC Inserm 1408, Saint Priest en Jarez, France. AD - Jean Monnet University, Saint-Etienne, France. FAU - Regnier, Veronique AU - Regnier V AD - Hygee Centre, Lucien Neuwirth Cancer Institut, CIC-EC Inserm 1408, Saint Priest en Jarez, France. FAU - Tinquaut, Fabien AU - Tinquaut F AD - Hygee Centre, Lucien Neuwirth Cancer Institut, CIC-EC Inserm 1408, Saint Priest en Jarez, France. FAU - Nourissat, Alice AU - Nourissat A AD - Hygee Centre, Lucien Neuwirth Cancer Institut, CIC-EC Inserm 1408, Saint Priest en Jarez, France. FAU - Bremond, Alain AU - Bremond A AD - Jean Monnet University, Saint-Etienne, France. FAU - Moumjid, Nora AU - Moumjid N AD - Lyon 1 University, Lyon, France. AD - GATE-LSE UMR 5824 CNRS, Lyon, France. AD - Leon Berard Cancer Centre, Lyon, France. FAU - Chauvin, Franck AU - Chauvin F AD - Hygee Centre, Lucien Neuwirth Cancer Institut, CIC-EC Inserm 1408, Saint Priest en Jarez, France. AD - EMR3738, Therapeutic Targeting in Oncology, Claude Bernard University, Lyon, France. AD - Jean Monnet University, Saint-Etienne, France. LA - eng PT - Journal Article PL - United States TA - Oncotarget JT - Oncotarget JID - 101532965 SB - IM PMC - PMC4914328 OID - NLM: PMC4914328 OTO - NOTNLM OT - breast cancer screening OT - decision aid OT - decision making patient education OT - informed decision OT - randomized control trial EDAT- 2016/02/18 06:00 MHDA- 2016/02/18 06:00 CRDT- 2016/02/18 06:00 PHST- 2015/10/30 [received] PHST- 2016/01/27 [accepted] AID - 7332 [pii] AID - 10.18632/oncotarget.7332 [doi] PST - ppublish SO - Oncotarget. 2016 Mar 15;7(11):12885-92. doi: 10.18632/oncotarget.7332. PMID- 26801410 OWN - NLM STAT- MEDLINE DA - 20160123 DCOM- 20161011 LR - 20161230 IS - 1532-3080 (Electronic) IS - 0960-9776 (Linking) VI - 25 DP - 2016 Feb TI - Information requirements of young women with breast cancer treated with mastectomy or breast conserving surgery: A systematic review. PG - 1-13 LID - 10.1016/j.breast.2015.11.001 [doi] LID - S0960-9776(15)00251-9 [pii] AB - OBJECTIVES: Young women with breast cancer have poorer prognosis, greater lifetime risk of local recurrence, contralateral recurrence, and distant disease, regardless of surgery received. Here we systematically review published evidence relating to the information requirements and preferences of young women diagnosed with early-stage breast cancer offered a choice between mastectomy and Breast Conservation Surgery (BCS). Findings will inform the development of a surgical decision aid for young women. METHODS: Eight databases were searched to identify research examining information requirements of young women facing breast oncological surgery treatment decisions (MESH headings). Twelve studies met the inclusion criteria. Data were extracted and summarised in a narrative synthesis. RESULTS: Findings indicate that young women prefer greater and more detailed information regarding treatment side effects, sexuality, and body image. Younger age of diagnosis leads to an increased risk perception of developing a second breast cancer. Young women's choices are influenced by factors associated with family and career. Information is required in a continuum throughout the treatment experience and not only at diagnosis when treatment decisions are made. Young women show differing levels of participation preferences. CONCLUSION: Young women find decision-making challenging when the characteristics of diagnosis provide a surgical choice between mastectomy and breast conservation surgery. Efforts should be made to provide information regarding sexuality, body image, reconstruction, fertility and likelihood of familial predisposition. Further research is needed to identify the specific level and information requirements of this young-onset group. The low number of studies indicate a need to design studies targeting specifically this age group of breast cancer patients. CI - Copyright (c) 2015 Elsevier Ltd. All rights reserved. FAU - Recio-Saucedo, Alejandra AU - Recio-Saucedo A AD - University of Southampton, Faculty of Health Sciences, Southampton SO17 1BJ, UK. Electronic address: A.Recio-Saucedo@soton.ac.uk. FAU - Gerty, Sue AU - Gerty S AD - Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton Foundation Trust, Tremona Road, Southampton SO16 6YA, UK. FAU - Foster, Claire AU - Foster C AD - University of Southampton, Faculty of Health Sciences, Southampton SO17 1BJ, UK. FAU - Eccles, Diana AU - Eccles D AD - Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton Foundation Trust, Tremona Road, Southampton SO16 6YA, UK. FAU - Cutress, Ramsey I AU - Cutress RI AD - Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton Foundation Trust, Tremona Road, Southampton SO16 6YA, UK. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20151130 PL - Netherlands TA - Breast JT - Breast (Edinburgh, Scotland) JID - 9213011 SB - IM MH - Adult MH - Age Factors MH - Age of Onset MH - Body Image MH - Breast Neoplasms/*psychology/surgery MH - Choice Behavior MH - *Decision Making MH - Female MH - Humans MH - *Information Seeking Behavior MH - Mastectomy/*psychology MH - Mastectomy, Segmental/*psychology MH - *Needs Assessment MH - Risk Assessment MH - Young Adult OTO - NOTNLM OT - Breast cancer OT - Decision-making OT - Surgery OT - Young women EDAT- 2016/01/24 06:00 MHDA- 2016/10/12 06:00 CRDT- 2016/01/24 06:00 PHST- 2014/10/06 [received] PHST- 2015/04/28 [revised] PHST- 2015/11/01 [accepted] AID - S0960-9776(15)00251-9 [pii] AID - 10.1016/j.breast.2015.11.001 [doi] PST - ppublish SO - Breast. 2016 Feb;25:1-13. doi: 10.1016/j.breast.2015.11.001. Epub 2015 Nov 30. PMID- 26601873 OWN - NLM STAT- MEDLINE DA - 20160106 DCOM- 20160505 LR - 20160106 IS - 1878-0539 (Electronic) IS - 1748-6815 (Linking) VI - 69 IP - 1 DP - 2016 Jan TI - Potential costs of breast augmentation mammaplasty. PG - 55-60 LID - 10.1016/j.bjps.2015.09.012 [doi] LID - S1748-6815(15)00445-3 [pii] AB - BACKGROUND: Augmentation mammaplasty is one of the most common surgical procedures performed by plastic surgeons. The aim of this study was to estimate the cost of the initial procedure and its subsequent complications, as well as project the cost of Food and Drug Administration (FDA)-recommended surveillance imaging. METHODS: The potential costs to the individual patient and society were calculated. Local plastic surgeons provided billing data for the initial primary silicone augmentation and reoperative procedures. Complication rates used for the cost analysis were obtained from the Allergen Core study on silicone implants. Imaging surveillance costs were considered in the estimations. RESULTS: The average baseline initial cost of silicone augmentation mammaplasty was calculated at $6335. The average total cost of primary breast augmentation over the first decade for an individual patient, including complications requiring reoperation and other ancillary costs, was calculated at $8226. Each decade thereafter cost an additional $1891. Costs may exceed $15,000 over an averaged lifetime, and the recommended implant surveillance could cost an additional $33,750. DISCUSSION: The potential cost of a breast augmentation, which includes the costs of complications and imaging, is significantly higher than the initial cost of the procedure. LEVEL OF EVIDENCE: Level III, economic and decision analysis study. CI - Copyright (c) 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. FAU - Schmitt, William P AU - Schmitt WP AD - Division of Plastic and Reconstructive Surgery, Grand Rapids Medical Education Partners/Michigan State University, 221 Michigan St. NE, Suite 200-A, Grand Rapids, MI 49503, USA. Electronic address: William.schmitt@grmep.com. FAU - Eichhorn, Mitchell G AU - Eichhorn MG AD - Division of Plastic and Reconstructive Surgery, Grand Rapids Medical Education Partners/Michigan State University, 221 Michigan St. NE, Suite 200-A, Grand Rapids, MI 49503, USA. FAU - Ford, Ronald D AU - Ford RD AD - Division of Plastic and Reconstructive Surgery, Grand Rapids Medical Education Partners/Michigan State University, 221 Michigan St. NE, Suite 200-A, Grand Rapids, MI 49503, USA. LA - eng PT - Journal Article DEP - 20151023 PL - Netherlands TA - J Plast Reconstr Aesthet Surg JT - Journal of plastic, reconstructive & aesthetic surgery : JPRAS JID - 101264239 SB - IM MH - Breast Implants/*economics MH - Costs and Cost Analysis MH - Female MH - Follow-Up Studies MH - Health Expenditures/*trends MH - Humans MH - Mammaplasty/*economics/methods MH - Middle Aged MH - Retrospective Studies MH - United States OTO - NOTNLM OT - Analysis OT - Augmentation OT - Breast OT - Costs OT - Lifetime EDAT- 2015/11/26 06:00 MHDA- 2016/05/06 06:00 CRDT- 2015/11/26 06:00 PHST- 2015/05/19 [received] PHST- 2015/09/21 [accepted] AID - S1748-6815(15)00445-3 [pii] AID - 10.1016/j.bjps.2015.09.012 [doi] PST - ppublish SO - J Plast Reconstr Aesthet Surg. 2016 Jan;69(1):55-60. doi: 10.1016/j.bjps.2015.09.012. Epub 2015 Oct 23. PMID- 26562292 OWN - NLM STAT- MEDLINE DA - 20160212 DCOM- 20160629 LR - 20161126 IS - 2374-2445 (Electronic) IS - 2374-2437 (Linking) VI - 2 IP - 2 DP - 2016 Feb TI - Risk Model-Guided Antiemetic Prophylaxis vs Physician's Choice in Patients Receiving Chemotherapy for Early-Stage Breast Cancer: A Randomized Clinical Trial. PG - 225-31 LID - 10.1001/jamaoncol.2015.3730 [doi] AB - IMPORTANCE: Despite multiple patient-centered factors being associated with the risk of chemotherapy-induced nausea and vomiting (CINV), these factors are rarely considered when making antiemetic recommendations. OBJECTIVE: To compare risk model-guided (RMG) antiemetic prophylaxis with physician's choice (PC) in patients receiving chemotherapy for early-stage breast cancer. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial of 324 patients with early-stage breast cancer undergoing chemotherapy (cyclophosphamide and an anthracycline) for the first time at 2 specialty cancer care centers in Ottawa from April 10, 2012, to September 2, 2014. Patients were randomized to either the RMG arm (n = 154) or the PC control arm (n = 170). Prior to each cycle of chemotherapy patients in the RMG group were categorized as low or high risk for CINV, and their antiemetic treatments were adjusted accordingly. INTERVENTIONS: Patients considered to be at low risk received standard dexamethasone and a 5-HT3 antagonist, while those at high risk also received aprepitant with or without olanzapine, based on their risk level. The PC control group received antiemetic agents according to the treating physician's discretion. MAIN OUTCOMES AND MEASURES: The primary end points were control of both nausea and vomiting in the acute posttreatment period (first 24 hours after therapy) and in the delayed posttreatment period (days 2-5 after therapy). RESULTS: The total numbers of chemotherapy cycles delivered in the RMG and PC control groups were 497 and 551 respectively. In the acute period, significantly more patients in the RMG group reported no nausea (53.7% [95% CI, 49.2%-58.1%] vs 41.6% [95% CI, 37.4%-45.3%]; P < .001) and no vomiting (91.8% [95% CI, 89.0%-94.0%] vs 82.2% [95% CI, 78.8%-85.3%]; P < .001) compared with the PC control group. Similarly, significantly more patients in the RMG group reported no nausea (39.6% [95% CI, 35.3%-44.1%] vs 30.7% [95% CI, 26.8%-34.7%]; P = .01) and no vomiting (87.1% [95% CI, 83.8%-90.0%) vs 78.0% [95% CI, 74.3%-81.4%]; P < .001) in the delayed period respectively. CONCLUSIONS AND RELEVANCE: In this trial, the RMG antiemetic prophylaxis led to improved control of acute and delayed CINV compared with physician's choice of therapy. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01913990. FAU - Clemons, Mark AU - Clemons M AD - Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada2Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. FAU - Bouganim, Nathaniel AU - Bouganim N AD - Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada. FAU - Smith, Stephanie AU - Smith S AD - Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. FAU - Mazzarello, Sasha AU - Mazzarello S AD - Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. FAU - Vandermeer, Lisa AU - Vandermeer L AD - Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. FAU - Segal, Roanne AU - Segal R AD - Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada. FAU - Dent, Susan AU - Dent S AD - Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada. FAU - Gertler, Stan AU - Gertler S AD - Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada. FAU - Song, Xinni AU - Song X AD - Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada. FAU - Wheatley-Price, Paul AU - Wheatley-Price P AD - Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada. FAU - Dranitsaris, George AU - Dranitsaris G AD - Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada. LA - eng SI - ClinicalTrials.gov/NCT01913990 PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PL - United States TA - JAMA Oncol JT - JAMA oncology JID - 101652861 RN - 0 (Anthracyclines) RN - 0 (Antiemetics) RN - 12794-10-4 (Benzodiazepines) RN - 4AF302ESOS (Ondansetron) RN - 7S5I7G3JQL (Dexamethasone) RN - 8N3DW7272P (Cyclophosphamide) RN - N7U69T4SZR (olanzapine) SB - IM CIN - Lancet Oncol. 2016 Jan;17(1):e7. PMID: 26776103 CIN - JAMA Oncol. 2016 Feb;2(2):232-3. PMID: 26561746 MH - Adult MH - Aged MH - Anthracyclines/adverse effects MH - Antiemetics/*administration & dosage/adverse effects MH - Antineoplastic Combined Chemotherapy Protocols/*adverse effects MH - Benzodiazepines/administration & dosage MH - Breast Neoplasms/*drug therapy/pathology MH - Choice Behavior MH - Cyclophosphamide/adverse effects MH - *Decision Support Techniques MH - Dexamethasone/administration & dosage MH - Drug Administration Schedule MH - Female MH - Humans MH - Middle Aged MH - Nausea/chemically induced/*prevention & control MH - Neoplasm Staging MH - Ondansetron/administration & dosage MH - Ontario MH - Patient Selection MH - *Practice Patterns, Physicians' MH - Predictive Value of Tests MH - Risk Assessment MH - Risk Factors MH - Time Factors MH - Treatment Outcome MH - Vomiting/chemically induced/*prevention & control EDAT- 2015/11/13 06:00 MHDA- 2016/06/30 06:00 CRDT- 2015/11/13 06:00 AID - 2469339 [pii] AID - 10.1001/jamaoncol.2015.3730 [doi] PST - ppublish SO - JAMA Oncol. 2016 Feb;2(2):225-31. doi: 10.1001/jamaoncol.2015.3730. PMID- 26554555 OWN - NLM STAT- MEDLINE DA - 20151111 DCOM- 20160505 LR - 20161019 IS - 1472-6947 (Electronic) IS - 1472-6947 (Linking) VI - 15 DP - 2015 Nov 10 TI - Impact of a decision aid on reducing uncertainty: pilot study of women in their 40s and screening mammography. PG - 89 LID - 10.1186/s12911-015-0210-2 [doi] AB - BACKGROUND: In 2009 the United States Preventive Services Task Force updated its breast cancer screening guidelines to recommend that average-risk women obtain a screening mammogram every two years starting at age 50 instead of annually starting at age 40. Inconsistencies in data regarding the benefit versus risk of routine screening for women less than 50-years-of-age led to a second recommendation - that women in their forties engage in a shared decision making process with their provider to make an individualized choice about screening mammography that was right for them. In response, a web-based interactive mammography screening decision aid was developed and evaluated. METHODS: The decision aid was developed using an agile, iterative process. It was further honed based on feedback from clinical and technical subject matter experts. A convenience sample of 51 age- and risk-appropriate women was recruited to pilot the aid. Pre-post decisional conflict and screening choice was assessed. RESULTS: Women reported a significant reduction in overall decisional conflict after using the decision aid (Z = -5.3, p < 0.001). These participants also reported statistically significant reductions in each of the decisional conflict subscales: feeling uncertain (Z = -4.7, p < 0.001), feeling uninformed (Z = -5.2, p < 0.001), feeling unclear about values (Z = -5.0, p < 0.001), and feeling unsupported (Z = -4.0, p < 0.001). However, a woman's intention to obtain a screening mammogram in the next 1-2 years was not significantly changed (Wilcoxon signed-rank Z = -1.508, p = 0.132). CONCLUSION: This mammography screening decision aid brings value to patient care not by impacting what a woman chooses but by lending clarity to why or how she chooses it. FAU - Scariati, Paula AU - Scariati P AD - Marin General Hospital, Greenbrae, CA, USA. scariati@vcom.vt.edu. FAU - Nelson, Lisa AU - Nelson L AD - ConvergeHEALTH by Deloitte, Newton, MA, USA. lisapnelson@gmail.com. FAU - Watson, Lindsey AU - Watson L AD - Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA. watsolin@ohsu.edu. FAU - Bedrick, Stephen AU - Bedrick S AD - Center for Spoken Language and Understanding, Oregon Health & Science University, Portland, OR, USA. bedricks@ohsu.edu. FAU - Eden, Karen B AU - Eden KB AD - Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA. edenk@ohsu.edu. AD - Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, OR, USA. edenk@ohsu.edu. LA - eng GR - T15 LM007088/LM/NLM NIH HHS/United States GR - 5T15 LM007088/LM/NLM NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20151110 PL - England TA - BMC Med Inform Decis Mak JT - BMC medical informatics and decision making JID - 101088682 SB - IM MH - Adult MH - Breast Neoplasms/*diagnosis/prevention & control MH - *Decision Support Techniques MH - Female MH - Humans MH - *Mammography MH - Middle Aged MH - *Patient Preference MH - Pilot Projects MH - *Uncertainty PMC - PMC4640415 OID - NLM: PMC4640415 EDAT- 2015/11/12 06:00 MHDA- 2016/05/06 06:00 CRDT- 2015/11/12 06:00 PHST- 2015/01/22 [received] PHST- 2015/10/14 [accepted] AID - 10.1186/s12911-015-0210-2 [doi] AID - 10.1186/s12911-015-0210-2 [pii] PST - epublish SO - BMC Med Inform Decis Mak. 2015 Nov 10;15:89. doi: 10.1186/s12911-015-0210-2. PMID- 26475704 OWN - NLM STAT- MEDLINE DA - 20160120 DCOM- 20160808 LR - 20160120 IS - 1573-7217 (Electronic) IS - 0167-6806 (Linking) VI - 154 IP - 1 DP - 2015 Nov TI - onlineDeCISion.org: a web-based decision aid for DCIS treatment. PG - 181-90 AB - Women diagnosed with DCIS face complex treatment decisions and often do so with inaccurate and incomplete understanding of the risks and benefits involved. Our objective was to create a tool to guide these decisions for both providers and patients. We developed a web-based decision aid designed to provide clinicians with tailored information about a patient's recurrence risks and survival outcomes following different treatment strategies for DCIS. A theoretical framework, microsimulation model (Soeteman et al., J Natl Cancer 105:774-781, 2013) and best practices for web-based decision tools guided the development of the decision aid. The development process used semi-structured interviews and usability testing with key stakeholders, including a diverse group of multidisciplinary clinicians and a patient advocate. We developed onlineDeCISion.org to include the following features that were rated as important by the stakeholders: (1) descriptions of each of the standard treatment options available; (2) visual projections of the likelihood of time-specific (10-year and lifetime) breast-preservation, recurrence, and survival outcomes; and (3) side-by-side comparisons of down-stream effects of each treatment choice. All clinicians reviewing the decision aid in usability testing were interested in using it in their clinical practice. The decision aid is available in a web-based format and is planned to be publicly available. To improve treatment decision making in patients with DCIS, we have developed a web-based decision aid onlineDeCISion.org that conforms to best practices and that clinicians are interested in using in their clinics with patients to better inform treatment decisions. FAU - Ozanne, Elissa M AU - Ozanne EM FAU - Schneider, Katharine H AU - Schneider KH FAU - Soeteman, Djora AU - Soeteman D FAU - Stout, Natasha AU - Stout N FAU - Schrag, Deborah AU - Schrag D FAU - Fordis, Michael AU - Fordis M FAU - Punglia, Rinaa S AU - Punglia RS LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. PL - Netherlands TA - Breast Cancer Res Treat JT - Breast cancer research and treatment JID - 8111104 SB - IM MH - Adult MH - Breast Neoplasms/*epidemiology/pathology/therapy MH - Carcinoma, Intraductal, Noninfiltrating/*epidemiology/pathology/therapy MH - *Decision Making MH - Decision Support Techniques MH - Female MH - Humans MH - Internet MH - Mammography MH - Middle Aged MH - Patient Education as Topic MH - *Patient Participation EDAT- 2015/10/18 06:00 MHDA- 2016/08/09 06:00 CRDT- 2015/10/18 06:00 PHST- 2015/07/25 [received] PHST- 2015/10/12 [accepted] AID - 10.1007/s10549-015-3605-y [doi] AID - 10.1007/s10549-015-3605-y [pii] PST - ppublish SO - Breast Cancer Res Treat. 2015 Nov;154(1):181-90. PMID- 26458964 OWN - NLM STAT- MEDLINE DA - 20151013 DCOM- 20160718 LR - 20170220 IS - 1745-6215 (Electronic) IS - 1745-6215 (Linking) VI - 16 DP - 2015 Oct 12 TI - Informed shared decision-making supported by decision coaches for women with ductal carcinoma in situ: study protocol for a cluster randomized controlled trial. PG - 452 LID - 10.1186/s13063-015-0991-8 [doi] AB - BACKGROUND: Women with breast cancer want to participate in treatment decision-making. Guidelines have confirmed the right of informed shared decision-making. However, previous research has shown that the implementation of informed shared decision-making is suboptimal for reasons of limited resources of physicians, power imbalances between patients and physicians and missing evidence-based patient information. We developed an informed shared decision-making program for women with primary ductal carcinoma in situ (DCIS). The program provides decision coaching for women by specialized nurses and aims at supporting involvement in decision-making and informed choices. In this trial, the informed shared decision-making program will be evaluated in breast care centers. METHODS/DESIGN: A cluster randomized controlled trial will be conducted to compare the informed shared decision-making program with standard care. The program comprises an evidence-based patient decision aid and training of physicians (2 hours) and specialized breast care and oncology nurses (4 days) in informed shared decision-making. Sixteen certified breast care centers will be included, with 192 women with primary DCIS being recruited. Primary outcome is the extent of patients' involvement in shared decision-making as assessed by the MAPPIN-Odyad (Multifocal approach to the 'sharing' in shared decision-making: observer instrument dyad). Secondary endpoints include the sub-measures of the MAPPIN-inventory (MAPPIN-Onurse, MAPPIN-Ophysician, MAPPIN-Opatient, MAPPIN-Qnurse, MAPPIN-Qpatient and MAPPIN-Qphysician), informed choice, decisional conflict and the duration of encounters. It is expected that decision coaching and the provision of evidence-based patient decision aids will increase patients' involvement in decision-making with informed choices and reduce decisional conflicts and duration of physician encounters. Furthermore, an accompanying process evaluation will be conducted. DISCUSSION: To our knowledge, this is the first study investigating the implementation of decision coaches in German breast care centers. TRIAL REGISTRATION: Current Controlled Trials ISRCTN46305518 , date of registration: 5 June 2015. FAU - Berger-Hoger, Birte AU - Berger-Hoger B AD - University of Hamburg, MIN-Faculty, Unit of Health Sciences and Education, Martin-Luther-King-Platz 6, D-20146, Hamburg, Germany. Birte.Berger-Hoeger@uni-hamburg.de. FAU - Liethmann, Katrin AU - Liethmann K AD - University of Hamburg, MIN-Faculty, Unit of Health Sciences and Education, Martin-Luther-King-Platz 6, D-20146, Hamburg, Germany. Katrin.Liethmann@uni-hamburg.de. FAU - Muhlhauser, Ingrid AU - Muhlhauser I AD - University of Hamburg, MIN-Faculty, Unit of Health Sciences and Education, Martin-Luther-King-Platz 6, D-20146, Hamburg, Germany. Ingrid_Muehlhauser@uni-hamburg.de. FAU - Haastert, Burkhard AU - Haastert B AD - mediStatistica Neuenrade, Lambertusweg 1b, D-58809, Neuenrade, Germany. haastert@medistatistica.de. FAU - Steckelberg, Anke AU - Steckelberg A AD - University of Hamburg, MIN-Faculty, Unit of Health Sciences and Education, Martin-Luther-King-Platz 6, D-20146, Hamburg, Germany. ASteckelberg@uni-hamburg.de. LA - eng SI - ISRCTN/ISRCTN46305518 PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20151012 PL - England TA - Trials JT - Trials JID - 101263253 SB - IM MH - Attitude of Health Personnel MH - Breast Neoplasms/diagnosis/nursing/psychology/*therapy MH - Carcinoma, Intraductal, Noninfiltrating/diagnosis/psychology/*therapy MH - *Choice Behavior MH - *Communication MH - Decision Support Techniques MH - Female MH - Germany MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Informed Consent MH - *Nurse-Patient Relations MH - Patient Education as Topic MH - *Patient Participation MH - *Physician-Patient Relations MH - Research Design PMC - PMC4603943 OID - NLM: PMC4603943 EDAT- 2015/10/16 06:00 MHDA- 2016/07/19 06:00 CRDT- 2015/10/14 06:00 PHST- 2015/06/25 [received] PHST- 2015/09/30 [accepted] AID - 10.1186/s13063-015-0991-8 [doi] AID - 10.1186/s13063-015-0991-8 [pii] PST - epublish SO - Trials. 2015 Oct 12;16:452. doi: 10.1186/s13063-015-0991-8. PMID- 26422125 OWN - NLM STAT- MEDLINE DA - 20151120 DCOM- 20160901 LR - 20161122 IS - 1532-3080 (Electronic) IS - 0960-9776 (Linking) VI - 24 IP - 6 DP - 2015 Dec TI - Exploring information provision in reconstructive breast surgery: A qualitative study. PG - 732-8 LID - 10.1016/j.breast.2015.09.003 [doi] LID - S0960-9776(15)00192-7 [pii] AB - OBJECTIVE: Women considering reconstructive breast surgery (RBS) require adequate information to make informed treatment decisions. This study explored patients' and health professionals' (HPs) perceptions of the adequacy of information provided for decision-making in RBS. METHODS: Semi-structured interviews with a purposive sample of patients who had undergone RBS and HPs providing specialist care explored participants' experiences of information provision prior to RBS. RESULTS: Professionals reported providing standardised verbal, written and photographic information about the process and outcomes of surgery. Women, by contrast, reported varying levels of information provision. Some felt fully-informed but others perceived they had received insufficient information about available treatment options or possible outcomes of surgery to make an informed decision. CONCLUSIONS: Women need adequate information to make informed decisions about RBS and current practice may not meet women's needs. Minimum agreed standards of information provision, especially about alternative types of reconstruction, are recommended to improve decision-making in RBS. CI - Copyright (c) 2015 Elsevier Ltd. All rights reserved. FAU - Potter, Shelley AU - Potter S AD - Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, United Kingdom; Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, United Kingdom. Electronic address: Shelley.Potter@bristol.ac.uk. FAU - Mills, Nicola AU - Mills N AD - Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, United Kingdom. FAU - Cawthorn, Simon AU - Cawthorn S AD - Breast Care Centre, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, United Kingdom. FAU - Wilson, Sherif AU - Wilson S AD - Department of Plastic Surgery, North Bristol NHS Trust, Bristol BS16 1LE, United Kingdom. FAU - Blazeby, Jane AU - Blazeby J AD - Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, United Kingdom; Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, United Kingdom. LA - eng GR - MR/K025643/1/Medical Research Council/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20150928 PL - Netherlands TA - Breast JT - Breast (Edinburgh, Scotland) JID - 9213011 SB - IM MH - Adult MH - Aged MH - *Attitude of Health Personnel MH - Breast Neoplasms/*psychology/surgery MH - Consumer Health Information/methods MH - Decision Making MH - Female MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - Male MH - Mammaplasty/*psychology MH - Middle Aged MH - Patient Education as Topic/standards MH - Qualitative Research OTO - NOTNLM OT - Breast cancer OT - Breast reconstruction OT - Decision-making OT - Information OT - Oncology OT - Qualitative study EDAT- 2015/10/01 06:00 MHDA- 2016/09/02 06:00 CRDT- 2015/10/01 06:00 PHST- 2014/07/31 [received] PHST- 2015/02/12 [revised] PHST- 2015/09/07 [accepted] AID - S0960-9776(15)00192-7 [pii] AID - 10.1016/j.breast.2015.09.003 [doi] PST - ppublish SO - Breast. 2015 Dec;24(6):732-8. doi: 10.1016/j.breast.2015.09.003. Epub 2015 Sep 28. PMID- 26420774 OWN - NLM STAT- MEDLINE DA - 20160216 DCOM- 20161114 LR - 20170301 IS - 1527-330X (Electronic) IS - 1090-820X (Linking) VI - 36 IP - 3 DP - 2016 Mar TI - Challenging Breast Augmentations: The Influence of Preoperative Anatomical Features on the Final Result. PG - 313-20 LID - 10.1093/asj/sjv181 [doi] AB - BACKGROUND: Achieving satisfactory results may be difficult in augmentation mammaplasty patients in the presence of breast, chest wall, or vertebral deformities. These deformities have not been classified previously, and the impact of each deformity or combination of deformities has not been defined. OBJECTIVES: The aims of this study are to determine the complicating factors in augmentation mammaplasty, to classify these factors according to their influence on surgical outcome, and to develop an identification system for simplifying the recognition of challenging cases. METHODS: We retrospectively analyzed photographs and records of 100 consecutive patients who underwent augmentation mammaplasty. We observed suboptimal results in 18 cases. Preoperative deformities of the breast, chest wall, and vertebra were recorded in order to determine which factor or factors had complicated the surgeries. Eventually, the relationship between suboptimal surgical results and complicating factors was evaluated. RESULTS: We observed that some deformities alone caused suboptimal results, whereas others did not. Deformities that caused suboptimal results alone were called major complicating factors, and any others were called minor complicating factors. We observed that suboptimal results were also obtained in patients who had four minor complicating factors. Patients who had suboptimal results because of major or minor complicating factors were considered challenging cases. CONCLUSIONS: In this study, complicating factors for augmentation mammaplasty were defined and classified as major or minor depending on their effect on the surgical outcome. We suggest an identification system that simplifies the recognition of challenging cases in breast augmentation. CI - (c) 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com. FAU - Bayram, Yalcin AU - Bayram Y AD - Drs Bayram and Zor are Associate Professors and Dr Ozturk is a Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Karagoz is an Associate Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery; GATA Haydarpasha Training Hospital, Istanbul, Turkey. Dr Kulahci is an Associate Professor, Department of Hand Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Afifi is an Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA. FAU - Zor, Fatih AU - Zor F AD - Drs Bayram and Zor are Associate Professors and Dr Ozturk is a Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Karagoz is an Associate Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery; GATA Haydarpasha Training Hospital, Istanbul, Turkey. Dr Kulahci is an Associate Professor, Department of Hand Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Afifi is an Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA. FAU - Karagoz, Huseyin AU - Karagoz H AD - Drs Bayram and Zor are Associate Professors and Dr Ozturk is a Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Karagoz is an Associate Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery; GATA Haydarpasha Training Hospital, Istanbul, Turkey. Dr Kulahci is an Associate Professor, Department of Hand Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Afifi is an Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA. FAU - Kulahci, Yalcin AU - Kulahci Y AD - Drs Bayram and Zor are Associate Professors and Dr Ozturk is a Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Karagoz is an Associate Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery; GATA Haydarpasha Training Hospital, Istanbul, Turkey. Dr Kulahci is an Associate Professor, Department of Hand Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Afifi is an Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA. FAU - Afifi, Ahmed M AU - Afifi AM AD - Drs Bayram and Zor are Associate Professors and Dr Ozturk is a Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Karagoz is an Associate Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery; GATA Haydarpasha Training Hospital, Istanbul, Turkey. Dr Kulahci is an Associate Professor, Department of Hand Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Afifi is an Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA. FAU - Ozturk, Serdar AU - Ozturk S AD - Drs Bayram and Zor are Associate Professors and Dr Ozturk is a Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Karagoz is an Associate Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery; GATA Haydarpasha Training Hospital, Istanbul, Turkey. Dr Kulahci is an Associate Professor, Department of Hand Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Afifi is an Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA. LA - eng PT - Journal Article DEP - 20150929 PL - England TA - Aesthet Surg J JT - Aesthetic surgery journal JID - 9707469 SB - IM CIN - Aesthet Surg J. 2016 Mar;36(3):321-3. PMID: 26843097 MH - Adult MH - Breast/abnormalities/*surgery MH - *Breast Implantation/adverse effects/instrumentation MH - Breast Implants MH - Decision Support Techniques MH - Female MH - Humans MH - Patient Satisfaction MH - Photography MH - Postoperative Complications/etiology MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Treatment Outcome MH - Young Adult PMC - PMC5127479 EDAT- 2015/10/01 06:00 MHDA- 2016/11/15 06:00 CRDT- 2015/10/01 06:00 PMCR- 2017/03/01 PHST- 2015/08/04 [accepted] AID - sjv181 [pii] AID - 10.1093/asj/sjv181 [doi] PST - ppublish SO - Aesthet Surg J. 2016 Mar;36(3):313-20. doi: 10.1093/asj/sjv181. Epub 2015 Sep 29. PMID- 26417898 OWN - NLM STAT- MEDLINE DA - 20151027 DCOM- 20160216 LR - 20170220 IS - 1096-9098 (Electronic) IS - 0022-4790 (Linking) VI - 112 IP - 6 DP - 2015 Nov TI - Quality of online information to support patient decision-making in breast cancer surgery. PG - 575-80 LID - 10.1002/jso.24046 [doi] AB - BACKGROUND: Breast cancer patients commonly use the internet as an information resource. Our objective was to evaluate the quality of online information available to support patients facing a decision for breast surgery. METHODS: Breast cancer surgery-related queries were performed (Google and Bing), and reviewed for content pertinent to breast cancer surgery. The DISCERN instrument was used to evaluate websites' structural components that influence publication reliability and ability of information to support treatment decision-making. Scores of 4/5 were considered "good." RESULTS: 45 unique websites were identified. Websites satisfied a median 5/9 content questions. Commonly omitted topics included: having a choice between breast conservation and mastectomy (67%) and potential for 2nd surgery to obtain negative margins after breast conservation (60%). Websites had a median DISCERN score of 2.9 (range 2.0-4.5). Websites achieved higher scores on structural criteria (median 3.6 [2.1-4.7]), with 24% rated as "good." Scores on supporting decision-making questions were lower (2.6 [1.3-4.4]), with only 7% scoring "good." CONCLUSION: Although numerous breast cancer-related websites exist, most do a poor job providing women with essential information necessary to actively participate in decision-making for breast cancer surgery. Providing easily- accessible, high-quality online information has the potential to significantly improve patients' experiences with decision-making. CI - (c) 2015 Wiley Periodicals, Inc. FAU - Bruce, Jordan G AU - Bruce JG AD - School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin. FAU - Tucholka, Jennifer L AU - Tucholka JL AD - Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Wisconsin Surgical Outcomes Research Program, Madison, Wisconsin. FAU - Steffens, Nicole M AU - Steffens NM AD - Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Wisconsin Surgical Outcomes Research Program, Madison, Wisconsin. FAU - Neuman, Heather B AU - Neuman HB AD - School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin. AD - Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Wisconsin Surgical Outcomes Research Program, Madison, Wisconsin. AD - Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin. LA - eng GR - K12 HD055894/HD/NICHD NIH HHS/United States GR - L30 CA179525/CA/NCI NIH HHS/United States GR - UL1 TR000427/TR/NCATS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20150929 PL - United States TA - J Surg Oncol JT - Journal of surgical oncology JID - 0222643 SB - IM MH - Breast Neoplasms/*surgery MH - *Decision Making MH - Female MH - *Health Services Needs and Demand MH - Humans MH - Information Dissemination/*methods MH - Internet/*standards MH - Mastectomy MH - Medical Informatics/*methods/*standards MH - Patient Education as Topic MH - Quality Control PMC - PMC4675620 MID - NIHMS742391 OID - NLM: NIHMS742391 OID - NLM: PMC4675620 OTO - NOTNLM OT - breast cancer OT - decision-making OT - information OT - internet EDAT- 2015/09/30 06:00 MHDA- 2016/02/18 06:00 CRDT- 2015/09/30 06:00 PHST- 2015/06/30 [received] PHST- 2015/09/03 [accepted] AID - 10.1002/jso.24046 [doi] PST - ppublish SO - J Surg Oncol. 2015 Nov;112(6):575-80. doi: 10.1002/jso.24046. Epub 2015 Sep 29. PMID- 26383833 OWN - NLM STAT- In-Process DA - 20150918 LR - 20170106 IS - 1099-1611 (Electronic) IS - 1057-9249 (Linking) VI - 25 IP - 12 DP - 2016 Dec TI - Acceptability and pilot efficacy trial of a web-based breast reconstruction decision support aid for women considering mastectomy. PG - 1424-1433 LID - 10.1002/pon.3984 [doi] AB - OBJECTIVE: The study aim was to test the acceptability and preliminary efficacy of a novel interactive web-based breast reconstruction decision support aid (BRAID) for newly diagnosed breast cancer patients considering mastectomy. METHODS: Fifty-five women considering mastectomy were randomly assigned to receive the BRAID versus the Cancer Support Community's Frankly Speaking About Cancer: Breast Reconstruction pamphlet. Participants completed measures of breast reconstruction (BR) knowledge, preparation to make a decision, decisional conflict, anxiety, and BR intentions before randomization and 2 weeks later. RESULTS: In terms of acceptability, enrollment into the study was satisfactory, but the rate of return for follow-up surveys was lower among BRAID participants than pamphlet participants. Both interventions were evaluated favorably in terms of their value in facilitating the BR decision, and the majority of participants completing the follow-up reported viewing the materials. In terms of preliminary efficacy, both interventions resulted in significant increases in BR knowledge and completeness and satisfaction with preparation to make a BR decision, and both interventions resulted in a significant reduction in decision conflict. However, there were no differences between interventions. CONCLUSION: A widely available free pamphlet and a web-based customized decision aid were highly utilized. The pamphlet was as effective in educating women about BR and prepared women equally as well to make the BR decision as compared with a more costly, customized web-based decision support aid. Copyright (c) 2015 John Wiley & Sons, Ltd. CI - Copyright (c) 2015 John Wiley & Sons, Ltd. FAU - Manne, Sharon L AU - Manne SL AD - Department of Medicine, Robert Wood Johnson Medical School, Section of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA. FAU - Topham, Neal AU - Topham N AD - Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA,, USA. FAU - D'Agostino, Thomas A AU - D'Agostino TA AD - Department of Medicine, Robert Wood Johnson Medical School, Section of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA. FAU - Myers Virtue, Shannon AU - Myers Virtue S AD - Department of Medicine, Robert Wood Johnson Medical School, Section of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA. FAU - Kirstein, Laurie AU - Kirstein L AD - Department of Medicine, Robert Wood Johnson Medical School, Section of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA. FAU - Brill, Kristin AU - Brill K AD - MD Anderson Cancer Center at Cooper Health Systems, Camden, NJ, USA. FAU - Manning, Cheryl AU - Manning C AD - Triad Interactive, Inc, Washington, DC, USA. FAU - Grana, Generosa AU - Grana G AD - MD Anderson Cancer Center at Cooper Health Systems, Camden, NJ, USA. FAU - Schwartz, Marc D AU - Schwartz MD AD - Lombardi Cancer Center, Washington, DC, USA. FAU - Ohman-Strickland, Pamela AU - Ohman-Strickland P AD - Department of Medicine, Robert Wood Johnson Medical School, Section of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA. LA - eng GR - R21 CA149531/CA/NCI NIH HHS/United States PT - Journal Article DEP - 20150918 PL - England TA - Psychooncology JT - Psycho-oncology JID - 9214524 EDAT- 2015/09/19 06:00 MHDA- 2015/09/19 06:00 CRDT- 2015/09/19 06:00 PHST- 2015/02/17 [received] PHST- 2015/07/10 [revised] PHST- 2015/08/21 [accepted] AID - 10.1002/pon.3984 [doi] PST - ppublish SO - Psychooncology. 2016 Dec;25(12):1424-1433. doi: 10.1002/pon.3984. Epub 2015 Sep 18. PMID- 26360918 OWN - NLM STAT- MEDLINE DA - 20151215 DCOM- 20160506 LR - 20161201 IS - 1931-843X (Electronic) IS - 1540-9996 (Linking) VI - 24 IP - 12 DP - 2015 Dec TI - Mammography Decision Aid Reduces Decisional Conflict for Women in Their Forties Considering Screening. PG - 1013-20 LID - 10.1089/jwh.2015.5256 [doi] AB - BACKGROUND: Clinical guidelines recommend a personalized approach to mammography screening for women in their forties; however, methods to do so are lacking. An evidence-based mammography screening decision aid was developed as an electronic mobile application and evaluated in a before-after study. METHODS: The decision aid (Mammopad) included modules on breast cancer, mammography, risk assessment, and priority setting about screening. Women aged 40-49 years who were patients of rural primary care clinics, had no major risk factors for breast cancer, and no mammography during the previous year were invited to use the decision aid. Twenty women participated in pretesting of the decision aid and 75 additional women completed the before-after study. The primary outcome was decisional conflict measured before and after using Mammopad. Secondary outcomes included decision self-efficacy and intention to begin or continue mammography screening. Differences comparing measures before versus after use were determined using Wilcoxon signed rank tests. RESULTS: After using Mammopad, women reported reduced decisional conflict based on mean Decisional Conflict Scale scores overall (46.33 versus 8.33; Z = -7.225; p < 0.001) and on all subscales (p < 0.001). Women also reported increased mean Decision Self-Efficacy Scale scores (79.67 versus 95.73; Z = 6.816, p < 0.001). Although 19% of women changed their screening intentions, this was not statistically significant. CONCLUSIONS: Women reported less conflict about their decisions for mammography screening, and felt more confident to make decisions after using Mammopad. This approach may help guide women through the decision making process to determine personalized screening choices that are appropriate for them. FAU - Eden, Karen B AU - Eden KB AD - 1 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University , Portland, Oregon. FAU - Scariati, Paula AU - Scariati P AD - 2 Marin General Hospital , Greenbrae, California. FAU - Klein, Krystal AU - Klein K AD - 1 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University , Portland, Oregon. FAU - Watson, Lindsey AU - Watson L AD - 1 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University , Portland, Oregon. FAU - Remiker, Mark AU - Remiker M AD - 3 Oregon Rural Practice-Based Research Network, Oregon Health and Science University , Portland, Oregon. FAU - Hribar, Michelle AU - Hribar M AD - 1 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University , Portland, Oregon. FAU - Forro, Vanessa AU - Forro V AD - 3 Oregon Rural Practice-Based Research Network, Oregon Health and Science University , Portland, Oregon. FAU - Michaels, LeAnn AU - Michaels L AD - 3 Oregon Rural Practice-Based Research Network, Oregon Health and Science University , Portland, Oregon. FAU - Nelson, Heidi D AU - Nelson HD AD - 1 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University , Portland, Oregon. AD - 4 Providence Cancer Center , Providence Health and Services, Portland, Oregon. LA - eng GR - T15 LM007088/LM/NLM NIH HHS/United States GR - T15LM007088/LM/NLM NIH HHS/United States GR - UL1TR000128/TR/NCATS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20150911 PL - United States TA - J Womens Health (Larchmt) JT - Journal of women's health (2002) JID - 101159262 SB - IM MH - Adult MH - Breast Neoplasms/*diagnosis/prevention & control/psychology MH - Conflict (Psychology) MH - Decision Making MH - *Decision Support Techniques MH - *Early Detection of Cancer MH - Female MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Intention MH - *Mammography MH - Middle Aged MH - *Patient Participation PMC - PMC4683542 OID - NLM: PMC4683542 [Available on 12/01/16] EDAT- 2015/09/12 06:00 MHDA- 2016/05/07 06:00 CRDT- 2015/09/12 06:00 AID - 10.1089/jwh.2015.5256 [doi] PST - ppublish SO - J Womens Health (Larchmt). 2015 Dec;24(12):1013-20. doi: 10.1089/jwh.2015.5256. Epub 2015 Sep 11. PMID- 26198675 OWN - NLM STAT- MEDLINE DA - 20150722 DCOM- 20160321 LR - 20161125 IS - 1472-6874 (Electronic) IS - 1472-6874 (Linking) VI - 15 DP - 2015 Jul 22 TI - Does a decision aid improve informed choice in mammography screening? Study protocol for a randomized controlled trial. PG - 53 LID - 10.1186/s12905-015-0210-5 [doi] AB - BACKGROUND: When invited for the first time at age 50, most women in Germany have to decide whether they wish to participate in the German mammography screening programme. For ethical reasons, screening decisions should be informed choices, but this is rarely the case with mammography screening. Decision aids are interventions with the potential to support informed choice by improving the following factors: knowledge, clarity of personal attitude, and implementation of an intention. Currently, no systematically evaluated decision aid exists for the German mammography screening programme. Therefore, the objective of this randomized controlled trial is to assess the effectiveness of a decision aid for first-time mammography screening programme invitees. METHODS/DESIGN: We have developed a decision aid for women invited to the mammography screening programme for the first time based on the criteria of the International Patient Decision Aids Standards Collaboration. The effectiveness of the decision aid will be evaluated in a randomized controlled trial with a 3-month follow-up. We will invite 7400 women aged 50 years from the district of Westfalen-Lippe, Germany, to participate. This sample will be drawn from registration office data. The primary outcome will be informed choice. The secondary outcomes will be the components of informed choice (knowledge, attitude, decision/implementation). Decisional conflict, decision regret, eHealth literacy, health behaviours, perceived behavioural control, subjective norms, invitation status, and demographic variables will be assessed. Data will be collected online at baseline, post-intervention, and at the 3-month follow-up. Participants will be randomized to receive either the decision aid or usual care (invitation and standard leaflet of the mammography screening programme). DISCUSSION: This paper describes the evaluation of a decision aid for the German mammography screening programme in a randomized controlled trial. If the decision aid proves to be an effective tool to enhance the rate of informed choice, it will be made accessible to the public and the use of this decision aid for first-time invitees will be recommended. The long-term effect could be an improvement in informed choices in women invited to the mammography screening programme. TRIAL REGISTRATION: German Clinical Trials Register DRKS00005176. FAU - Reder, Maren AU - Reder M AD - Bielefeld University, School of Public Health, Department of Prevention and Health Promotion, Universitatsstrasse 25, Bielefeld, 33615, Germany. maren.reder@uni-bielefeld.de. FAU - Kolip, Petra AU - Kolip P AD - Bielefeld University, School of Public Health, Department of Prevention and Health Promotion, Universitatsstrasse 25, Bielefeld, 33615, Germany. petra.kolip@uni-bielefeld.de. LA - eng SI - DRKS/DRKS00005176 PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20150722 PL - England TA - BMC Womens Health JT - BMC women's health JID - 101088690 SB - IM MH - Breast Neoplasms/diagnostic imaging/*psychology MH - *Choice Behavior MH - Clinical Protocols MH - Decision Support Techniques MH - Early Detection of Cancer/*psychology MH - Female MH - Germany MH - Humans MH - Mammography/*psychology MH - Middle Aged MH - Patient Acceptance of Health Care/*psychology MH - *Patient Participation MH - Randomized Controlled Trials as Topic/*psychology MH - Research Design PMC - PMC4510898 OID - NLM: PMC4510898 EDAT- 2015/07/23 06:00 MHDA- 2016/03/22 06:00 CRDT- 2015/07/23 06:00 PHST- 2014/08/04 [received] PHST- 2015/07/01 [accepted] AID - 10.1186/s12905-015-0210-5 [doi] AID - 10.1186/s12905-015-0210-5 [pii] PST - epublish SO - BMC Womens Health. 2015 Jul 22;15:53. doi: 10.1186/s12905-015-0210-5. PMID- 26178202 OWN - NLM STAT- MEDLINE DA - 20160318 DCOM- 20170111 LR - 20170403 IS - 1178-1661 (Electronic) IS - 1178-1653 (Linking) VI - 9 IP - 2 DP - 2016 Apr TI - Evaluating a Decision Aid for Improving Decision Making in Patients with Early-stage Breast Cancer. PG - 161-9 LID - 10.1007/s40271-015-0135-y [doi] AB - BACKGROUND: Early-stage breast cancer patients face a series of complex treatment decisions, with the first typically being choice of locoregional treatment. There is a need for tools to support patients in this decision-making process. METHODS: We developed an innovative, online locoregional treatment tool based on International Patient Decision Aids Standards criteria. We evaluated its impact on patient knowledge about treatment and appraisal of decision making in a pilot study using a clinical sample of newly diagnosed, breast cancer patients who were randomized to view the decision aid website first or complete a survey prior to viewing the decision aid. Differences in knowledge and decision appraisal between the two groups were compared using t-tests and chi-square tests. Computer-generated preferences for treatment were compared with patients' stated preferences using chi-square tests. RESULTS: One hundred and one newly diagnosed patients were randomized to view the website first or take a survey first. Women who viewed the website first had slightly higher, though not significantly, knowledge about surgery (p = 0.29) and reconstruction (p = 0.10) than the survey-first group. Those who viewed the website first also appraised their decision process significantly more favorably than did those who took the survey first (p < 0.05 for most decision outcomes). There was very good concordance between computer-suggested and stated treatment preferences. CONCLUSION: This pilot study suggests that an interactive decision tool shows promise for supporting early-stage breast cancer patients with complicated treatment decision making. FAU - Hawley, Sarah T AU - Hawley ST AD - Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, 4th Floor, Ann Arbor, MI, 48109, USA. sarahawl@umich.edu. AD - Ann Arbor VA Healthcare System, Ann Arbor, MI, USA. sarahawl@umich.edu. FAU - Newman, Lisa AU - Newman L AD - Department of Surgery, University of Michigan, Ann Arbor, MI, USA. FAU - Griggs, Jennifer J AU - Griggs JJ AD - Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, 4th Floor, Ann Arbor, MI, 48109, USA. FAU - Kosir, Mary Ann AU - Kosir MA AD - Karmanos Cancer Institute, Detroit, MI, USA. FAU - Katz, Steven J AU - Katz SJ AD - Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, 4th Floor, Ann Arbor, MI, 48109, USA. LA - eng GR - R21 CA129859/CA/NCI NIH HHS/United States PT - Evaluation Studies PT - Journal Article PT - Research Support, N.I.H., Extramural PL - New Zealand TA - Patient JT - The patient JID - 101309314 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/*psychology/surgery MH - Decision Making MH - *Decision Support Techniques MH - Female MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - Mammaplasty/psychology/statistics & numerical data MH - Mastectomy/classification/methods/*psychology MH - Mastectomy, Segmental/psychology/statistics & numerical data MH - Middle Aged MH - Patient Education as Topic/methods MH - Patient Participation MH - Patient Preference/*psychology/statistics & numerical data PMC - PMC4715777 MID - NIHMS708502 OID - NLM: NIHMS708502 [Available on 04/01/17] OID - NLM: PMC4715777 [Available on 04/01/17] EDAT- 2015/07/17 06:00 MHDA- 2017/01/12 06:00 CRDT- 2015/07/17 06:00 AID - 10.1007/s40271-015-0135-y [doi] AID - 10.1007/s40271-015-0135-y [pii] PST - ppublish SO - Patient. 2016 Apr;9(2):161-9. doi: 10.1007/s40271-015-0135-y. PMID- 26176340 OWN - NLM STAT- MEDLINE DA - 20150716 DCOM- 20150925 LR - 20150716 IS - 1365-2168 (Electronic) IS - 0007-1323 (Linking) VI - 102 IP - 9 DP - 2015 Aug TI - Impact of preoperative evaluation of tumour grade by core needle biopsy on clinical risk assessment and patient selection for adjuvant systemic treatment in breast cancer. PG - 1048-55 LID - 10.1002/bjs.9858 [doi] AB - BACKGROUND: Histological characteristics are important when making a decision on adjuvant systemic treatment in breast cancer. Preoperative assessments of core needle biopsy (CNB) specimens are becoming increasingly relevant as novel minimally invasive ablative techniques are introduced, because a surgical specimen is no longer obtained with these methods. The clinical impact of potential underestimation of tumour grade on preoperative CNB on clinical decision-making was evaluated. METHODS: Histological tumour grade was reassessed on CNB and resection specimens from consecutive invasive ductal carcinomas diagnosed between 2010 and 2013. For each patient, the indication for systemic therapy was assessed, based on either CNB or surgical excision, in combination with clinical characteristics and imaging findings. The clinical impact of discordance between tumour grade on CNB versus the resection specimen was assessed. RESULTS: The analysis included 213 invasive ductal carcinomas in 199 patients. Discordance in tumour grade between CNB and the resection specimen was observed in 64 (30.0 per cent) of 213 tumours (kappa = 0.53, 95 per cent c.i. 0.43 to 0.63). A decision on adjuvant treatment based on CNB would have resulted in overtreatment in seven (3.5 per cent) and undertreatment in three (1.5 per cent) of 199 patients. In the undertreated patients, incorrect omission of adjuvant systemic treatment would have increased the predicted 10-year mortality rate by 2.6-5.2 per cent and 10-year recurrence rate by 8.2-15.3 per cent based on the online risk assessment tool Adjuvant! CONCLUSION: The substantial discordance in tumour grading between CNB and resection specimens from breast cancer affects the indication for adjuvant therapy in only a small minority of patients with invasive ductal carcinoma. Assessment of tumour grade by CNB is feasible and accurate for the planning of postoperative treatment. CI - (c) 2015 BJS Society Ltd Published by John Wiley & Sons Ltd. FAU - Waaijer, L AU - Waaijer L AD - Departments of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands. FAU - Willems, S M AU - Willems SM AD - Departments of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands. FAU - Verkooijen, H M AU - Verkooijen HM AD - Departments of Imaging Division, University Medical Centre Utrecht, Utrecht, The Netherlands. FAU - Buck, D B AU - Buck DB AD - Departments of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands. FAU - van der Pol, C C AU - van der Pol CC AD - Departments of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands. FAU - van Diest, P J AU - van Diest PJ AD - Departments of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands. FAU - Witkamp, A J AU - Witkamp AJ AD - Departments of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands. LA - eng PT - Evaluation Studies PT - Journal Article DEP - 20150616 PL - England TA - Br J Surg JT - The British journal of surgery JID - 0372553 RN - 0 (Antineoplastic Agents) SB - AIM SB - IM MH - Adult MH - Aged MH - Antineoplastic Agents/therapeutic use MH - Biopsy, Large-Core Needle MH - Breast Neoplasms/drug therapy/*pathology/surgery MH - Carcinoma, Ductal, Breast/drug therapy/*pathology/surgery MH - Chemotherapy, Adjuvant MH - Decision Support Techniques MH - Female MH - Humans MH - *Mastectomy MH - Middle Aged MH - Neoplasm Grading MH - *Patient Selection MH - *Preoperative Care MH - Retrospective Studies MH - Risk Assessment EDAT- 2015/07/16 06:00 MHDA- 2015/09/26 06:00 CRDT- 2015/07/16 06:00 PHST- 2014/11/17 [received] PHST- 2015/02/05 [revised] PHST- 2015/04/16 [accepted] AID - 10.1002/bjs.9858 [doi] PST - ppublish SO - Br J Surg. 2015 Aug;102(9):1048-55. doi: 10.1002/bjs.9858. Epub 2015 Jun 16. PMID- 26171096 OWN - NLM STAT- PubMed-not-MEDLINE DA - 20150714 DCOM- 20150714 LR - 20170220 IS - 1937-5719 (Print) IS - 1937-5719 (Linking) VI - 15 DP - 2015 TI - Design and Focus Test of a Preconsultation Decision Aid for Breast Cancer Reconstruction Patients: A Quality Improvement Initiative. PG - e24 AB - OBJECTIVE: To design, develop, and evaluate via focus group a preconsultation decision aid to improve patient satisfaction for breast reconstruction. METHODS: The design of the decision aid was based on perceived patient needs, literature, existing decision aids, and current standard of breast cancer reconstruction treatment and consultation at Stanford. Our decision aid was designed to (1) reducing fear of the unknown in patients via providing a knowledge base that they can rely on, (2) helping patients identify their key breast reconstruction concerns, (3) addressing common patient concerns, (4) providing a framework to help patients identify the treatment option that may be right for them, and (5) promoting shared decision making. Physicians were consulted on the decision aid, following which a focus group was conducted for patient feedback. RESULTS: Interviewed patients (n = 12) were supportive of the decision aid initiative. Participants were especially pleased with the side-by-side comparison of surgical options and the parsimonious way information was represented. All patients before undergoing reconstruction (n = 3) requested the decision guide to reference at home. All interviewed patients believed information level was "about right." CONCLUSIONS: Decision aid was well received by patients in the focus group. As the initiative is for quality improvement, we saw no need to further delay the distribution of the decision aid. A pilot study will be conducted to evaluate whether our decision aid has an effect on patients' decision regret, stress, and anxiety. FAU - Hui, Kenneth J AU - Hui KJ AD - Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, Calif. FAU - Liu, Xiang X AU - Liu XX AD - Division of Plastic and Reconstructive Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. FAU - Luan, Anna AU - Luan A AD - Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, Calif. FAU - Lee, Gordon K AU - Lee GK AD - Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, Calif. LA - eng PT - Journal Article DEP - 20150622 PL - United States TA - Eplasty JT - Eplasty JID - 101316107 PMC - PMC4485615 OID - NLM: PMC4485615 OTO - NOTNLM OT - breast reconstruction OT - clinical outcomes OT - decision aid OT - patient satisfaction OT - regret EDAT- 2015/07/15 06:00 MHDA- 2015/07/15 06:01 CRDT- 2015/07/15 06:00 PST - epublish SO - Eplasty. 2015 Jun 22;15:e24. eCollection 2015. PMID- 26165568 OWN - NLM STAT- MEDLINE DA - 20150713 DCOM- 20160408 LR - 20150713 IS - 1536-3708 (Electronic) IS - 0148-7043 (Linking) VI - 75 IP - 2 DP - 2015 Aug TI - Addressing the Potential Need for Coronary Artery Bypass Grafting After Free Tissue Transfer for Breast Reconstruction: An Algorithmic Approach. PG - 140-3 LID - 10.1097/SAP.0000000000000070 [doi] AB - The number one cause of death in American women is heart disease. Studies have clearly shown the superiority of internal mammary artery (IMA) grafts for coronary revascularization over other conduits or intracoronary techniques. Our goal was to design an algorithm for recipient vessel selection in patients undergoing free tissue transfer breast reconstruction.A review of the literature was performed to identify potential evidence to contribute to a best-practice guideline. The lack of high-level evidence led us to create a guideline based on a workgroup consensus, expert opinion, cadaveric studies, and case reports.As we operate on older patient populations, the need for IMA use for coronary artery bypass grafting (CABG) after autologous breast reconstruction may arise more frequently. We discuss the current literature regarding recipient vessel choices and level of recipient vessel harvest in free flap breast reconstruction to help continually evolve the practices of our specialty to the potential future needs of our patients. We also present a best-practice decision algorithm for vessel selection and harvest, as well as a sample case of CABG using the left IMA 35 days after previous autologous breast reconstruction using the left IMA.As the number of patients we operate on who may later require their IMA for CABG increases, so too must our understanding of the implications of our selection of recipient vessels for free autologous breast reconstruction. FAU - Maher, Janae L AU - Maher JL AD - From the Division of Plastic Surgery, Scott & White Memorial Hospital; and Division of Plastic Surgery, Texas A&M Health Science Center, Temple, TX. FAU - Mahabir, Raman C AU - Mahabir RC FAU - Roehl, Kendall R AU - Roehl KR LA - eng PT - Case Reports PT - Journal Article PT - Review PL - United States TA - Ann Plast Surg JT - Annals of plastic surgery JID - 7805336 SB - IM MH - *Algorithms MH - *Coronary Artery Bypass MH - *Decision Support Techniques MH - Female MH - Free Tissue Flaps/blood supply/*transplantation MH - Humans MH - Mammaplasty/*methods MH - Mammary Arteries/*transplantation MH - Middle Aged MH - Risk Assessment EDAT- 2015/07/15 06:00 MHDA- 2016/04/09 06:00 CRDT- 2015/07/14 06:00 AID - 10.1097/SAP.0000000000000070 [doi] AID - 00000637-201508000-00006 [pii] PST - ppublish SO - Ann Plast Surg. 2015 Aug;75(2):140-3. doi: 10.1097/SAP.0000000000000070. PMID- 26164840 OWN - NLM STAT- MEDLINE DA - 20150811 DCOM- 20160518 LR - 20150811 IS - 1751-4266 (Electronic) IS - 1751-4258 (Linking) VI - 9 IP - 3 DP - 2015 Sep TI - Managing psychosocial issues faced by young women with breast cancer at the time of diagnosis and during active treatment. PG - 279-84 LID - 10.1097/SPC.0000000000000161 [doi] AB - PURPOSE OF REVIEW: This review examines recent literature on the psychosocial needs of and interventions for young women. We focus on the active treatment period given the toxicity of treatment, the incidence of anxiety, and depressive symptoms in these women during treatment. This review summarizes research relevant to addressing their social and emotional concerns. RECENT FINDINGS: Young women undergoing treatment for breast cancer remain understudied despite unique needs. Psychoeducational interventions help to relieve symptoms and emotional distress during treatment, but effects do not appear to persist over the longer term. In the clinical context, the performance of prognostic-risk prediction models in this population is poor. Surgical decision-making is often driven by fear of recurrence and body image rather than prognosis, and decision aids may help young women to synthesize information to preserve their role in the treatment process. SUMMARY: First, shared decision-making, second, balancing body image, fear of recurrence, and recommended treatment, and third, palliative care for metastasis are essential research priorities for the clinical setting. In the larger social context, unique family/partner dynamics as well as financial and insurance concerns warrant particular attention in this population. FAU - Fernandes-Taylor, Sara AU - Fernandes-Taylor S AD - aWisconsin Surgical Outcomes Research Program, Department of Surgery, University of Wisconsin, Madison, Wisconsin bSchool of Public Health, University of California at Berkeley, Berkeley, California, USA. FAU - Adesoye, Taiwo AU - Adesoye T FAU - Bloom, Joan R AU - Bloom JR LA - eng GR - R21 HS023395-01/HS/AHRQ HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Review PL - United States TA - Curr Opin Support Palliat Care JT - Current opinion in supportive and palliative care JID - 101297402 SB - IM MH - Adult MH - Anxiety/psychology MH - Body Image MH - Breast Neoplasms/*psychology/*surgery MH - Communication MH - *Decision Making MH - Depression/psychology MH - Family Relations MH - Fear MH - Female MH - Humans MH - Mastectomy/*psychology MH - Neoplasm Recurrence, Local/psychology MH - Physician-Patient Relations MH - Quality of Life MH - Risk Assessment MH - Stress, Psychological/psychology EDAT- 2015/07/15 06:00 MHDA- 2016/05/19 06:00 CRDT- 2015/07/13 06:00 AID - 10.1097/SPC.0000000000000161 [doi] PST - ppublish SO - Curr Opin Support Palliat Care. 2015 Sep;9(3):279-84. doi: 10.1097/SPC.0000000000000161. PMID- 26062750 OWN - NLM STAT- MEDLINE DA - 20150616 DCOM- 20160304 LR - 20170603 IS - 1573-7217 (Electronic) IS - 0167-6806 (Linking) VI - 152 IP - 1 DP - 2015 Jul TI - Benefits and risks of contralateral prophylactic mastectomy in women undergoing treatment for sporadic unilateral breast cancer: a decision analysis. PG - 217-226 LID - 10.1007/s10549-015-3462-8 [doi] AB - The rate of contralateral prophylactic mastectomy (CPM) is rising rapidly, despite limited evidence about the procedure's relative benefits and harms. The objective of this study is to examine the impact of CPM on life expectancy (LE) and quality-adjusted life expectancy (QALE) in women with sporadic unilateral breast cancer. A Markov model was developed to compare 18 hypothetical cohorts of 45-year-old women with newly diagnosed unilateral, sporadic breast cancer treated with or without CPM. The probability of developing distant metastases by American Joint Committee on Cancer stage and molecular subtype was derived from British Columbia Cancer Agency data. Additional model parameters were identified from the medical literature. Sensitivity analyses were performed to examine the impact of plausible variations in key model parameters on results. CPM improved LE in all cohorts (range 0.06-0.54 years). Stage had more effect on LE than subtype (stage I mean, 0.44 years, stage III mean, 0.11 years). However, after adjusting for quality-of-life, No CPM was favored in all cohorts. Univariate sensitivity analysis demonstrated that the most influential model parameter was the post-CPM health state utility. The preferred strategy shifted from No CPM to CPM when the post-CPM utility exceeded 0.83 (base case value 0.81). PSA indicated that LE gains and QALE decreases were stable in all cohorts. The primary determinant of survival after unilateral breast cancer is stage at diagnosis. Our results suggest that routine CPM would not improve quality-adjusted survival for the majority of women with unilateral sporadic breast cancer. FAU - Lester-Coll, Nataniel H AU - Lester-Coll NH AD - Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, 06510, United States. nataniel.lester-coll@yale.edu. FAU - Lee, Janie M AU - Lee JM AD - Department of Radiology, University of Washington, Seattle, WA, 98195, United States. FAU - Gogineni, Keerthi AU - Gogineni K AD - Department of Medicine, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, United States. FAU - Hwang, Wei-Ting AU - Hwang WT AD - Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, United States. FAU - Schwartz, J Sanford AU - Schwartz JS AD - Department of Medicine, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, United States. FAU - Prosnitz, Robert G AU - Prosnitz RG AD - The John and Dorothy Morgan Cancer Center, Lehigh Valley Health Network, Allentown, PA, 18103, United States. LA - eng GR - K07CA128816/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20150611 PL - Netherlands TA - Breast Cancer Res Treat JT - Breast cancer research and treatment JID - 8111104 SB - IM MH - British Columbia/epidemiology MH - Clinical Decision-Making MH - Decision Support Techniques MH - Female MH - Humans MH - Incidence MH - Life Expectancy MH - Markov Chains MH - *Mastectomy/methods MH - Neoplasm Metastasis MH - Prognosis MH - Quality-Adjusted Life Years MH - *Risk Assessment MH - Sensitivity and Specificity MH - Unilateral Breast Neoplasms/epidemiology/*prevention & control/*surgery EDAT- 2015/06/13 06:00 MHDA- 2016/03/05 06:00 CRDT- 2015/06/12 06:00 PHST- 2015/05/21 [received] PHST- 2015/06/05 [accepted] AID - 10.1007/s10549-015-3462-8 [doi] AID - 10.1007/s10549-015-3462-8 [pii] PST - ppublish SO - Breast Cancer Res Treat. 2015 Jul;152(1):217-226. doi: 10.1007/s10549-015-3462-8. Epub 2015 Jun 11. PMID- 26033878 OWN - NLM STAT- MEDLINE DA - 20150716 DCOM- 20160413 LR - 20150716 IS - 1740-7753 (Electronic) IS - 1740-7745 (Linking) VI - 12 IP - 4 DP - 2015 Aug TI - Development and piloting of a decision aid for women considering participation in the Sentinel Node Biopsy versus Axillary Clearance 2 breast cancer trial. PG - 409-17 LID - 10.1177/1740774515586404 [doi] AB - BACKGROUND/AIMS: This study aimed to (1) develop a decision aid for women considering participation in the Sentinel Node Biopsy versus Axillary Clearance 2 (SNAC-2) breast cancer surgical trial and (2) obtain evidence on its acceptability, feasibility, and potential efficacy in routine trial clinical practice via a two-stage pilot. METHODS: The decision aid was developed according to International Patient Decision Aid Standards. Study 1: an initial pilot involved 25 members of the consumer advocacy group, Breast Cancer Network Australia. Study 2: the main pilot involved 20 women eligible to participate in the SNAC-2 trial in New Zealand. In both pilots, a questionnaire assessed: information and involvement preferences, decisional conflict, SNAC-2 trial-related understanding and attitudes, psychological distress, and general decision aid feedback. A follow-up telephone interview elicited more detailed feedback on the decision aid design and content. RESULTS: In both pilots, participants indicated good subjective and objective understanding of SNAC-2 trial and reported low decisional conflict and anxiety. The decision aid was found helpful when deciding about trial participation and provided additional, useful information to the standard trial information sheet. CONCLUSION: The development and two-stage piloting process for this decision aid resulted in a resource that women found very acceptable and helpful in assisting decision-making about SNAC-2 trial participation. The process and findings provide a guide for developing other trial decision aids. CI - (c) The Author(s) 2015. FAU - Juraskova, Ilona AU - Juraskova I AD - Centre for Medical Psychology and Evidence-Based Decision Making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia ilona.juraskova@sydney.edu.au. FAU - Butow, Phyllis AU - Butow P AD - Centre for Medical Psychology and Evidence-Based Decision Making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia. FAU - Fisher, Alana AU - Fisher A AD - Centre for Medical Psychology and Evidence-Based Decision Making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia. FAU - Bonner, Carissa AU - Bonner C AD - Centre for Medical Psychology and Evidence-Based Decision Making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia. FAU - Anderson, Caroline AU - Anderson C AD - Centre for Medical Psychology and Evidence-Based Decision Making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia. FAU - Bu, Stella AU - Bu S AD - Centre for Medical Psychology and Evidence-Based Decision Making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia. FAU - Scarlet, Jenni AU - Scarlet J AD - Breast Cancer Centre, Waikato Hospital, Hamilton, New Zealand. FAU - Stockler, Martin R AU - Stockler MR AD - NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia. FAU - Wetzig, Neil AU - Wetzig N AD - Princess Alexandra Hospital, Brisbane, QLD, Australia. FAU - Ung, Owen AU - Ung O AD - Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia. FAU - Campbell, Ian AU - Campbell I AD - Breast Cancer Centre, Waikato Hospital, Hamilton, New Zealand. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20150601 PL - England TA - Clin Trials JT - Clinical trials (London, England) JID - 101197451 SB - IM MH - Adult MH - Breast Neoplasms/*surgery MH - *Clinical Trials as Topic MH - *Decision Support Techniques MH - Female MH - Humans MH - Interviews as Topic MH - Middle Aged MH - Patient Participation/*psychology MH - Pilot Projects MH - *Sentinel Lymph Node Biopsy MH - Surveys and Questionnaires OTO - NOTNLM OT - Decision aid (DA) OT - Sentinel Node Biopsy versus Axillary Clearance 2 OT - axillary clearance OT - breast cancer OT - clinical trial participation OT - informed consent OT - sentinel node biopsy EDAT- 2015/06/03 06:00 MHDA- 2016/04/14 06:00 CRDT- 2015/06/03 06:00 AID - 1740774515586404 [pii] AID - 10.1177/1740774515586404 [doi] PST - ppublish SO - Clin Trials. 2015 Aug;12(4):409-17. doi: 10.1177/1740774515586404. Epub 2015 Jun 1. PMID- 26017564 OWN - NLM STAT- MEDLINE DA - 20150528 DCOM- 20160516 LR - 20170220 IS - 1472-6963 (Electronic) IS - 1472-6963 (Linking) VI - 15 DP - 2015 May 28 TI - Coaching patients in the use of decision and communication aids: RE-AIM evaluation of a patient support program. PG - 209 LID - 10.1186/s12913-015-0872-6 [doi] AB - BACKGROUND: Decision aids educate patients about treatment options and outcomes. Communication aids include question lists, consultation summaries, and audio-recordings. In efficacy studies, decision aids increased patient knowledge, while communication aids increased patient question-asking and information recall. Starting in 2004, we trained successive cohorts of post-baccalaureate, pre-medical interns to coach patients in the use of decision and communication aids at our university-based breast cancer clinic. METHODS: From July 2005 through June 2012, we used the RE-AIM framework to measure Reach, Effectiveness, Adoption, Implementation and Maintenance of our interventions. RESULTS: 1. Reach: Over the study period, our program sent a total of 5,153 decision aids and directly administered 2,004 communication aids. In the most recent program year (2012), out of 1,524 eligible patient appointments, we successfully contacted 1,212 (80%); coached 1,110 (73%) in the self-administered use of decision and communication aids; sent 958 (63%) decision aids; and directly administered communication aids for 419 (27%) patients. In a 2010 survey, coached patients reported self-administering one or more communication aids in 81% of visits 2. Effectiveness: In our pre-post comparisons, decision aids were associated with increased patient knowledge and decreased decisional conflict. Communication aids were associated with increased self-efficacy and number of questions; and with high ratings of patient preparedness and satisfaction 3. Adoption: Among visitors sent decision aids, 82% of survey respondents reviewed some or all; among those administered communication aids, 86% reviewed one or more after the visit 4. IMPLEMENTATION: Through continuous quality adaptations, we increased the proportion of available staff time used for patient support (i.e. exploitation of workforce capacity) from 29% in 2005 to 84% in 2012 5. Maintenance: The main barrier to sustainability was the cost of paid intern labor. We addressed this by testing a service learning model in which student interns work as program coaches in exchange for academic credit rather than salary. The feasibility test succeeded, and we are now expanding the use of unpaid interns. CONCLUSION: We have sustained a clinic-wide implementation of decision and communication aids through a novel staffing model that uses paid and unpaid student interns as coaches. FAU - Belkora, Jeff AU - Belkora J AD - Philip R. Lee Institute For Health Policy Studies, University of California, San Francisco, 3333, California St, Suite 265, San Francisco, CA, 94118, USA. Jeff.belkora@ucsf.edu. FAU - Volz, Shelley AU - Volz S AD - Philip R. Lee Institute For Health Policy Studies, University of California, San Francisco, 3333, California St, Suite 265, San Francisco, CA, 94118, USA. Shelley.volz@ucsf.edu. FAU - Loth, Meredith AU - Loth M AD - Philip R. Lee Institute For Health Policy Studies, University of California, San Francisco, 3333, California St, Suite 265, San Francisco, CA, 94118, USA. Meredith.Loth@gmail.com. FAU - Teng, Alexandra AU - Teng A AD - Philip R. Lee Institute For Health Policy Studies, University of California, San Francisco, 3333, California St, Suite 265, San Francisco, CA, 94118, USA. Alexandra.Teng@ucsf.edu. FAU - Zarin-Pass, Margot AU - Zarin-Pass M AD - Philip R. Lee Institute For Health Policy Studies, University of California, San Francisco, 3333, California St, Suite 265, San Francisco, CA, 94118, USA. Margot.Zarin-Pass@ucsf.edu. FAU - Moore, Dan AU - Moore D AD - Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 1600 Divisadero Street, San Francisco, CA, 94115, USA. dmoore@cc.ucsf.edu. FAU - Esserman, Laura AU - Esserman L AD - Carol Franc Buck Breast Care Center, University of California, San Francisco, 1600 Divisadero Street, 2nd Floor, San Francisco, CA, 94115, USA. Laura.Esserman@ucsf.edu. LA - eng PT - Evaluation Studies PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20150528 PL - England TA - BMC Health Serv Res JT - BMC health services research JID - 101088677 SB - IM MH - Adult MH - Breast Neoplasms/*therapy MH - California MH - *Communication MH - *Decision Making MH - *Decision Support Techniques MH - Female MH - Health Personnel/*education MH - Humans MH - Male MH - Middle Aged MH - Patient Education as Topic/*methods MH - Program Evaluation MH - Surveys and Questionnaires PMC - PMC4446845 OID - NLM: PMC4446845 EDAT- 2015/05/29 06:00 MHDA- 2016/05/18 06:00 CRDT- 2015/05/29 06:00 PHST- 2014/12/02 [received] PHST- 2015/05/18 [accepted] AID - 10.1186/s12913-015-0872-6 [doi] AID - 10.1186/s12913-015-0872-6 [pii] PST - epublish SO - BMC Health Serv Res. 2015 May 28;15:209. doi: 10.1186/s12913-015-0872-6. PMID- 25987488 OWN - NLM STAT- MEDLINE DA - 20150613 DCOM- 20160304 LR - 20150613 IS - 1532-3080 (Electronic) IS - 0960-9776 (Linking) VI - 24 IP - 4 DP - 2015 Aug TI - Translating the concept of intrinsic subtypes into an oncoplastic cohort of more than 1000 patients - predictors of recurrence and survival. PG - 384-90 LID - 10.1016/j.breast.2015.02.030 [doi] LID - S0960-9776(15)00056-9 [pii] AB - INTRODUCTION: A paradigm shift in breast cancer was introduced by Sorlie's concept of intrinsic subtypes [1]. We validated this concept - which was originally based on 84 individuals - in a large cohort study of 1035 patients with oncoplastic surgery and analyzed if early and late recurrences are linked to a specific intrinsic tumor subtype or resection margins. MATERIALS AND METHODS: 1035 patients with oncoplastic surgery (2004-2009) were analyzed with regard to treatment characteristics and patterns of early (<5 years) and late recurrence (>5 years) and survival related to the intrinsic subtypes. Data was retrieved from patient's charts, customized patients questionnaires and cancer registries. RESULTS: 944 patients with primary, unilateral breast cancer, median age 58 years, were eligible for analysis. At a median FU of 5.2 years, LRR was 4.0%, 5-year-OS 94.5% and DFS 90.9%. Intrinsic subtypes, but not T-size, nodal-status, resections margins nor histopathology, governed local control and survival. There was no signal for prevelance of unclear margins in any of intrinsic subgroups and no preference of any oncoplastic technique attributed to them. TNBC and Her2 non-luminal breast cancer had highest recurrence and lowest survival rates. Although sentinel involvement (SLN+) was prevailing in the Luminal-B-Her 2 negative subtype at 34.3%, this did not translate into a higher axillary dissection rate. CONCLUSION: This study confirmed the intrinsic subtype concept on a large clinical basis and describes the patterns of early and late recurrence in oncoplastic surgery, concluding that bigger risk may not be overcome by bigger surgery. CI - Copyright (c) 2015 The Authors. Published by Elsevier Ltd.. All rights reserved. FAU - Rezai, M AU - Rezai M AD - Breast Center Dusseldorf Luisenkrankenhaus, Director: Dr.Mahdi Rezai, Hans-Gunther-Sohl-Str.6-10, 40235 Dusseldorf, Germany. FAU - Kellersmann, S AU - Kellersmann S AD - Breast Center Dusseldorf Luisenkrankenhaus, Director: Dr.Mahdi Rezai, Hans-Gunther-Sohl-Str.6-10, 40235 Dusseldorf, Germany; University Hospital of Essen, Department of Gynecology and Obstetrics, West German Cancer Center, Hufelandstr.55, D-45147 Essen, Germany. FAU - Knispel, S AU - Knispel S AD - Breast Center Dusseldorf Luisenkrankenhaus, Director: Dr.Mahdi Rezai, Hans-Gunther-Sohl-Str.6-10, 40235 Dusseldorf, Germany; University Hospital of Essen, Department of Gynecology and Obstetrics, West German Cancer Center, Hufelandstr.55, D-45147 Essen, Germany. FAU - Lax, H AU - Lax H AD - Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Zweigertstr. 37, D-45130 Essen, Germany. FAU - Kimmig, R AU - Kimmig R AD - University Hospital of Essen, Department of Gynecology and Obstetrics, West German Cancer Center, Hufelandstr.55, D-45147 Essen, Germany. FAU - Kern, P AU - Kern P AD - Breast Center Dusseldorf Luisenkrankenhaus, Director: Dr.Mahdi Rezai, Hans-Gunther-Sohl-Str.6-10, 40235 Dusseldorf, Germany; University Hospital of Essen, Department of Gynecology and Obstetrics, West German Cancer Center, Hufelandstr.55, D-45147 Essen, Germany. LA - eng PT - Journal Article DEP - 20150516 PL - Netherlands TA - Breast JT - Breast (Edinburgh, Scotland) JID - 9213011 RN - EC 2.7.10.1 (ERBB2 protein, human) RN - EC 2.7.10.1 (Receptor, ErbB-2) SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Axilla MH - Breast Neoplasms/chemistry/*classification/mortality/pathology/surgery MH - Cohort Studies MH - Decision Support Techniques MH - Disease-Free Survival MH - Female MH - Humans MH - Lymph Node Excision/*mortality MH - Lymph Nodes/pathology/*surgery MH - Mammaplasty/*mortality MH - Middle Aged MH - Neoplasm Recurrence, Local/*epidemiology MH - Receptor, ErbB-2 MH - Registries MH - Surveys and Questionnaires OTO - NOTNLM OT - Breast cancer OT - Intrinsic subtype OT - Margins OT - Recurrence OT - Survival EDAT- 2015/05/20 06:00 MHDA- 2016/03/05 06:00 CRDT- 2015/05/20 06:00 PHST- 2014/06/30 [received] PHST- 2015/02/01 [revised] PHST- 2015/02/22 [accepted] AID - S0960-9776(15)00056-9 [pii] AID - 10.1016/j.breast.2015.02.030 [doi] PST - ppublish SO - Breast. 2015 Aug;24(4):384-90. doi: 10.1016/j.breast.2015.02.030. Epub 2015 May 16. PMID- 25959986 OWN - NLM STAT- MEDLINE DA - 20150615 DCOM- 20161213 LR - 20161230 IS - 1873-5134 (Electronic) IS - 0738-3991 (Linking) VI - 98 IP - 8 DP - 2015 Aug TI - Towards informed decisions on breast cancer screening: Development and pilot testing of a decision aid for Chinese women. PG - 961-9 LID - 10.1016/j.pec.2015.04.014 [doi] LID - S0738-3991(15)00194-9 [pii] AB - OBJECTIVE: To pilot-test a novel, self-use breast cancer (BC) screening decision aid (DA) targeting Hong Kong (HK) Chinese women at average risk of BC. METHODS: Women were recruited through a population-based telephone survey using random digit dialling between October 2013 and January 2014. Eligible participants completed our baseline survey and then received the DA by post. Participants (n=90) completed follow-up telephone interviews one month later. RESULTS: Most participants thought that all/most DA content was presented clearly (86.7%), and was useful in helping women make screening-related decisions (88.9%). It also achieved its expected impact of improving informed decision-making and increasing shared-participation preference without increasing participants' anxiety levels. Participants showed a modest non-statistical increase in their screening knowledge scores. Older women rated the perceived severity of a BC diagnosis as significantly lower, and more educated women reported significantly lower perceived anxiety about the disease. CONCLUSION: Our DA appears acceptable and feasible for self-use by HK Chinese women who need to make an informed decision about BC screening without increasing overall anxiety levels. PRACTICE IMPLICATIONS: This study supports the potential of self-use DAs for cancer screening-related decision support in a Chinese population. CI - Copyright (c) 2015 Elsevier Ireland Ltd. All rights reserved. FAU - Wong, Irene O L AU - Wong IO AD - School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. Electronic address: iolwong@hku.hk. FAU - Lam, Wendy W T AU - Lam WW AD - School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. FAU - Wong, Cheuk Nam AU - Wong CN AD - School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. FAU - Cowling, Benjamin J AU - Cowling BJ AD - School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. FAU - Leung, Gabriel M AU - Leung GM AD - School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. FAU - Fielding, Richard AU - Fielding R AD - School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. LA - eng PT - Journal Article DEP - 20150429 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Adult MH - Aged MH - Aged, 80 and over MH - Asian Continental Ancestry Group/*statistics & numerical data MH - Breast Neoplasms/*diagnosis/prevention & control MH - *Decision Making MH - *Decision Support Techniques MH - Early Detection of Cancer MH - Female MH - *Health Knowledge, Attitudes, Practice MH - Hong Kong MH - Humans MH - Middle Aged MH - Patient Acceptance of Health Care/ethnology/*psychology MH - Patient Participation MH - Pilot Projects MH - Population Surveillance MH - Surveys and Questionnaires MH - Telephone OTO - NOTNLM OT - Breast cancer screening OT - Chinese OT - Decision aid OT - Informed decision EDAT- 2015/05/12 06:00 MHDA- 2016/12/15 06:00 CRDT- 2015/05/12 06:00 PHST- 2014/12/31 [received] PHST- 2015/04/08 [revised] PHST- 2015/04/18 [accepted] AID - S0738-3991(15)00194-9 [pii] AID - 10.1016/j.pec.2015.04.014 [doi] PST - ppublish SO - Patient Educ Couns. 2015 Aug;98(8):961-9. doi: 10.1016/j.pec.2015.04.014. Epub 2015 Apr 29. PMID- 25887713 OWN - NLM STAT- MEDLINE DA - 20150418 DCOM- 20160127 LR - 20170220 IS - 1745-6215 (Electronic) IS - 1745-6215 (Linking) VI - 16 DP - 2015 Feb 15 TI - A complex nursing intervention of complementary and alternative medicine (CAM) to increase quality of life in patients with breast and gynecologic cancer undergoing chemotherapy: study protocol for a partially randomized patient preference trial. PG - 51 LID - 10.1186/s13063-014-0538-4 [doi] AB - BACKGROUND: Health-related quality of life (HRQoL) is most adversely affected in cancer patients between diagnosis and the end of chemotherapy. The aim of the Complementary Nursing in Gynecologic Oncology (CONGO) study is to assess the effectiveness of a complex nursing care intervention of CAM to increase HRQoL in cancer patients undergoing chemotherapy. METHODS/DESIGN: CONGO is a prospective partially randomized patient preference (PRPP) trial including adult women diagnosed with breast and gynecologic cancer starting a new chemotherapy regimen. Patients without strong preferences for CAM will be randomized to usual nursing care or complex nursing care; those patients with strong preferences will be allowed their choice. The intervention consists of three interacting and intertwined elements: CAM nursing intervention packet, counseling on CAM using a resource-oriented approach and evidence-based informational material on CAM. Primary outcome data on participants' HRQoL will be collected from baseline until the end of treatment and long-term follow-up using the EORTC-QLQ-C30. Secondary outcomes include nausea, fatigue, pain, anxiety/depression, social support, self-efficacy, patient competence, spiritual wellbeing, and satisfaction with care. Accompanying research on economic outcomes as well as a mixed-methods process evaluation will be conducted. A total of 590 patients (236 patients in the randomized part of the study and 354 patients in the observational part of the study) will be recruited in the two outpatient clinics. The first analysis step will be the intention-to-treat (ITT) analysis of the randomized part of the trial. A linear mixed model will be used to compare the continuous primary endpoint between the intervention and control arm of the randomized group. The observational part of the trial will be analyzed descriptively. External validity will be assessed by comparing randomized with nonrandomized patients. DISCUSSION: Cancer patients are increasingly using CAM as supportive cancer care, however, a patient-centered model of care that includes CAM for the patient during chemotherapy still needs to be evaluated. This protocol has been designed to test if the effects of the intervention go beyond potential benefits in quality-of-life outcomes. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00006056 (15 April 2014). FAU - Klafke, Nadja AU - Klafke N AD - Department of General Practice and Health Services Research, University Hospital Heidelberg, Vossstr. 2, D-69115, Heidelberg, Germany. nadja.klafke@med.uni-heidelberg.de. FAU - Mahler, Cornelia AU - Mahler C AD - Department of General Practice and Health Services Research, University Hospital Heidelberg, Vossstr. 2, D-69115, Heidelberg, Germany. cornelia.mahler@med.uni-heidelberg.de. FAU - von Hagens, Cornelia AU - von Hagens C AD - Department of Gynaecological Endocrinology and Reproductive Medicine, University Women's Hospital Heidelberg, Im Neuenheimer Feld 440, D-69120, Heidelberg, Germany. cornelia.von.hagens@med.uni-heidelberg.de. FAU - Rochon, Justine AU - Rochon J AD - Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, D-69120, Heidelberg, Germany. rochon@imbi.uni-heidelberg.de. FAU - Schneeweiss, Andreas AU - Schneeweiss A AD - National Center for Tumor Diseases, University Hospital, Im Neuenheimer Feld 460, D-69120, Heidelberg, Germany. andreas.schneeweiss@med.uni-heidelberg.de. FAU - Muller, Andreas AU - Muller A AD - Community Hospital Karlsruhe, Moltkestrasse 90, D-76133, Karlsruhe, Germany. andreas.mueller.fk@klinikum-karlsruhe.de. FAU - Salize, Hans-Joachim AU - Salize HJ AD - Central Institute of Mental Health, Mental Health Services Research Group, Medical Faculty Mannheim/Heidelberg University, Mannheim, D-68159, Germany. hans-joachim.salize@zi-mannheim.de. FAU - Joos, Stefanie AU - Joos S AD - Department of General Practice and Health Services Research, University Hospital Heidelberg, Vossstr. 2, D-69115, Heidelberg, Germany. stefanie.joos@uni-tuebingen.de. AD - Institute of General Practice, University Hospital Tuebingen, Oesterbergstr. 9, D-72074, Tuebingen, Germany. stefanie.joos@uni-tuebingen.de. LA - eng SI - DRKS/DRKS00006056 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20150215 PL - England TA - Trials JT - Trials JID - 101263253 SB - IM MH - Breast Neoplasms/psychology/*therapy MH - Complementary Therapies/*nursing MH - Data Interpretation, Statistical MH - Female MH - Genital Neoplasms, Female/psychology/*therapy MH - Humans MH - Outcome Assessment (Health Care) MH - Quality Assurance, Health Care MH - *Quality of Life MH - Sample Size MH - Social Support PMC - PMC4337273 OID - NLM: PMC4337273 EDAT- 2015/04/19 06:00 MHDA- 2016/01/28 06:00 CRDT- 2015/04/19 06:00 PHST- 2014/06/14 [received] PHST- 2014/12/19 [accepted] AID - 10.1186/s13063-014-0538-4 [doi] AID - 10.1186/s13063-014-0538-4 [pii] PST - epublish SO - Trials. 2015 Feb 15;16:51. doi: 10.1186/s13063-014-0538-4. PMID- 25880673 OWN - NLM STAT- PubMed-not-MEDLINE DA - 20150417 DCOM- 20160702 LR - 20150417 IS - 2330-7749 (Print) IS - 2330-7749 (Linking) VI - 13 IP - 3 DP - 2015 Mar TI - The need for decision and communication aids: a survey of breast cancer survivors. PG - 104-12 LID - 10.12788/jcso.0116 [doi] AB - BACKGROUND: Qualitative studies have identified barriers to communication and informed decision making among breast cancer survivors making treatment decisions. The prevalence of these barriers is unknown. OBJECTIVE: To quantify the need for decision support among breast cancer survivors. METHODS: We surveyed 2,521 breast cancer survivors participating in an online registry hosted by the Cancer Support Community to find out what proportion of breast cancer patients: made decisions during their first visit with a specialist; received satisfactory information before that visit; asked questions and received responses; and endorsed expanded use of decision support. RESULTS: We received 1,017 (41%) responses and analyzed 917 surveys from women who lived in the United States. Most of the respondents recalled making treatment decisions during their first visit (52%). A minority (14%) received information before the first specialist visit. At least 25% of respondents rated their satisfaction below 7 on a scale of 10 for decision-making, information, and questions asked and answered. Respondents endorsed the need for assistance with obtaining information, listing questions, taking notes, and making audio-recordings of visits. LIMITATIONS: The respondent sample skewed younger and had higher-stage cancer compared with all breast cancer survivors. Responses were subject to recall bias. CONCLUSIONS: Cancer survivors expressed gaps in their care with respect to reviewing information, asking questions, obtaining answers, and making decisions. Implementing decision and communication aids immediately upon diagnosis, when treatment decisions are being made, would address these gaps. CI - (c)2015 Frontline Medical Communications. FAU - Belkora, Jeffrey K AU - Belkora JK AD - Institute for Health Policy Studies, University of California, San Francisco, California, USA. FAU - Miller, Melissa F AU - Miller MF AD - Public Health Research Scientist, Fairfax, Virginia, USA. FAU - Dougherty, Kasey AU - Dougherty K AD - Research Partnership, Horsham, Pennsylvania, USA. FAU - Gayer, Christopher AU - Gayer C AD - Research & Training Institute, Cancer Support Community, Philadelphia, Pennsylvania, USA. FAU - Golant, Mitch AU - Golant M AD - Research & Training Institute, Cancer Support Community, Philadelphia, Pennsylvania, USA. FAU - Buzaglo, Joanne S AU - Buzaglo JS AD - Research & Training Institute, Cancer Support Community, Philadelphia, Pennsylvania, USA. joanne@cancersupportcommunity.org. LA - eng PT - Journal Article PL - United States TA - J Community Support Oncol JT - The Journal of community and supportive oncology JID - 101621609 OTO - NOTNLM OT - breast cancer OT - communication aids OT - decision aids OT - decision support OT - office visits OT - shared decision making OT - visit preparation EDAT- 2015/04/17 06:00 MHDA- 2015/04/17 06:01 CRDT- 2015/04/17 06:00 PHST- 2014/11/05 [accepted] AID - 10.12788/jcso.0116 [doi] PST - ppublish SO - J Community Support Oncol. 2015 Mar;13(3):104-12. doi: 10.12788/jcso.0116. PMID- 25870388 OWN - NLM STAT- MEDLINE DA - 20150414 DCOM- 20150514 LR - 20150414 IS - 1460-2105 (Electronic) IS - 0027-8874 (Linking) VI - 107 IP - 4 DP - 2015 Apr TI - Response. LID - 10.1093/jnci/djv093 [doi] LID - djv093 [pii] FAU - Portschy, Pamela R AU - Portschy PR AD - Department of Surgery, University of Minnesota (PRP, TMT);Department of Health Policy and Management, University of Minnesota (KMK). ports001@umn.edu. FAU - Kuntz, Karen M AU - Kuntz KM AD - Department of Surgery, University of Minnesota (PRP, TMT);Department of Health Policy and Management, University of Minnesota (KMK). FAU - Tuttle, Todd M AU - Tuttle TM AD - Department of Surgery, University of Minnesota (PRP, TMT);Department of Health Policy and Management, University of Minnesota (KMK). LA - eng PT - Comment PT - Letter PL - United States TA - J Natl Cancer Inst JT - Journal of the National Cancer Institute JID - 7503089 SB - IM CON - J Natl Cancer Inst. 2015 Apr;107(4). pii: djv092. doi: 10.1093/jnci/djv092. PMID: 25870387 CON - J Natl Cancer Inst. 2014 Aug;106(8). pii: dju160. doi: 10.1093/jnci/dju160. PMID: 25031308 MH - Breast Neoplasms/*mortality/*surgery MH - *Decision Support Techniques MH - Female MH - Humans MH - *Mastectomy MH - Secondary Prevention/*methods EDAT- 2015/04/15 06:00 MHDA- 2015/05/15 06:00 CRDT- 2015/04/15 06:00 AID - djv093 [pii] AID - 10.1093/jnci/djv093 [doi] PST - ppublish SO - J Natl Cancer Inst. 2015 Apr;107(4). pii: djv093. doi: 10.1093/jnci/djv093. PMID- 25870387 OWN - NLM STAT- MEDLINE DA - 20150414 DCOM- 20150514 LR - 20150414 IS - 1460-2105 (Electronic) IS - 0027-8874 (Linking) VI - 107 IP - 4 DP - 2015 Apr TI - Re: Survival outcomes after contralateral prophylactic mastectomy: a decision analysis. LID - 10.1093/jnci/djv092 [doi] LID - djv092 [pii] FAU - Narod, Steven A AU - Narod SA AD - Familial Breast Cancer Research Unit, Women's College Research Institute steven.narod@wchospital.ca. LA - eng PT - Comment PT - Letter PL - United States TA - J Natl Cancer Inst JT - Journal of the National Cancer Institute JID - 7503089 SB - IM CON - J Natl Cancer Inst. 2014 Aug;106(8). pii: dju160. doi: 10.1093/jnci/dju160. PMID: 25031308 CIN - J Natl Cancer Inst. 2015 Apr;107(4). pii: djv093. doi: 10.1093/jnci/djv093. PMID: 25870388 MH - Breast Neoplasms/*mortality/*surgery MH - *Decision Support Techniques MH - Female MH - Humans MH - *Mastectomy MH - Secondary Prevention/*methods EDAT- 2015/04/15 06:00 MHDA- 2015/05/15 06:00 CRDT- 2015/04/15 06:00 AID - djv092 [pii] AID - 10.1093/jnci/djv092 [doi] PST - ppublish SO - J Natl Cancer Inst. 2015 Apr;107(4). pii: djv092. doi: 10.1093/jnci/djv092. PMID- 25862439 OWN - NLM STAT- MEDLINE DA - 20150525 DCOM- 20160513 LR - 20161017 IS - 1569-8041 (Electronic) IS - 0923-7534 (Linking) VI - 26 IP - 6 DP - 2015 Jun TI - Dynamic prediction in breast cancer: proving feasibility in clinical practice using the TEAM trial. PG - 1254-62 LID - 10.1093/annonc/mdv146 [doi] AB - BACKGROUND: Predictive models are an integral part of current clinical practice and help determine optimal treatment strategies for individual patients. A drawback is that covariates are assumed to have constant effects on overall survival (OS), when in fact, these effects may change during follow-up (FU). Furthermore, breast cancer (BC) patients may experience events that alter their prognosis from that time onwards. We investigated the 'dynamic' effects of different covariates on OS and developed a nomogram to calculate 5-year dynamic OS (DOS) probability at different prediction timepoints (tP) during FU. METHODS: Dutch and Belgian postmenopausal, endocrine-sensitive, early BC patients enrolled in the TEAM trial were included. We assessed time-varying effects of specific covariates and obtained 5-year DOS predictions using a proportional baselines landmark supermodel. Covariates included age, histological grade, hormone receptor and HER2 status, T- and N-stage, locoregional recurrence (LRR), distant recurrence, and treatment compliance. A nomogram was designed to calculate 5-year DOS based on individual characteristics. RESULTS: A total of 2602 patients were included (mean FU 6.2 years). N-stage, LRR, and HER2 status demonstrated time-varying effects on 5-year DOS. Hazard ratio (HR) functions for LRR, high-risk N-stage (N2/3), and HER2 positivity were HR = (8.427 x 0.583[Formula: see text], HR = (3.621 x 0.816[Formula: see text], and HR = (1.235 x 0.851[Formula: see text], respectively. Treatment discontinuation was associated with a higher mortality risk, but without a time-varying effect [HR 1.263 (0.867-1.841)]. All other covariates were time-constant. DISCUSSION: The current nomogram accounts for elapsed time since starting adjuvant endocrine treatment and optimizes prediction of individual 5-year DOS during FU for postmenopausal, endocrine-sensitive BC patients. The nomogram can facilitate in determining whether further therapy will benefit an individual patient, although validation in an independent dataset is still needed. CI - (c) The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com. FAU - Fontein, D B Y AU - Fontein DB AD - Department of Surgery. FAU - Klinten Grand, M AU - Klinten Grand M AD - Department of Medical Statistics. FAU - Nortier, J W R AU - Nortier JW AD - Department of Medical Oncology, Leiden University Medical Center, Leiden. FAU - Seynaeve, C AU - Seynaeve C AD - Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands. FAU - Meershoek-Klein Kranenbarg, E AU - Meershoek-Klein Kranenbarg E AD - Department of Surgery. FAU - Dirix, L Y AU - Dirix LY AD - Department of Medical Oncology, Academisch Ziekenhuis Sint-Augustinus Antwerp, Antwerp, Belgium. FAU - van de Velde, C J H AU - van de Velde CJ AD - Department of Surgery. FAU - Putter, H AU - Putter H AD - Department of Medical Statistics h.putter@lumc.nl. LA - eng SI - NTR/NTR267 PT - Clinical Trial, Phase III PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20150410 PL - England TA - Ann Oncol JT - Annals of oncology : official journal of the European Society for Medical Oncology JID - 9007735 RN - 0 (Antineoplastic Agents, Hormonal) RN - 0 (Biomarkers, Tumor) RN - EC 2.7.10.1 (ERBB2 protein, human) RN - EC 2.7.10.1 (Receptor, ErbB-2) SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Antineoplastic Agents, Hormonal/adverse effects/*therapeutic use MH - Belgium MH - Biomarkers, Tumor/analysis MH - Breast Neoplasms/chemistry/mortality/pathology/*therapy MH - Chemotherapy, Adjuvant MH - *Decision Support Techniques MH - Feasibility Studies MH - Female MH - Humans MH - *Mastectomy/adverse effects/mortality MH - Middle Aged MH - Neoplasm Recurrence, Local MH - Neoplasm Staging MH - Netherlands MH - Nomograms MH - Patient Selection MH - Predictive Value of Tests MH - Receptor, ErbB-2/analysis MH - Risk Assessment MH - Risk Factors MH - Survival Analysis MH - Time Factors MH - Treatment Outcome OTO - NOTNLM OT - breast cancer OT - dynamic prediction OT - landmark analysis OT - personalized therapy OT - survival probability EDAT- 2015/04/12 06:00 MHDA- 2016/05/14 06:00 CRDT- 2015/04/12 06:00 PHST- 2014/04/16 [received] PHST- 2015/03/05 [accepted] AID - mdv146 [pii] AID - 10.1093/annonc/mdv146 [doi] PST - ppublish SO - Ann Oncol. 2015 Jun;26(6):1254-62. doi: 10.1093/annonc/mdv146. Epub 2015 Apr 10. PMID- 25829374 OWN - NLM STAT- MEDLINE DA - 20150401 DCOM- 20151221 LR - 20170220 IS - 2044-6055 (Electronic) IS - 2044-6055 (Linking) VI - 5 IP - 3 DP - 2015 Mar 31 TI - Protocol for a pre-implementation and post-implementation study on shared decision-making in the surgical treatment of women with early-stage breast cancer. PG - e007698 LID - 10.1136/bmjopen-2015-007698 [doi] AB - BACKGROUND: The majority of patients diagnosed with early-stage breast cancer are in a position to choose between having a mastectomy or lumpectomy with radiation therapy (breast-conserving therapy). Since the long-term survival rates for mastectomy and for lumpectomy with radiation therapy are comparable, patients' informed preferences are important for decision-making. Although most clinicians believe that they do include patients in the decision-making process, the information that women with breast cancer receive regarding the surgical options is often rather subjective, and does not invite patients to express their preferences. Shared decision-making (SDM) is meant to help patients clarify their preferences, resulting in greater satisfaction with their final choice. Patient decision aids can be very supportive in SDM. We present the protocol of a study to beta test a patient decision aid and optimise strategies for the implementation of SDM regarding the treatment of early-stage breast cancer in the actual clinical setting. METHODS/DESIGN: This paper concerns a pre-implementation and post-implementation study, lasting from October 2014 to June 2015. The intervention consists of implementing SDM using a patient decision aid. The intervention will be evaluated using qualitative and quantitative measures, acquired prior to, during and after the implementation of SDM. Outcome measures are knowledge about treatment, perceived SDM and decisional conflict. We will also conduct face-to-face interviews with a sample of these patients and their care providers, to assess their experiences with the implementation of SDM and the patient decision aid. ETHICS AND DISSEMINATION: This protocol was approved by the Maastricht University Medical Centre (MUMC) ethics committee. The findings will be disseminated through peer-reviewed journal articles and presentations at national conferences. Findings will be used to finalise a multi-faceted implementation strategy to test the implementation of SDM and a patient decision aid in terms of cost-effectiveness, in a multicentre cluster randomised controlled trial (RCT). STUDY REGISTRATION NUMBER: NTR4879. CI - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. FAU - Savelberg, Wilma AU - Savelberg W AD - Oncology Center, Maastricht University Medical Center, Maastricht, The Netherlands. FAU - Moser, Albine AU - Moser A AD - Zuyd University of Applied Sciences, Heerlen, The Netherlands. FAU - Smidt, Marjolein AU - Smidt M AD - Oncology Center, Maastricht University Medical Center, Maastricht, The Netherlands. FAU - Boersma, Liesbeth AU - Boersma L AD - Department of Radiotherapy, Maastricht University Medical Center, Maastricht, The Netherlands. FAU - Haekens, Christel AU - Haekens C AD - Oncology Center, Maastricht University Medical Center, Maastricht, The Netherlands. FAU - van der Weijden, Trudy AU - van der Weijden T AD - Department of Family Medicine, Maastricht University, Maastricht, The Netherlands School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands. LA - eng SI - NTR/NTR4879 PT - Journal Article PT - Multicenter Study DEP - 20150331 PL - England TA - BMJ Open JT - BMJ open JID - 101552874 SB - IM MH - Attitude of Health Personnel MH - Breast Neoplasms/*pathology/radiotherapy/*surgery MH - Clinical Protocols MH - *Decision Making MH - Decision Support Techniques MH - Female MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Mastectomy, Segmental MH - Neoplasm Staging MH - Outcome Assessment (Health Care) MH - *Patient Participation MH - Patient Preference MH - Qualitative Research MH - Research Design PMC - PMC4386223 OID - NLM: PMC4386223 OTO - NOTNLM OT - Decision support Techniques OT - Patient participation OT - Patient preferences OT - Quality improvement OT - Shared decision making EDAT- 2015/04/02 06:00 MHDA- 2015/12/22 06:00 CRDT- 2015/04/02 06:00 AID - bmjopen-2015-007698 [pii] AID - 10.1136/bmjopen-2015-007698 [doi] PST - epublish SO - BMJ Open. 2015 Mar 31;5(3):e007698. doi: 10.1136/bmjopen-2015-007698. PMID- 25805427 OWN - NLM STAT- MEDLINE DA - 20150325 DCOM- 20151215 LR - 20150325 IS - 1532-3080 (Electronic) IS - 0960-9776 (Linking) VI - 24 IP - 2 DP - 2015 Apr TI - Prediction of pathological complete response to neoadjuvant chemotherapy by magnetic resonance imaging in breast cancer patients. PG - 159-65 LID - 10.1016/j.breast.2015.01.001 [doi] LID - S0960-9776(15)00002-8 [pii] AB - The purpose of this study was to evaluate whether the baseline breast MRI findings would be useful for the prediction for pathological complete response (pCR) by breast cancer patients to neoadjuvant chemotherapy. Primary breast cancer patients (stage II-III) preoperatively treated with sequential paclitaxel (12 cycles) and fluorouracil, epirubicin, and cyclophosphamide (4 cycles), followed by surgery were retrospectively enrolled, and 229 patients were eligible. Before chemotherapy, breast MRI studies were performed. Breast tumors were dichotomized into round + oval and irregular types based on MRI morphology. The round + oval tumors showed a significantly higher pCR rate than the irregular tumors (42.0% vs 17.3%; P < 0.001). In addition, PAM50 analysis revealed that basal and HER2-enriched tumors were significantly more prevalent among round + oval than irregular type tumors (P = 0.015). Baseline MRI morphology appears to be a significant predictor for pCR. The higher rate of the basal and HER2-enriched tumors among the round + oval tumors may explain their better chemo-sensitivity. CI - Copyright (c) 2015 Elsevier Ltd. All rights reserved. FAU - Michishita, Shintaro AU - Michishita S AD - Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan. FAU - Kim, Seung Jin AU - Kim SJ AD - Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan. Electronic address: kimsj@onsurg.med.osaka-u.ac.jp. FAU - Shimazu, Kenzo AU - Shimazu K AD - Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan. FAU - Sota, Yoshiaki AU - Sota Y AD - Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan. FAU - Naoi, Yasuto AU - Naoi Y AD - Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan. FAU - Maruyama, Naomi AU - Maruyama N AD - Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan. FAU - Kagara, Naofumi AU - Kagara N AD - Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan. FAU - Shimoda, Masafumi AU - Shimoda M AD - Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan. FAU - Shimomura, Atsushi AU - Shimomura A AD - Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan. FAU - Noguchi, Shinzaburo AU - Noguchi S AD - Department of Breast and Endocrine Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan. LA - eng PT - Clinical Study PT - Journal Article PL - Netherlands TA - Breast JT - Breast (Edinburgh, Scotland) JID - 9213011 RN - 0 (Estrogen Receptor alpha) RN - 0 (Receptors, Progesterone) RN - 0 (estrogen receptor alpha, human) RN - 3Z8479ZZ5X (Epirubicin) RN - 8N3DW7272P (Cyclophosphamide) RN - EC 2.7.10.1 (ERBB2 protein, human) RN - EC 2.7.10.1 (Receptor, ErbB-2) RN - P88XT4IS4D (Paclitaxel) RN - U3P01618RT (Fluorouracil) SB - IM MH - Adult MH - Aged MH - Antineoplastic Combined Chemotherapy Protocols/*therapeutic use MH - Breast Neoplasms/*drug therapy/metabolism/pathology MH - Carcinoma, Ductal, Breast/*drug therapy/metabolism/pathology MH - Carcinoma, Lobular/*drug therapy/metabolism/pathology MH - Cohort Studies MH - Cyclophosphamide/administration & dosage MH - Decision Support Techniques MH - Epirubicin/administration & dosage MH - Estrogen Receptor alpha/metabolism MH - Female MH - Fluorouracil/administration & dosage MH - Humans MH - Magnetic Resonance Imaging MH - *Mastectomy MH - Mastectomy, Segmental MH - Middle Aged MH - Neoadjuvant Therapy MH - Neoplasm Grading MH - Neoplasm Staging MH - Paclitaxel/administration & dosage MH - Prognosis MH - Receptor, ErbB-2/metabolism MH - Receptors, Progesterone/metabolism MH - Retrospective Studies MH - Treatment Outcome MH - Tumor Burden MH - Young Adult OTO - NOTNLM OT - Intrinsic subtype OT - MRI morphology OT - Neoadjuvant chemotherapy OT - Predictor OT - pCR EDAT- 2015/03/26 06:00 MHDA- 2015/12/17 06:00 CRDT- 2015/03/26 06:00 PHST- 2014/09/06 [received] PHST- 2014/12/14 [revised] PHST- 2015/01/01 [accepted] AID - S0960-9776(15)00002-8 [pii] AID - 10.1016/j.breast.2015.01.001 [doi] PST - ppublish SO - Breast. 2015 Apr;24(2):159-65. doi: 10.1016/j.breast.2015.01.001. PMID- 25752562 OWN - NLM STAT- MEDLINE DA - 20150310 DCOM- 20150709 LR - 20151119 IS - 1474-5488 (Electronic) IS - 1470-2045 (Linking) VI - 16 IP - 3 DP - 2015 Mar TI - Radiation therapy in the locoregional treatment of triple-negative breast cancer. PG - e113-22 LID - 10.1016/S1470-2045(14)71104-0 [doi] LID - S1470-2045(14)71104-0 [pii] AB - This Review assesses the relevant data and controversies regarding the use of radiotherapy for, and locoregional management of, women with triple-negative breast cancer (TNBC). In view of the strong association between BRCA1 and TNBC, knowledge of baseline mutation status can be useful to guide locoregional treatment decisions. TNBC is not a contraindication for breast conservation therapy because data suggest increased locoregional recurrence risks (relative to luminal subtypes) with breast conservation therapy or mastectomy. Although a boost to the tumour bed should routinely be considered after whole breast radiation therapy, TNBC should not be the sole indication for post-mastectomy radiation, and accelerated delivery methods for TNBC should be offered on clinical trials. Preliminary data implying a relative radioresistance for TNBC do not imply radiation omission because radiation provides an absolute locoregional risk reduction. At present, the integration of subtypes in locoregional management decisions is still in its infancy. Until level 1 data supporting treatment decisions based on subtypes are available, standard locoregional management principles should be adhered to. CI - Copyright (c) 2015 Elsevier Ltd. All rights reserved. FAU - Moran, Meena S AU - Moran MS AD - Yale University School of Medicine, Department of Therapeutic Radiology, New Haven, CT, USA. Electronic address: Meena.Moran@yale.edu. LA - eng PT - Journal Article PT - Review PL - England TA - Lancet Oncol JT - The Lancet. Oncology JID - 100957246 RN - 0 (Biomarkers, Tumor) SB - IM MH - Biomarkers, Tumor/analysis/genetics MH - Decision Support Techniques MH - Dose Fractionation MH - Female MH - Genetic Predisposition to Disease MH - Humans MH - *Mastectomy MH - Neoplasm Recurrence, Local MH - Patient Selection MH - Phenotype MH - Predictive Value of Tests MH - Radiation Tolerance MH - Radiotherapy, Adjuvant MH - Risk Assessment MH - Risk Factors MH - Treatment Outcome MH - Triple Negative Breast Neoplasms/chemistry/genetics/pathology/*radiotherapy/*surgery EDAT- 2015/03/11 06:00 MHDA- 2015/07/15 06:00 CRDT- 2015/03/11 06:00 AID - S1470-2045(14)71104-0 [pii] AID - 10.1016/S1470-2045(14)71104-0 [doi] PST - ppublish SO - Lancet Oncol. 2015 Mar;16(3):e113-22. doi: 10.1016/S1470-2045(14)71104-0. PMID- 25749023 OWN - NLM STAT- MEDLINE DA - 20150430 DCOM- 20161031 LR - 20161230 IS - 1873-5134 (Electronic) IS - 0738-3991 (Linking) VI - 98 IP - 6 DP - 2015 Jun TI - Primary systemic therapy for breast cancer: Does the patient's involvement in decision-making create a new future? PG - 695-703 LID - 10.1016/j.pec.2015.02.012 [doi] LID - S0738-3991(15)00082-8 [pii] AB - OBJECTIVE: Primary systemic therapy (PST) followed by surgery is the standard initial treatment for locally advanced breast cancer (LABC). However, some patients are averse to mastectomy or breast-conserving surgery and do not consent to these procedures. The reasons for this controversial decision, the factors influencing the decision-making and optimal solutions for decision aiding need to be investigated. METHODS: We addressed these questions by a review of literature on the possibilities associated with different patient choices and subsequent treatment options in relation to LABC. RESULTS: A total of 5 reviews and 22 clinical studies were summarized in relation to decision making and the most successful decision aids. A discussion is given of the issues of those few patients who cannot be convinced to undergo surgery. CONCLUSION: Currently there is no guideline for the treatment of patients who reject the surgical procedures after PST. Medical oncologists should be able to apply decision aid modalities in a personalized manner to give all needed information to their patients thereby ensuring a deliberate decision-making process, facilitating acceptance of a need for surgery, and thus improving the chances of prolonged survival. PRACTICE IMPLICATIONS: Currently multidisciplinary tumor boards are the most suitable decision aids in oncological practice. CI - Copyright (c) 2015 Elsevier Ireland Ltd. All rights reserved. FAU - Tokes, Timea AU - Tokes T AD - Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary. Electronic address: tokes.timea@med.semmelweis-univ.hu. FAU - Torgyik, Laszlo AU - Torgyik L AD - Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary. FAU - Szentmartoni, Gyongyver AU - Szentmartoni G AD - Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary. FAU - Somlai, Krisztian AU - Somlai K AD - Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary; St. Margaret Hospital, Surgical Division, Budapest, Hungary. FAU - Toth, Andrea AU - Toth A AD - Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary. FAU - Kulka, Janina AU - Kulka J AD - Semmelweis University, 2nd Department of Pathology, Budapest, Hungary. FAU - Dank, Magdolna AU - Dank M AD - Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20150225 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 RN - 0 (Antineoplastic Agents) SB - N MH - Adult MH - Antineoplastic Agents/therapeutic use MH - Breast Neoplasms/drug therapy/surgery/*therapy MH - *Decision Making MH - Decision Support Techniques MH - Female MH - Humans MH - Mastectomy MH - Outcome and Process Assessment (Health Care)/*trends MH - *Patient Participation OTO - NOTNLM OT - Breast cancer OT - Breast-conserving surgery OT - Decision making OT - Decision-aid OT - Primary systemic therapy EDAT- 2015/03/10 06:00 MHDA- 2016/11/01 06:00 CRDT- 2015/03/10 06:00 PHST- 2014/08/21 [received] PHST- 2015/02/05 [revised] PHST- 2015/02/15 [accepted] AID - S0738-3991(15)00082-8 [pii] AID - 10.1016/j.pec.2015.02.012 [doi] PST - ppublish SO - Patient Educ Couns. 2015 Jun;98(6):695-703. doi: 10.1016/j.pec.2015.02.012. Epub 2015 Feb 25. PMID- 25719688 OWN - NLM STAT- MEDLINE DA - 20150227 DCOM- 20150611 LR - 20161025 IS - 1529-4242 (Electronic) IS - 0032-1052 (Linking) VI - 135 IP - 3 DP - 2015 Mar TI - Defining the relationship between patient decisions to undergo breast reconstruction and contralateral prophylactic mastectomy. PG - 661-70 LID - 10.1097/PRS.0000000000001044 [doi] AB - BACKGROUND: Recent studies suggest that the decisions to undergo breast reconstruction and contralateral prophylactic mastectomy are closely related. In this article, the relationship between method of reconstruction and decision to undergo contralateral prophylactic mastectomy is described. Recent trends in contralateral use in the context of literature questioning its oncologic benefit are also evaluated. METHODS: Female patients with unilateral breast cancer were identified and data extracted from the Surveillance, Epidemiology, and End Results database from 2000 through 2010. Logistic regression analyses were performed to study the relationship between having contralateral prophylactic mastectomy and key demographic, oncologic, and reconstructive factors among women with unilateral breast cancer. RESULTS: A total of 157,042 patients with unilateral breast cancer were included. The contralateral prophylactic mastectomy rate increased from 7.7 percent to 28.3 percent during the study period, and the proportion of reconstructed patients who underwent contralateral prophylactic mastectomy increased from 19 percent to 46 percent. Reconstruction was associated with higher odds of contralateral prophylactic mastectomy (OR, 2.79; 95 percent CI, 2.70 to 2.88; p < 0.0001). Among women who had reconstruction, implant-based reconstruction was associated with significantly higher odds of contralateral prophylactic mastectomy than autologous tissue reconstruction (OR, 1.38; p < 0.0001). CONCLUSIONS: This study confirms that reconstruction and the decision to undergo contralateral prophylactic mastectomy are closely related, with implant reconstruction dominating in these patients. Given the close relationship between reconstruction and the choice for contralateral prophylactic mastectomy, plastic surgeons should play an active role in educating patients to avoid decisions made based on inaccurate information. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II. FAU - Agarwal, Shailesh AU - Agarwal S AD - Ann Arbor, Mich. From the Section of Plastic Surgery, Department of Surgery, the Section of Surgical Oncology, Department of Surgery, University of Michigan Medical School; and the Department of Biostatistics, School of Public Health, University of Michigan. FAU - Kidwell, Kelley M AU - Kidwell KM FAU - Kraft, Casey T AU - Kraft CT FAU - Kozlow, Jeffrey H AU - Kozlow JH FAU - Sabel, Michael S AU - Sabel MS FAU - Chung, Kevin C AU - Chung KC FAU - Momoh, Adeyiza O AU - Momoh AO LA - eng GR - K24 AR053120/AR/NIAMS NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - United States TA - Plast Reconstr Surg JT - Plastic and reconstructive surgery JID - 1306050 SB - AIM SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/psychology/*surgery MH - Choice Behavior MH - Female MH - Follow-Up Studies MH - Humans MH - Mammaplasty/*methods/psychology MH - Mastectomy/*methods/psychology MH - Middle Aged MH - Patient Compliance/*psychology MH - *Patient Education as Topic MH - Prognosis MH - *Registries MH - Retrospective Studies MH - Surveys and Questionnaires MH - United States MH - Young Adult PMC - PMC4822506 MID - NIHMS773268 OID - NLM: NIHMS773268 OID - NLM: PMC4822506 EDAT- 2015/02/27 06:00 MHDA- 2015/06/13 06:00 CRDT- 2015/02/27 06:00 AID - 10.1097/PRS.0000000000001044 [doi] AID - 00006534-201503000-00003 [pii] PST - ppublish SO - Plast Reconstr Surg. 2015 Mar;135(3):661-70. doi: 10.1097/PRS.0000000000001044. PMID- 25713152 OWN - NLM STAT- MEDLINE DA - 20150307 DCOM- 20150406 LR - 20150307 IS - 1460-2105 (Electronic) IS - 0027-8874 (Linking) VI - 107 IP - 3 DP - 2015 Mar TI - Response. LID - 10.1093/jnci/dju508 [doi] FAU - Portschy, Pamela R AU - Portschy PR FAU - Kuntz, Karen M AU - Kuntz KM FAU - Tuttle, Todd M AU - Tuttle TM LA - eng PT - Comment PT - Letter PL - United States TA - J Natl Cancer Inst JT - Journal of the National Cancer Institute JID - 7503089 SB - IM CON - J Natl Cancer Inst. 2015 Mar;107(3). doi: 10.1093/jnci/dju507. PMID: 25713151 CON - J Natl Cancer Inst. 2014 Aug;106(8). pii: dju160. doi: 10.1093/jnci/dju160. PMID: 25031308 MH - Breast Neoplasms/*mortality/*surgery MH - *Decision Support Techniques MH - Female MH - Humans MH - *Mastectomy MH - Secondary Prevention/*methods EDAT- 2015/02/26 06:00 MHDA- 2015/04/07 06:00 CRDT- 2015/02/26 06:00 AID - dju508 [pii] AID - 10.1093/jnci/dju508 [doi] PST - ppublish SO - J Natl Cancer Inst. 2015 Mar;107(3). doi: 10.1093/jnci/dju508. PMID- 25713151 OWN - NLM STAT- MEDLINE DA - 20150307 DCOM- 20150406 LR - 20150307 IS - 1460-2105 (Electronic) IS - 0027-8874 (Linking) VI - 107 IP - 3 DP - 2015 Mar TI - Re: Survival outcomes after contralateral prophylactic mastectomy: a decision analysis. LID - 10.1093/jnci/dju507 [doi] FAU - Narod, Steven A AU - Narod SA LA - eng PT - Comment PT - Letter PL - United States TA - J Natl Cancer Inst JT - Journal of the National Cancer Institute JID - 7503089 SB - IM CON - J Natl Cancer Inst. 2014 Aug;106(8). pii: dju160. doi: 10.1093/jnci/dju160. PMID: 25031308 CIN - J Natl Cancer Inst. 2015 Mar;107(3). doi: 10.1093/jnci/dju508. PMID: 25713152 MH - Breast Neoplasms/*mortality/*surgery MH - *Decision Support Techniques MH - Female MH - Humans MH - *Mastectomy MH - Secondary Prevention/*methods EDAT- 2015/02/26 06:00 MHDA- 2015/04/07 06:00 CRDT- 2015/02/26 06:00 AID - dju507 [pii] AID - 10.1093/jnci/dju507 [doi] PST - ppublish SO - J Natl Cancer Inst. 2015 Mar;107(3). doi: 10.1093/jnci/dju507. PMID- 25701388 OWN - NLM STAT- MEDLINE DA - 20150311 DCOM- 20160204 LR - 20160610 IS - 1432-5241 (Electronic) IS - 0364-216X (Linking) VI - 39 IP - 2 DP - 2015 Apr TI - Chinese women's preferences and concerns regarding incision location for breast augmentation surgery: a survey of 216 patients. PG - 214-26 LID - 10.1007/s00266-015-0457-0 [doi] AB - BACKGROUND: The axillary approach is the dominant incision used in China for breast augmentation. Systematic preoperative education regarding incision locations for breast augmentation is scarce in China. In this study, we surveyed Chinese patients to ascertain their preferences and concerns for incision location based on a comprehensive understanding of different incisions. METHODS: We used a literature review, patient interviews, and expert panels to develop the preoperative education material and questionnaire regarding different incision locations. The respondents were requested to choose one incision location before and after they received the preoperative education. Their initial choices and final decisions as well as the reasons for these choices were recorded and analyzed. Multinomial logistic regression was preformed to analyze the affecting factors on the incision choice. RESULTS: A total of 216 Chinese women participated in the study between 2012.5 and 2014.1. Initially, 176 (81.48%) women chose axillary incision, 27 (12.50%) chose periareolar incision, and 13 (6.02%) chose inframammary fold (IMF) incision. After they received preoperative education on incisions, the axillary and periareolar approaches decreased to 117 (54.17%) and 13 (6.02%), respectively, while IMF increased to 86 (39.81%). The easily hidden scar (43.98%), lower capsular contracture rate (23.15%), and lower possibility of injury to the breast parenchyma (17.13%) ranked as the top 3 reasons for the incision choice. Patients with a preoperative cup size of AA were 12.316 times more likely to choose the axillary approach relative to the IMF approach compared with those with a B cup (P = 0.044; 95% confidence interval [CI] 1.069-141.923). For each one-unit increase in BMI, the odds that a patient would choose the axillary versus the periareolar approach decreased by 32.4% (P = 0.049; 95% CI 0.457-0.999). CONCLUSIONS: The systematic and objective preoperative education material and questionnaire regarding different incision locations helped the Chinese patients make truly informed decisions and express their personal requirements. The axillary approach was the first option for more than half of Chinese women mainly because an easily hidden scar was considered the primary concern during the decision-making process. The patients with a low BMI and a small preoperative breast cup size were more likely to choose an axillary incision. However, a considerable number of Chinese women would choose the IMF incision and value its superiority in terms of a lower capsular contracture rate, less tissue trauma, and lower possibility of injury to the breast parenchyma. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. FAU - Sun, Jingjing AU - Sun J AD - Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China. FAU - Liu, Chunjun AU - Liu C FAU - Mu, Dali AU - Mu D FAU - Wang, Keming AU - Wang K FAU - Zhu, Sainan AU - Zhu S FAU - He, Yi AU - He Y FAU - Luan, Jie AU - Luan J LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20150221 PL - United States TA - Aesthetic Plast Surg JT - Aesthetic plastic surgery JID - 7701756 SB - IM CIN - Aesthetic Plast Surg. 2015 Jun;39(3):452-3. PMID: 25900451 CIN - Aesthetic Plast Surg. 2016 Feb;40(1):184-5. PMID: 26715574 MH - Adult MH - Attitude to Health MH - China MH - Cicatrix/prevention & control MH - Female MH - Humans MH - Logistic Models MH - Mammaplasty/*methods MH - Middle Aged MH - Patient Education as Topic MH - Patient Satisfaction MH - Young Adult EDAT- 2015/02/24 06:00 MHDA- 2016/02/05 06:00 CRDT- 2015/02/22 06:00 PHST- 2014/10/25 [received] PHST- 2015/01/29 [accepted] AID - 10.1007/s00266-015-0457-0 [doi] PST - ppublish SO - Aesthetic Plast Surg. 2015 Apr;39(2):214-26. doi: 10.1007/s00266-015-0457-0. Epub 2015 Feb 21. PMID- 25701273 OWN - NLM STAT- MEDLINE DA - 20150506 DCOM- 20150720 LR - 20161125 IS - 1474-547X (Electronic) IS - 0140-6736 (Linking) VI - 385 IP - 9978 DP - 2015 Apr 25 TI - Use of a decision aid including information on overdetection to support informed choice about breast cancer screening: a randomised controlled trial. PG - 1642-52 LID - 10.1016/S0140-6736(15)60123-4 [doi] LID - S0140-6736(15)60123-4 [pii] AB - BACKGROUND: Mammography screening can reduce breast cancer mortality. However, most women are unaware that inconsequential disease can also be detected by screening, leading to overdiagnosis and overtreatment. We aimed to investigate whether including information about overdetection of breast cancer in a decision aid would help women aged around 50 years to make an informed choice about breast screening. METHODS: We did a community-based, parallel-group, randomised controlled trial in New South Wales, Australia, using a random cohort of women aged 48-50 years. Recruitment to the study was done by telephone; women were eligible if they had not had mammography in the past 2 years and did not have a personal or strong family history of breast cancer. With a computer program, we randomly assigned 879 participants to either the intervention decision aid (comprising evidence-based explanatory and quantitative information on overdetection, breast cancer mortality reduction, and false positives) or a control decision aid (including information on breast cancer mortality reduction and false positives). Participants and interviewers were masked to group assignment. The primary outcome was informed choice (defined as adequate knowledge and consistency between attitudes and screening intentions), which we assessed by telephone interview about 3 weeks after random allocation. The primary outcome was analysed in all women who completed the relevant follow-up interview questions fully. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12613001035718. FINDINGS: Between January, 2014, and July, 2014, 440 women were allocated to the intervention group and 439 were assigned to the control group. 21 women in the intervention group and 20 controls were lost to follow-up; a further ten women assigned to the intervention and 11 controls did not answer all questions on attitudes. Therefore, 409 women in the intervention group and 408 controls were analysed for the primary outcome. 99 (24%) of 409 women in the intervention group made an informed choice compared with 63 (15%) of 408 in the control group (difference 9%, 95% CI 3-14; p=0.0017). Compared with controls, more women in the intervention group met the threshold for adequate overall knowledge (122/419 [29%] vs 71/419 [17%]; difference 12%, 95% CI 6-18; p<0.0001), fewer women expressed positive attitudes towards screening (282/409 [69%] vs 340/408 [83%]; 14%, 9-20; p<0.0001), and fewer women intended to be screened (308/419 [74%] vs 363/419 [87%]; 13%, 8-19; p<0.0001). When conceptual knowledge alone was considered, 203 (50%) of 409 women in the intervention group made an informed choice compared with 79 (19%) of 408 in the control group (p<0.0001). INTERPRETATION: Information on overdetection of breast cancer provided within a decision aid increased the number of women making an informed choice about breast screening. Becoming better informed might mean women are less likely to choose screening. FUNDING: Australian National Health and Medical Research Council. CI - Copyright (c) 2015 Elsevier Ltd. All rights reserved. FAU - Hersch, Jolyn AU - Hersch J AD - Screening & Test Evaluation Program (STEP), The University of Sydney, Sydney, NSW 2006, Australia; Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW 2006, Australia. FAU - Barratt, Alexandra AU - Barratt A AD - Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW 2006, Australia. FAU - Jansen, Jesse AU - Jansen J AD - Screening & Test Evaluation Program (STEP), The University of Sydney, Sydney, NSW 2006, Australia; Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW 2006, Australia. FAU - Irwig, Les AU - Irwig L AD - Screening & Test Evaluation Program (STEP), The University of Sydney, Sydney, NSW 2006, Australia. FAU - McGeechan, Kevin AU - McGeechan K AD - Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW 2006, Australia. FAU - Jacklyn, Gemma AU - Jacklyn G AD - School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia. FAU - Thornton, Hazel AU - Thornton H AD - Department of Health Sciences, University of Leicester; Leicester, UK. FAU - Dhillon, Haryana AU - Dhillon H AD - Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW 2006, Australia; Central Clinical School, The University of Sydney, Sydney, NSW 2006, Australia. FAU - Houssami, Nehmat AU - Houssami N AD - Screening & Test Evaluation Program (STEP), The University of Sydney, Sydney, NSW 2006, Australia. FAU - McCaffery, Kirsten AU - McCaffery K AD - Screening & Test Evaluation Program (STEP), The University of Sydney, Sydney, NSW 2006, Australia; Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW 2006, Australia. Electronic address: kirsten.mccaffery@sydney.edu.au. LA - eng SI - ANZCTR/ACTRN12613001035718 PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20150218 PL - England TA - Lancet JT - Lancet (London, England) JID - 2985213R SB - AIM SB - IM CIN - Lancet. 2015 Apr 25;385(9978):1597-9. PMID: 25701272 EIN - Lancet. 2015 Apr 25;385(9978):1622. PMID: 25943820 MH - Breast Neoplasms/diagnostic imaging/prevention & control MH - Decision Making MH - *Decision Support Techniques MH - Female MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - Mammography/*utilization MH - Middle Aged MH - Patient Education as Topic MH - Patient Participation EDAT- 2015/02/24 06:00 MHDA- 2015/07/21 06:00 CRDT- 2015/02/22 06:00 AID - S0140-6736(15)60123-4 [pii] AID - 10.1016/S0140-6736(15)60123-4 [doi] PST - ppublish SO - Lancet. 2015 Apr 25;385(9978):1642-52. doi: 10.1016/S0140-6736(15)60123-4. Epub 2015 Feb 18. PMID- 25647821 OWN - NLM STAT- MEDLINE DA - 20150204 DCOM- 20150928 LR - 20161020 IS - 1024-2708 (Print) IS - 1024-2708 (Linking) VI - 20 Suppl 7 DP - 2014 Dec TI - Decision aids for breast cancer surgery: a randomised controlled trial. PG - 24-7 FAU - Lam, W W T AU - Lam WW AD - Department of Community Medicine, School of Public Health, The University of Hong Kong. FAU - Fielding, R AU - Fielding R AD - Department of Community Medicine, School of Public Health, The University of Hong Kong. FAU - Butow, P AU - Butow P AD - School of Psychology, University of Sydney. FAU - Cowling, B J AU - Cowling BJ AD - Department of Community Medicine, School of Public Health, The University of Hong Kong. FAU - Chan, M AU - Chan M AD - The Breast Centre, Department of Surgery, Kwong Wah Hospital. FAU - Or, A AU - Or A AD - The Breast Centre, Department of Surgery, Kwong Wah Hospital. FAU - Kwong, A AU - Kwong A AD - Breast Surgery Division, Department of Surgery, The University of Hong Kong. FAU - Suen, D AU - Suen D AD - Breast Surgery Division, Department of Surgery, The University of Hong Kong. LA - eng PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PL - China TA - Hong Kong Med J JT - Hong Kong medical journal = Xianggang yi xue za zhi JID - 9512509 SB - IM MH - Adult MH - Aged MH - Breast Neoplasms/*surgery MH - China MH - Decision Making MH - *Decision Support Techniques MH - Female MH - Follow-Up Studies MH - Humans MH - Mastectomy/*methods/psychology MH - Middle Aged MH - Pamphlets EDAT- 2015/02/04 06:00 MHDA- 2015/09/29 06:00 CRDT- 2015/02/04 06:00 PST - ppublish SO - Hong Kong Med J. 2014 Dec;20 Suppl 7:24-7. PMID- 25590246 OWN - NLM STAT- MEDLINE DA - 20150116 DCOM- 20150519 LR - 20150116 IS - 1536-3708 (Electronic) IS - 0148-7043 (Linking) VI - 74 IP - 2 DP - 2015 Feb TI - A classification system for fat necrosis in autologous breast reconstruction. PG - 269 LID - 10.1097/01.sap.0000460803.22412.44 [doi] FAU - Konneker, Soren AU - Konneker S AD - Department of Plastic Hand and Reconstructive Surgery Hannover Medical School Hannover, Germany. FAU - Vogt, Peter M AU - Vogt PM FAU - Jokuszies, Andreas AU - Jokuszies A LA - eng PT - Comment PT - Letter PL - United States TA - Ann Plast Surg JT - Annals of plastic surgery JID - 7805336 SB - IM CON - Ann Plast Surg. 2013 May;70(5):553-6. PMID: 23542852 MH - *Decision Support Techniques MH - Fat Necrosis/*classification MH - Female MH - Humans MH - *Mammaplasty MH - Postoperative Complications/*classification EDAT- 2015/01/16 06:00 MHDA- 2015/05/20 06:00 CRDT- 2015/01/16 06:00 AID - 10.1097/01.sap.0000460803.22412.44 [doi] PST - ppublish SO - Ann Plast Surg. 2015 Feb;74(2):269. doi: 10.1097/01.sap.0000460803.22412.44. PMID- 26958276 OWN - NLM STAT- PubMed-not-MEDLINE DA - 20160309 LR - 20170220 IS - 1942-597X (Electronic) IS - 1559-4076 (Linking) VI - 2015 DP - 2015 TI - Barriers and Facilitators to Patient-Provider Communication When Discussing Breast Cancer Risk to Aid in the Development of Decision Support Tools. PG - 1352-60 AB - The purpose of this study was to identify barriers and facilitators to patient-provider communication when discussing breast cancer risk to aid in the development of decision support tools. Four patient focus groups (N=34) and eight provider focus groups (N=10) took place in Northern Manhattan. A qualitative analysis was conducted using Atlas.ti software. The coding yielded 62.3%-94.5% agreement. The results showed that 1) barriers are time constraints, lack of knowledge, low health literacy, and language barriers, and 2) facilitators are information needs, desire for personalization, and autonomy when communicating risk in patient-provider encounters. These results will inform the development of a patient-centered decision aid (RealRisks) and a provider-facing breast cancer risk navigation (BNAV) tool, which are designed to facilitate patient-provider risk communication and shared decision-making about breast cancer prevention strategies, such as chemoprevention. FAU - Yi, Haeseung AU - Yi H AD - Columbia University, New York, NY. FAU - Xiao, Tong AU - Xiao T AD - Columbia University, New York, NY. FAU - Thomas, Parijatham S AU - Thomas PS AD - MD Anderson Cancer Center, Houston, TX. FAU - Aguirre, Alejandra N AU - Aguirre AN AD - Columbia University, New York, NY. FAU - Smalletz, Cindy AU - Smalletz C AD - Columbia University, New York, NY. FAU - Dimond, Jill AU - Dimond J AD - Sassafras Tech Collective, Ann Arbor, MI. FAU - Finkelstein, Joseph AU - Finkelstein J AD - Columbia University, New York, NY. FAU - Infante, Katherine AU - Infante K AD - Columbia University, New York, NY. FAU - Trivedi, Meghna AU - Trivedi M AD - Columbia University, New York, NY. FAU - David, Raven AU - David R AD - Columbia University, New York, NY. FAU - Vargas, Jennifer AU - Vargas J AD - Columbia University, New York, NY. FAU - Crew, Katherine D AU - Crew KD AD - Columbia University, New York, NY. FAU - Kukafka, Rita AU - Kukafka R AD - Columbia University, New York, NY. LA - eng GR - R01 CA177995/CA/NCI NIH HHS/United States GR - R18 HS019313/HS/AHRQ HHS/United States PT - Journal Article DEP - 20151105 PL - United States TA - AMIA Annu Symp Proc JT - AMIA ... Annual Symposium proceedings. AMIA Symposium JID - 101209213 SB - IM PMC - PMC4765687 OID - NLM: PMC4765687 EDAT- 2015/01/01 00:00 MHDA- 2015/01/01 00:01 CRDT- 2016/03/10 06:00 PST - epublish SO - AMIA Annu Symp Proc. 2015 Nov 5;2015:1352-60. eCollection 2015. PMID- 25517410 OWN - NLM STAT- MEDLINE DA - 20150327 DCOM- 20150601 LR - 20151103 IS - 1529-4242 (Electronic) IS - 0032-1052 (Linking) VI - 135 IP - 4 DP - 2015 Apr TI - A cost-utility analysis of the use of preoperative computed tomographic angiography in abdomen-based perforator flap breast reconstruction. PG - 662e-9e LID - 10.1097/PRS.0000000000001133 [doi] AB - BACKGROUND: Computed tomographic angiography is a diagnostic tool increasingly used for preoperative vascular mapping in abdomen-based perforator flap breast reconstruction. This study compared the use of computed tomographic angiography and the conventional practice of Doppler ultrasonography only in postmastectomy reconstruction using a cost-utility model. METHODS: Following a comprehensive literature review, a decision analytic model was created using the three most clinically relevant health outcomes in free autologous breast reconstruction with computed tomographic angiography versus Doppler ultrasonography only. Cost and utility estimates for each health outcome were used to derive the quality-adjusted life-years and incremental cost-utility ratio. One-way sensitivity analysis was performed to scrutinize the robustness of the authors' results. RESULTS: Six studies and 782 patients were identified. Cost-utility analysis revealed a baseline cost savings of $3179, a gain in quality-adjusted life-years of 0.25. This yielded an incremental cost-utility ratio of -$12,716, implying a dominant choice favoring preoperative computed tomographic angiography. Sensitivity analysis revealed that computed tomographic angiography was costlier when the operative time difference between the two techniques was less than 21.3 minutes. However, the clinical advantage of computed tomographic angiography over Doppler ultrasonography only showed that computed tomographic angiography would still remain the cost-effective option even if it offered no additional operating time advantage. CONCLUSIONS: The authors' results show that computed tomographic angiography is a cost-effective technology for identifying lower abdominal perforators for autologous breast reconstruction. Although the perfect study would be a randomized controlled trial of the two approaches with true cost accrual, the authors' results represent the best available evidence. FAU - Offodile, Anaeze C 2nd AU - Offodile AC 2nd AD - Burlington, Mass.; and Philadelphia, Pa. From the Department of Plastic Surgery, Lahey Hospital and Medical Center; and the Divisions of Endocrine and Oncologic Surgery, Department of Surgery, University of Pennsylvania. FAU - Chatterjee, Abhishek AU - Chatterjee A FAU - Vallejo, Sergio AU - Vallejo S FAU - Fisher, Carla S AU - Fisher CS FAU - Tchou, Julia C AU - Tchou JC FAU - Guo, Lifei AU - Guo L LA - eng PT - Comparative Study PT - Evaluation Studies PT - Journal Article PT - Review PL - United States TA - Plast Reconstr Surg JT - Plastic and reconstructive surgery JID - 1306050 SB - AIM SB - IM EIN - Plast Reconstr Surg. 2015 Sep;136(3):626 MH - Abdomen MH - Angiography/*economics/*methods MH - *Cost-Benefit Analysis MH - Decision Support Techniques MH - Humans MH - Mammaplasty/*economics MH - Perforator Flap/*economics MH - Preoperative Care/*economics MH - Tomography, X-Ray Computed/*economics MH - Ultrasonography, Doppler/*economics EDAT- 2014/12/18 06:00 MHDA- 2015/06/02 06:00 CRDT- 2014/12/18 06:00 AID - 10.1097/PRS.0000000000001133 [doi] PST - ppublish SO - Plast Reconstr Surg. 2015 Apr;135(4):662e-9e. doi: 10.1097/PRS.0000000000001133. PMID- 25433370 OWN - NLM STAT- MEDLINE DA - 20150428 DCOM- 20151116 LR - 20170220 IS - 1748-5908 (Electronic) IS - 1748-5908 (Linking) VI - 9 DP - 2014 Nov 29 TI - Enablers and barriers to using patient decision aids in early stage breast cancer consultations: a qualitative study of surgeons' views. PG - 174 LID - 10.1186/s13012-014-0174-0 [doi] AB - BACKGROUND: For early stage breast cancer, randomized controlled trials (RCTs) have shown that patient decision aids (PtDAs), when used by surgeons, result in increased patient knowledge about options and different patient treatment choices as compared to standard care. Yet, recent data suggests that PtDAs are used by less than 25% of Canadian cancer physicians. We conducted a study to explore breast cancer surgeons' views on enablers and barriers to the use of PtDAs in their practice. METHODS: Purposeful sampling was used to select breast cancer surgeons in three Ontario health regions to participate in semi-structured interviews. Inductive coding and the constant comparative method were used to identify the main themes. RESULTS: Twenty-two surgeons (79%) agreed to participate (median age, 50 years; 9 (40%) female). Surgeons practiced in academic (n = 7, 32%) or community (n = 15, 68%) hospitals. Fourteen surgeons were aware of PtDAs, nine had used a PtDA with patients as part of an RCT, and six had developed their own informal PtDA for use in their practice. Enablers of informal PtDA use included surgeon exposure during training and surgeon perceived need for a systematic approach when communicating risks and benefits of surgical treatments with patients. Barriers to formal PtDA use included high surgeon confidence in their verbal communication skills, surgeon belief that patients understood conveyed information, and difficulties embedding such tools in practice routines. CONCLUSIONS: Surgeons in this study valued systematic communication with patients. Several surgeons changed their practice to include formal or informal PtDAs provided they perceived there was a clear benefit to themselves or to patients. However, high surgeon confidence in their personal communications skills coupled with beliefs that patients understand conveyed information may be key barriers to PtDA uptake once surgeons have established communication routines. FAU - O'Brien, Mary Ann AU - O'Brien MA AD - Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Fifth Floor, Toronto, ON, M5G 1 V7, Canada. maryann.obrien@utoronto.ca. AD - Knowledge Translation Research Network, Health Services Research Program, Ontario Institute for Cancer Research, Toronto, ON, Canada. maryann.obrien@utoronto.ca. FAU - Charles, Cathy AU - Charles C AD - Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. charlesc@mcmaster.ca. FAU - Lovrics, Peter AU - Lovrics P AD - St. Joseph's Healthcare, Hamilton, ON, Canada. lovricsp@mcmaster.ca. FAU - Wright, Frances C AU - Wright FC AD - Odette Cancer Centre, Toronto, ON, Canada. Frances.Wright@sunnybrook.ca. FAU - Whelan, Tim AU - Whelan T AD - Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Tim.Whelan@jcc.hhsc.ca. AD - Juravinski Cancer Centre, Hamilton, ON, Canada. Tim.Whelan@jcc.hhsc.ca. FAU - Simunovic, Marko AU - Simunovic M AD - Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Marko.Simunovic@jcc.hhsc.ca. AD - Juravinski Cancer Centre, Hamilton, ON, Canada. Marko.Simunovic@jcc.hhsc.ca. FAU - Kennedy, Erin AU - Kennedy E AD - Mount Sinai Hospital, University Health Network, Toronto, ON, Canada. EKennedy@mtsinai.on.ca. FAU - Grunfeld, Eva AU - Grunfeld E AD - Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Fifth Floor, Toronto, ON, M5G 1 V7, Canada. eva.grunfeld@utoronto.ca. AD - Knowledge Translation Research Network, Health Services Research Program, Ontario Institute for Cancer Research, Toronto, ON, Canada. eva.grunfeld@utoronto.ca. LA - eng GR - Canadian Institutes of Health Research/Canada PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20141129 PL - England TA - Implement Sci JT - Implementation science : IS JID - 101258411 SB - IM MH - *Attitude of Health Personnel MH - Awareness MH - Breast Neoplasms/*surgery MH - Clinical Competence/standards MH - Communication MH - Decision Support Systems, Clinical/*utilization MH - Diffusion of Innovation MH - Female MH - *General Surgery MH - Humans MH - Male MH - Middle Aged MH - Ontario MH - Referral and Consultation/standards PMC - PMC4258030 OID - NLM: PMC4258030 EDAT- 2014/12/01 06:00 MHDA- 2015/11/17 06:00 CRDT- 2014/12/01 06:00 PHST- 2014/03/28 [received] PHST- 2014/11/08 [accepted] AID - 10.1186/s13012-014-0174-0 [doi] AID - s13012-014-0174-0 [pii] PST - epublish SO - Implement Sci. 2014 Nov 29;9:174. doi: 10.1186/s13012-014-0174-0. PMID- 25375000 OWN - NLM STAT- MEDLINE DA - 20141106 DCOM- 20141126 LR - 20151119 IS - 0890-9091 (Print) IS - 0890-9091 (Linking) VI - 28 Suppl 2 DP - 2014 May TI - The current clinical value of the DCIS Score. PG - C2, 1-8, C3 AB - The management of ductal carcinoma in situ (DCIS) can be controversial. Widespread adoption of mammographic screening has made DCIS a more frequent diagnosis, and increasingly smaller, lower-grade lesions are being detected. DCIS is commonly treated with breast-conserving surgery and radiation. However, there is greater recognition that acceptable cancer control outcomes can be achieved for some patients with breast-conserving surgery alone, with radiotherapy reserved for those at higher risk of in-breast recurrence. The primary clinical dilemma is that there are currently no reliable clinicopathologic features that accurately predict which patients will have a recurrence, but risk stratification is an area of active research. Molecular profiling has the potential to assess recurrence risk based on the individual patient's tumor biology and guide treatment decisions. The DCIS Score is a 12-gene assay intended to support personalized treatment planning for patients with DCIS following local excision. It provides information on local failure risk independent of traditional clinicopathologic features. Our group of expert breast surgeons and radiation oncologists met in December 2013 at the San Antonio Breast Cancer Symposium to discuss current controversies in DCIS management and determine the potential value of the DCIS Score in managing these situations. We concluded that the DCIS Score provides clinically relevant information about personal risk that can guide patient discussions and facilitate shared decision making. FAU - Wood, William C AU - Wood WC FAU - Alvarado, Michael AU - Alvarado M FAU - Buchholz, Daniel J AU - Buchholz DJ FAU - Hyams, David AU - Hyams D FAU - Hwang, Shelley AU - Hwang S FAU - Manders, Jennifer AU - Manders J FAU - Park, Catherine AU - Park C FAU - Solin, Lawrence J AU - Solin LJ FAU - White, Julia AU - White J FAU - Willey, Shawna AU - Willey S LA - eng PT - Congresses PT - Research Support, Non-U.S. Gov't PL - United States TA - Oncology (Williston Park) JT - Oncology (Williston Park, N.Y.) JID - 8712059 RN - 0 (Biomarkers, Tumor) RN - 0 (Genetic Markers) SB - IM MH - Biomarkers, Tumor/*genetics MH - Breast Neoplasms/*genetics/mortality/pathology/therapy MH - Carcinoma, Intraductal, Noninfiltrating/*genetics/mortality/secondary/therapy MH - *Decision Support Techniques MH - Disease-Free Survival MH - Female MH - Genetic Markers MH - Genetic Predisposition to Disease MH - *Genetic Testing MH - Humans MH - Mastectomy MH - Neoplasm Recurrence, Local MH - Patient Selection MH - Phenotype MH - *Precision Medicine MH - Predictive Value of Tests MH - Radiotherapy, Adjuvant MH - Risk Assessment MH - Risk Factors MH - Time Factors MH - Treatment Outcome EDAT- 2014/11/07 06:00 MHDA- 2014/12/15 06:00 CRDT- 2014/11/07 06:00 AID - 202867 [pii] PST - ppublish SO - Oncology (Williston Park). 2014 May;28 Suppl 2:C2, 1-8, C3. PMID- 25357022 OWN - NLM STAT- MEDLINE DA - 20141031 DCOM- 20141229 LR - 20170220 IS - 1529-4242 (Electronic) IS - 0032-1052 (Linking) VI - 134 IP - 4 DP - 2014 Oct TI - Helping patients make choices about breast reconstruction: a decision analysis approach. PG - 597-608 LID - 10.1097/PRS.0000000000000514 [doi] AB - Decision analysis can help breast reconstruction patients and their surgeons to methodically evaluate clinical alternatives and make hard decisions. The purpose of this article is to help plastic surgeons guide patients in making decisions though a case study in breast reconstruction. By making good decisions, patient outcomes may be improved. This article aims to illustrate decision analysis techniques from the patient perspective, with an emphasis on her values and preferences. The authors introduce normative decision-making through a fictional breast reconstruction patient and systematically build the decision basis to help her make a good decision. The authors broadly identify alternatives of breast reconstruction, propose types of outcomes that the patient should consider, discuss sources of probabilistic information and outcome values, and demonstrate how to make a good decision. The concepts presented here may be extended to other shared decision-making problems in plastic and reconstructive surgery. In addition, the authors discuss how sensitivity analysis may test the robustness of the decision and how to evaluate the quality of decisions. The authors also present tools to help implement these concepts in practice. Finally, the authors examine limitations that hamper adoption of patient decision analysis in reconstructive surgery and health care in general. In particular, the authors emphasize the need for routine collection of quality-of-life information, out-of-pocket expense, and recovery time. FAU - Sun, Clement S AU - Sun CS AD - Austin, Texas From the Department of Biomedical Engineering, The University of Texas at Austin; and the Departments of Plastic Surgery, Behavioral Science, Health Services Research, and Imaging Physics, The University of Texas M. D. Anderson Cancer Center. FAU - Cantor, Scott B AU - Cantor SB FAU - Reece, Gregory P AU - Reece GP FAU - Fingeret, Michelle C AU - Fingeret MC FAU - Crosby, Melissa A AU - Crosby MA FAU - Markey, Mia K AU - Markey MK LA - eng GR - R01 CA143190/CA/NCI NIH HHS/United States GR - R01CA143190/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - United States TA - Plast Reconstr Surg JT - Plastic and reconstructive surgery JID - 1306050 SB - AIM SB - IM MH - Breast Neoplasms/*psychology/*surgery MH - *Choice Behavior MH - *Decision Support Techniques MH - Female MH - Humans MH - *Mammaplasty PMC - PMC4217136 MID - NIHMS600333 OID - NLM: NIHMS600333 OID - NLM: PMC4217136 EDAT- 2014/10/31 06:00 MHDA- 2014/12/30 06:00 CRDT- 2014/10/31 06:00 AID - 10.1097/PRS.0000000000000514 [doi] AID - 00006534-201410000-00006 [pii] PST - ppublish SO - Plast Reconstr Surg. 2014 Oct;134(4):597-608. doi: 10.1097/PRS.0000000000000514. PMID- 25351455 OWN - NLM STAT- MEDLINE DA - 20150330 DCOM- 20150617 LR - 20151119 IS - 1433-7339 (Electronic) IS - 0941-4355 (Linking) VI - 23 IP - 5 DP - 2015 May TI - Pre-consultation educational group intervention to improve shared decision-making for postmastectomy breast reconstruction: a pilot randomized controlled trial. PG - 1365-75 LID - 10.1007/s00520-014-2479-6 [doi] AB - PURPOSE: Breast cancer survivors who make preference-sensitive decisions about postmastectomy breast reconstruction often have large gaps in knowledge and undergo procedures that are misaligned with their treatment goals. We evaluated the feasibility and effect of a pre-consultation educational group intervention on the decision-making process for breast reconstruction. METHODS: We conducted a pilot randomized controlled trial (RCT) where participants were randomly assigned to the intervention with routine education or routine education alone. The outcomes evaluated were decisional conflict, decision self-efficacy, satisfaction with information, perceived involvement in care, and uptake of reconstruction following surgical consultation. Trial feasibility and acceptability were evaluated, and effect sizes were calculated to determine the primary outcome for the full-scale RCT. RESULTS: Of the 41 patients enrolled, recruitment rate was 72 %, treatment fidelity was 98 %, and retention rate was 95 %. The Cohen's d effect size in reduction of decisional conflict was moderate to high for the intervention group compared to routine education (0.69, 95 % CI = 0.02-1.42), while the effect sizes of increase in decision self-efficacy (0.05, 95 % CI = -0.60-0.71) and satisfaction with information (0.11, 95 % CI = -0.53-0.76) were small. A higher proportion of patients receiving routine education signed informed consent to undergo breast reconstruction (14/20 or 70 %) compared to the intervention group (8/21 or 38 %) P = 0.06. CONCLUSIONS: A pre-consultation educational group intervention improves patients' shared decision-making quality compared to routine preoperative patient education. A full-scale definitive RCT is warranted based on high feasibility outcomes, and the primary outcome for the main trial will be decisional conflict. FAU - Causarano, Natalie AU - Causarano N AD - Division of Plastic & Reconstructive Surgery, Breast Reconstruction Program, University Health Network, 8N871, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada. FAU - Platt, Jennica AU - Platt J FAU - Baxter, Nancy N AU - Baxter NN FAU - Bagher, Shaghayegh AU - Bagher S FAU - Jones, Jennifer M AU - Jones JM FAU - Metcalfe, Kelly A AU - Metcalfe KA FAU - Hofer, Stefan O P AU - Hofer SO FAU - O'Neill, Anne C AU - O'Neill AC FAU - Cheng, Terry AU - Cheng T FAU - Starenkyj, Elizabeth AU - Starenkyj E FAU - Zhong, Toni AU - Zhong T LA - eng PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20141029 PL - Germany TA - Support Care Cancer JT - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer JID - 9302957 SB - IM MH - Adult MH - Aged MH - Breast Neoplasms/*surgery MH - *Decision Making MH - *Decision Support Techniques MH - Female MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Informed Consent MH - Mammaplasty/*education MH - Mastectomy MH - Middle Aged MH - *Patient Education as Topic MH - Physician-Patient Relations MH - Pilot Projects MH - Referral and Consultation MH - Self Efficacy MH - Surveys and Questionnaires EDAT- 2014/10/30 06:00 MHDA- 2015/06/18 06:00 CRDT- 2014/10/30 06:00 PHST- 2013/12/09 [received] PHST- 2014/10/06 [accepted] AID - 10.1007/s00520-014-2479-6 [doi] PST - ppublish SO - Support Care Cancer. 2015 May;23(5):1365-75. doi: 10.1007/s00520-014-2479-6. Epub 2014 Oct 29. PMID- 25105083 OWN - NLM STAT- Publisher DA - 20140808 LR - 20170220 IS - 2169-7574 (Print) IS - 2169-7574 (Linking) VI - 2 IP - 3 DP - 2014 Mar TI - Assessing Women's Preferences and Preference Modeling for Breast Reconstruction Decision-Making. PG - e125 AB - BACKGROUND: Women considering breast reconstruction must make challenging trade-offs amongst issues that often conflict. It may be useful to quantify possible outcomes using a single summary measure to aid a breast cancer patient in choosing a form of breast reconstruction. METHODS: In this study, we used multiattribute utility theory to combine multiple objectives to yield a summary value using nine different preference models. We elicited the preferences of 36 women, aged 32 or older with no history of breast cancer, for the patient-reported outcome measures of breast satisfaction, psychosocial well-being, chest well-being, abdominal well-being, and sexual wellbeing as measured by the BREAST-Q in addition to time lost to reconstruction and out-of-pocket cost. Participants ranked hypothetical breast reconstruction outcomes. We examined each multiattribute utility preference model and assessed how often each model agreed with participants' rankings. RESULTS: The median amount of time required to assess preferences was 34 minutes. Agreement among the nine preference models with the participants ranged from 75.9% to 78.9%. None of the preference models performed significantly worse than the best performing risk averse multiplicative model. We hypothesize an average theoretical agreement of 94.6% for this model if participant error is included. There was a statistically significant positive correlation with more unequal distribution of weight given to the seven attributes. CONCLUSIONS: We recommend the risk averse multiplicative model for modeling the preferences of patients considering different forms of breast reconstruction because it agreed most often with the participants in this study. FAU - Sun, Clement S AU - Sun CS AD - Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX ; Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX. FAU - Cantor, Scott B AU - Cantor SB AD - Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX. FAU - Reece, Gregory P AU - Reece GP AD - Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX. FAU - Crosby, Melissa A AU - Crosby MA AD - Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX. FAU - Fingeret, Michelle C AU - Fingeret MC AD - Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX ; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX. FAU - Markey, Mia K AU - Markey MK AD - Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX ; Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX. LA - eng GR - R01 CA143190/CA/NCI NIH HHS/United States PT - Journal Article PL - United States TA - Plast Reconstr Surg Glob Open JT - Plastic and reconstructive surgery. Global open JID - 101622231 PMC - PMC4120963 MID - NIHMS558203 OTO - NOTNLM OT - BREAST-Q OT - Multiattribute utility theory OT - breast reconstruction OT - consistency OT - decision analysis OT - decision-making OT - multiple objectives OT - patient reported outcome measures OT - risk attitude OT - utility EDAT- 2014/08/12 06:00 MHDA- 2014/08/12 06:00 CRDT- 2014/08/09 06:00 AID - 10.1097/GOX.0000000000000062 [doi] PST - ppublish SO - Plast Reconstr Surg Glob Open. 2014 Mar;2(3):e125. PMID- 25068322 OWN - NLM STAT- MEDLINE DA - 20140729 DCOM- 20141016 LR - 20150624 IS - 1529-4242 (Electronic) IS - 0032-1052 (Linking) VI - 134 IP - 2 DP - 2014 Aug TI - The tissue-based triad: a process approach to augmentation mastopexy. PG - 215-25 LID - 10.1097/PRS.0000000000000387 [doi] AB - BACKGROUND: Among the most exigent operations in plastic surgery is the combination of augmentation and mastopexy. The surgical challenge is related to oppositional forces that complicate the operative predictability. The purpose of this study was to investigate use of the tissue-based triad process approach in patients undergoing augmentation mastopexy. Measured components of the approach include skin stretch, nipple to inframammary fold distance on maximal stretch, and vertical excess. METHODS: Patients were selected for the study if they had been treated with one- or two-stage augmentation mastopexy, or mastopexy alone. Data gathered included preoperative measurements, operative details, complications, and outcomes including reoperation rate. RESULTS: A total of 176 consecutive patients were identified as meeting study inclusion criteria. Mean follow-up was 1.5 years. Seventy-one of 176 patients underwent mastopexy alone. Of the 176 patients included, 105 were treated with augmentation mastopexy. Ninety-one of 105 augmentation mastopexy operations were performed in one stage. The average amount of vertical excess was 5 cm. Nine patients exhibited delayed wound healing, while six (6.5 percent) required reoperations for scar revision (n=1), delayed wound healing requiring revision (n=2), hematoma (n=1), seroma (n=1), and soft-tissue stretch (n=1). Fourteen of 105 patients were treated in two stages. Average vertical excess was 7.5 cm. CONCLUSIONS: Use of the tissue-based triad process approach provided objectivity in determining which patients should undergo one- versus two-stage augmentation mastopexy. Use of this approach helps guide surgical decision making and is associated with lower reoperation rates. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. FAU - Lee, Michael R AU - Lee MR AD - Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center. FAU - Unger, Jacob G AU - Unger JG FAU - Adams, William P Jr AU - Adams WP Jr LA - eng PT - Clinical Trial PT - Journal Article PT - Video-Audio Media PL - United States TA - Plast Reconstr Surg JT - Plastic and reconstructive surgery JID - 1306050 SB - AIM SB - IM MH - Adult MH - *Algorithms MH - *Decision Support Techniques MH - Female MH - Follow-Up Studies MH - Humans MH - Mammaplasty/*methods MH - Middle Aged MH - Outcome and Process Assessment (Health Care) MH - *Patient Care Planning MH - Postoperative Complications/epidemiology MH - Prospective Studies MH - Reoperation/statistics & numerical data EDAT- 2014/07/30 06:00 MHDA- 2014/10/17 06:00 CRDT- 2014/07/29 06:00 AID - 10.1097/PRS.0000000000000387 [doi] AID - 00006534-201408000-00012 [pii] PST - ppublish SO - Plast Reconstr Surg. 2014 Aug;134(2):215-25. doi: 10.1097/PRS.0000000000000387. PMID- 25068319 OWN - NLM STAT- MEDLINE DA - 20140729 DCOM- 20141016 LR - 20150624 IS - 1529-4242 (Electronic) IS - 0032-1052 (Linking) VI - 134 IP - 2 DP - 2014 Aug TI - Discussion: An algorithmic approach for selective acellular dermal matrix use in immediate two-stage breast reconstruction: indications and outcomes. PG - 189-90 LID - 10.1097/PRS.0000000000000328 [doi] FAU - Hanasono, Matthew M AU - Hanasono MM AD - Houston, Texas From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center. LA - eng PT - Comment PT - Journal Article PL - United States TA - Plast Reconstr Surg JT - Plastic and reconstructive surgery JID - 1306050 SB - AIM SB - IM CON - Plast Reconstr Surg. 2014 Aug;134(2):178-88. PMID: 25068318 MH - *Acellular Dermis MH - *Algorithms MH - *Decision Support Techniques MH - Female MH - Humans MH - Mammaplasty/*methods EDAT- 2014/07/30 06:00 MHDA- 2014/10/17 06:00 CRDT- 2014/07/29 06:00 AID - 10.1097/PRS.0000000000000328 [doi] AID - 00006534-201408000-00005 [pii] PST - ppublish SO - Plast Reconstr Surg. 2014 Aug;134(2):189-90. doi: 10.1097/PRS.0000000000000328. PMID- 25068318 OWN - NLM STAT- MEDLINE DA - 20140729 DCOM- 20141016 LR - 20150624 IS - 1529-4242 (Electronic) IS - 0032-1052 (Linking) VI - 134 IP - 2 DP - 2014 Aug TI - An algorithmic approach for selective acellular dermal matrix use in immediate two-stage breast reconstruction: indications and outcomes. PG - 178-88 LID - 10.1097/PRS.0000000000000366 [doi] AB - BACKGROUND: Acellular dermal matrix use has gained widespread acceptance--despite higher material costs--because of its ease of use and potential for enhanced cosmesis. The authors developed a resource-sensitive algorithm for selective acellular dermal matrix use with indications and contraindications based on body mass index, breast size, radiation therapy, flap vascularity, and pectoralis anatomy. METHODS: The algorithm incorporates preoperative and intraoperative decision points. Complication rates and aesthetic scores were compared for procedures performed before and after adoption of the algorithm. Multiple logistic regression was used to determine the independent influence of the algorithm on postoperative outcomes. RESULTS: One hundred ninety-three breasts underwent reconstruction before and 179 underwent reconstruction after implementation of the algorithm. Overall complication rates did not differ between the cohorts (22.8 percent versus 20.7 percent; p=0.138). After adjusting for potential confounders, the algorithm did not significantly affect the incidence of infection, seroma, flap necrosis, explantation, or overall complications (all p>0.05). Aesthetic scores were not affected (2.75 of 4 versus 3.03 of 4; p=0.138). Acellular dermal matrix use decreased from 84 percent to 36 percent, resulting in a materials cost savings of $270,000 over the study period. CONCLUSIONS: This algorithm obviated placement of acellular dermal matrix in an estimated 48 percent of immediate tissue-expander reconstructions. Patients treated after adoption of this algorithm experienced similar complication rates and aesthetic outcomes as those who underwent reconstruction before. The authors' preliminary outcomes demonstrate that evidence-based measures can be taken to selectively use acellular dermal matrix without a concomitant worsening of patient outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. FAU - Jordan, Sumanas W AU - Jordan SW AD - Chicago, Ill. From the Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine. FAU - Khavanin, Nima AU - Khavanin N FAU - Fine, Neil A AU - Fine NA FAU - Kim, John Y S AU - Kim JY LA - eng PT - Evaluation Studies PT - Journal Article PL - United States TA - Plast Reconstr Surg JT - Plastic and reconstructive surgery JID - 1306050 SB - AIM SB - IM CIN - Plast Reconstr Surg. 2014 Aug;134(2):189-90. PMID: 25068319 MH - *Acellular Dermis/contraindications/economics/utilization MH - Adult MH - *Algorithms MH - Breast Neoplasms/surgery MH - Chicago MH - *Decision Support Techniques MH - Esthetics MH - Female MH - Humans MH - Incidence MH - Logistic Models MH - Mammaplasty/economics/*methods MH - Mastectomy MH - Middle Aged MH - Postoperative Complications/epidemiology/etiology MH - Retrospective Studies EDAT- 2014/07/30 06:00 MHDA- 2014/10/17 06:00 CRDT- 2014/07/29 06:00 AID - 10.1097/PRS.0000000000000366 [doi] AID - 00006534-201408000-00004 [pii] PST - ppublish SO - Plast Reconstr Surg. 2014 Aug;134(2):178-88. doi: 10.1097/PRS.0000000000000366. PMID- 25031309 OWN - NLM STAT- MEDLINE DA - 20140717 DCOM- 20140911 LR - 20140717 IS - 1460-2105 (Electronic) IS - 0027-8874 (Linking) VI - 106 IP - 8 DP - 2014 Aug TI - How big is big enough? Thinking about contralateral prophylactic mastectomy. LID - 10.1093/jnci/dju175 [doi] LID - dju175 [pii] FAU - Pauker, Stephen G AU - Pauker SG AD - Affiliation of authors: Division of Clinical Decision Making, Department of Medicine, Tufts Medical Center, Boston, MA. FAU - Alseiari, Mohamed AU - Alseiari M AD - Affiliation of authors: Division of Clinical Decision Making, Department of Medicine, Tufts Medical Center, Boston, MA. LA - eng PT - Comment PT - Editorial DEP - 20140716 PL - United States TA - J Natl Cancer Inst JT - Journal of the National Cancer Institute JID - 7503089 SB - IM CON - J Natl Cancer Inst. 2014 Aug;106(8). pii: dju160. doi: 10.1093/jnci/dju160. PMID: 25031308 MH - Breast Neoplasms/*mortality/*surgery MH - *Decision Support Techniques MH - Female MH - Humans MH - *Mastectomy MH - Secondary Prevention/*methods EDAT- 2014/07/18 06:00 MHDA- 2014/09/12 06:00 CRDT- 2014/07/18 06:00 AID - dju175 [pii] AID - 10.1093/jnci/dju175 [doi] PST - epublish SO - J Natl Cancer Inst. 2014 Jul 16;106(8). pii: dju175. doi: 10.1093/jnci/dju175. Print 2014 Aug. PMID- 25031308 OWN - NLM STAT- MEDLINE DA - 20140717 DCOM- 20140911 LR - 20150514 IS - 1460-2105 (Electronic) IS - 0027-8874 (Linking) VI - 106 IP - 8 DP - 2014 Aug TI - Survival outcomes after contralateral prophylactic mastectomy: a decision analysis. LID - 10.1093/jnci/dju160 [doi] LID - dju160 [pii] AB - BACKGROUND: Contralateral prophylactic mastectomy (CPM) rates have substantially increased in recent years and may reflect an exaggerated perceived benefit from the procedure. The objective of this study was to evaluate the magnitude of the survival benefit of CPM for women with unilateral breast cancer. METHODS: We developed a Markov model to simulate survival outcomes after CPM and no CPM among women with stage I or II breast cancer without a BRCA mutation. Probabilities for developing contralateral breast cancer (CBC), dying from CBC, dying from primary breast cancer, and age-specific mortality rates were estimated from published studies. We estimated life expectancy (LE) gain, 20-year overall survival, and disease-free survival with each intervention strategy among cohorts of women defined by age, estrogen receptor (ER) status, and stage of cancer. RESULTS: Predicted LE gain from CPM ranged from 0.13 to 0.59 years for women with stage I breast cancer and 0.08 to 0.29 years for those with stage II breast cancer. Absolute 20-year survival differences ranged from 0.56% to 0.94% for women with stage I breast cancer and 0.36% to 0.61% for women with stage II breast cancer. CPM was more beneficial among younger women, stage I, and ER-negative breast cancer. Sensitivity analyses yielded a maximum 20-year survival difference with CPM of only 1.45%. CONCLUSIONS: The absolute 20-year survival benefit from CPM was less than 1% among all age, ER status, and cancer stage groups. Estimates of LE gains and survival differences derived from decision models may provide more realistic expectations of CPM. CI - (c) The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com. FAU - Portschy, Pamela R AU - Portschy PR AD - Affiliations of authors: Department of Surgery (PRP, TMT) and Division of Health Policy and Management (KMK), University of Minnesota, Minneapolis, MN. FAU - Kuntz, Karen M AU - Kuntz KM AD - Affiliations of authors: Department of Surgery (PRP, TMT) and Division of Health Policy and Management (KMK), University of Minnesota, Minneapolis, MN. FAU - Tuttle, Todd M AU - Tuttle TM AD - Affiliations of authors: Department of Surgery (PRP, TMT) and Division of Health Policy and Management (KMK), University of Minnesota, Minneapolis, MN. tuttl006@umn.edu. LA - eng PT - Journal Article DEP - 20140716 PL - United States TA - J Natl Cancer Inst JT - Journal of the National Cancer Institute JID - 7503089 SB - IM CIN - J Natl Cancer Inst. 2015 Mar;107(3). doi: 10.1093/jnci/dju507. PMID: 25713151 CIN - J Natl Cancer Inst. 2015 Mar;107(3). doi: 10.1093/jnci/dju508. PMID: 25713152 CIN - J Natl Cancer Inst. 2014 Aug;106(8). pii: dju175. doi: 10.1093/jnci/dju175. PMID: 25031309 CIN - J Natl Cancer Inst. 2015 Apr;107(4). pii: djv093. doi: 10.1093/jnci/djv093. PMID: 25870388 CIN - J Natl Cancer Inst. 2015 Apr;107(4). pii: djv092. doi: 10.1093/jnci/djv092. PMID: 25870387 MH - Adult MH - Breast Neoplasms/*mortality/pathology/*surgery MH - *Decision Support Techniques MH - Disease-Free Survival MH - Female MH - Humans MH - Life Expectancy MH - Markov Chains MH - *Mastectomy/methods MH - Middle Aged MH - Neoplasm Staging MH - Predictive Value of Tests MH - Secondary Prevention/*methods MH - United States/epidemiology EDAT- 2014/07/18 06:00 MHDA- 2014/09/12 06:00 CRDT- 2014/07/18 06:00 AID - dju160 [pii] AID - 10.1093/jnci/dju160 [doi] PST - epublish SO - J Natl Cancer Inst. 2014 Jul 16;106(8). pii: dju160. doi: 10.1093/jnci/dju160. Print 2014 Aug. PMID- 24991748 OWN - NLM STAT- MEDLINE DA - 20140704 DCOM- 20150226 LR - 20140704 IS - 1099-1611 (Electronic) IS - 1057-9249 (Linking) VI - 23 IP - 7 DP - 2014 Jul TI - BRECONDA: development and acceptability of an interactive decisional support tool for women considering breast reconstruction. PG - 835-8 LID - 10.1002/pon.3498 [doi] FAU - Sherman, Kerry A AU - Sherman KA AD - Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia; Westmead Breast Cancer Institute, Westmead Hospital, University of Sydney, Sydney, Australia. FAU - Harcourt, Diana M AU - Harcourt DM FAU - Lam, Thomas C AU - Lam TC FAU - Shaw, Laura-Kate AU - Shaw LK FAU - Boyages, John AU - Boyages J LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20140206 PL - England TA - Psychooncology JT - Psycho-oncology JID - 9214524 SB - IM MH - Adult MH - Australia MH - Breast Neoplasms/psychology/surgery MH - Carcinoma, Intraductal, Noninfiltrating/psychology/surgery MH - Choice Behavior MH - Decision Making MH - *Decision Support Techniques MH - Female MH - Humans MH - *Mammaplasty MH - Middle Aged MH - Patient Acceptance of Health Care MH - Patient Participation OTO - NOTNLM OT - breast cancer OT - cancer OT - decision aid OT - oncology OT - reconstruction OT - surgery EDAT- 2014/07/06 06:00 MHDA- 2015/02/27 06:00 CRDT- 2014/07/04 06:00 PHST- 2013/08/13 [received] PHST- 2014/01/12 [revised] PHST- 2014/01/15 [accepted] AID - 10.1002/pon.3498 [doi] PST - ppublish SO - Psychooncology. 2014 Jul;23(7):835-8. doi: 10.1002/pon.3498. Epub 2014 Feb 6. PMID- 24966093 OWN - NLM STAT- MEDLINE DA - 20140904 DCOM- 20150514 LR - 20151119 IS - 1524-4741 (Electronic) IS - 1075-122X (Linking) VI - 20 IP - 5 DP - 2014 Sep-Oct TI - Survey of American and Canadian general surgeons' perceptions of margin status and practice patterns for breast conserving surgery. PG - 481-8 LID - 10.1111/tbj.12299 [doi] AB - Although breast conservation surgery (BCS) is commonly performed, several aspects of the procedure remain controversial. We undertook a cross-sectional survey to compare Canadian (CDN) and American (AM) general surgeons' reported BCS practice patterns to better understand the cross-border differences in early-stage breast cancer surgery care. A modified Dillman Method survey was mailed to 1,447 AM and 1,443 CDN surgeons. Factors evaluated included preoperative assessment, margin definition, surgical techniques, and re-excision practices. The response rate was 26% and 51% for AM and CDN surgeons, respectively. There was variation in use of preoperative core biopsies. American surgeons required wider margins for invasive cancer and ductal carcinoma in situ, and more often recommend re-excision for invasive cancer with 1 and 2 mm margins (p < 0.05). There was also variability in surgical techniques used for intraoperative margin assessment. Wide variation in BCS practice was observed, with some of this variability related to surgeon country. CI - (c) 2014 Wiley Periodicals, Inc. FAU - Parvez, Elena AU - Parvez E AD - Department of Surgery, McMaster University, Hamilton, Ontario, Canada. FAU - Hodgson, Nicole AU - Hodgson N FAU - Cornacchi, Sylvie D AU - Cornacchi SD FAU - Ramsaroop, Amanda AU - Ramsaroop A FAU - Gordon, Maggie AU - Gordon M FAU - Farrokhyar, Forough AU - Farrokhyar F FAU - Porter, Geoffrey AU - Porter G FAU - Quan, May Lynn AU - Quan ML FAU - Wright, Francis AU - Wright F FAU - Lovrics, Peter J AU - Lovrics PJ LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20140626 PL - United States TA - Breast J JT - The breast journal JID - 9505539 SB - IM MH - *Attitude of Health Personnel MH - Breast Neoplasms/*surgery MH - Canada MH - Carcinoma, Intraductal, Noninfiltrating/surgery MH - Cross-Sectional Studies MH - Data Collection MH - Decision Support Techniques MH - Female MH - Humans MH - Male MH - Mastectomy, Segmental/*statistics & numerical data MH - Practice Patterns, Physicians'/*statistics & numerical data MH - United States OTO - NOTNLM OT - breast conserving surgery OT - margin status OT - mastectomy OT - re-excision OT - surgical decision-making OT - survey EDAT- 2014/06/27 06:00 MHDA- 2015/05/15 06:00 CRDT- 2014/06/27 06:00 AID - 10.1111/tbj.12299 [doi] PST - ppublish SO - Breast J. 2014 Sep-Oct;20(5):481-8. doi: 10.1111/tbj.12299. Epub 2014 Jun 26. PMID- 24910814 OWN - NLM STAT- Publisher DA - 20140609 LR - 20170220 IS - 2169-7574 (Print) IS - 2169-7574 (Linking) VI - 1 IP - 6 DP - 2013 Nov 01 TI - Plastic Surgeon Expertise in Predicting Breast Reconstruction Outcomes for Patient Decision Analysis. PG - e78 AB - BACKGROUND: Decision analysis offers a framework that may help breast cancer patients make good breast reconstruction decisions. A requirement for this type of analysis is information about the possibility of outcomes occurring in the form of probabilities. The purpose of this study was to determine if plastic surgeons are good sources of probability information, both individually and as a group, when data are limited. METHODS: Seven plastic surgeons were provided with pertinent medical information and preoperative photographs of patients, and were asked to assign probabilities to predict number of revisions, complications, and final aesthetic outcome using a questionnaire designed for the study. Logarithmic strictly proper scoring was used to evaluate the surgeons' abilities to predict breast reconstruction outcomes. Surgeons' responses were analyzed for calibration and confidence in their answers. RESULTS: As individuals, there was variation in surgeons' ability to predict outcomes. For each prediction category, a different surgeon was more accurate. As a group, surgeons possessed knowledge of future events despite not being well calibrated in their probability assessments. Prediction accuracy for the group was up to six-fold greater than that of the best individual. CONCLUSIONS: The use of individual plastic surgeon-elicited probability information is not encouraged unless the individual's prediction skill has been evaluated. In the absence of this information, a group consensus on the probability of outcomes is preferred. Without a large evidence base for calculating probabilities, estimates assessed from a group of plastic surgeons may be acceptable for purposes of breast reconstruction decision analysis. FAU - Sun, Clement S AU - Sun CS AD - Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX ; Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX. FAU - Reece, Gregory P AU - Reece GP AD - Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX. FAU - Crosby, Melissa A AU - Crosby MA AD - Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX. FAU - Fingeret, Michelle C AU - Fingeret MC AD - Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX ; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX. FAU - Skoracki, Roman J AU - Skoracki RJ AD - Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX. FAU - Villa, Mark T AU - Villa MT AD - Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX. FAU - Hanasono, Matthew M AU - Hanasono MM AD - Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX. FAU - Baumann, Donald P AU - Baumann DP AD - Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX. FAU - Chang, David W AU - Chang DW AD - Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX. FAU - Cantor, Scott B AU - Cantor SB AD - Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX. FAU - Markey, Mia K AU - Markey MK AD - Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX ; Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX. LA - eng GR - R01 CA143190/CA/NCI NIH HHS/United States PT - Journal Article PL - United States TA - Plast Reconstr Surg Glob Open JT - Plastic and reconstructive surgery. Global open JID - 101622231 PMC - PMC4044723 MID - NIHMS543308 EDAT- 2014/06/10 06:00 MHDA- 2014/06/10 06:00 CRDT- 2014/06/10 06:00 AID - 10.1097/GOX.0000000000000010 [doi] PST - ppublish SO - Plast Reconstr Surg Glob Open. 2013 Nov 1;1(6):e78. PMID- 24892447 OWN - NLM STAT- MEDLINE DA - 20140709 DCOM- 20141106 LR - 20151119 IS - 1532-1827 (Electronic) IS - 0007-0920 (Linking) VI - 111 IP - 1 DP - 2014 Jul 08 TI - Improving decision making about clinical trial participation - a randomised controlled trial of a decision aid for women considering participation in the IBIS-II breast cancer prevention trial. PG - 1-7 LID - 10.1038/bjc.2014.144 [doi] AB - BACKGROUND: Decision aids may improve informed consent in clinical trial recruitment, but have not been evaluated in this context. This study investigated whether decision aids (DAs) can reduce decisional difficulties among women considering participation in the International Breast Cancer Intervention Study-II (IBIS-II) trial. METHODS: The IBIS-II trial investigated breast cancer prevention with anastrazole in two cohorts: women with increased risk (Prevention), and women treated for ductal carcinoma in situ (DCIS). Australia, New Zealand and United Kingdom participants were randomised to receive a DA (DA group) or standard trial consent materials (control group). Questionnaires were completed after deciding about participation in IBIS-II (post decision) and 3 months later (follow-up). RESULTS: Data from 112 Prevention and 34 DCIS participants were analysed post decision (73 DA; 73 control); 95 Prevention and 24 DCIS participants were analysed at follow-up (58 DA; 61 control). There was no effect on the primary outcome of decisional conflict. The DCIS-DA group had higher knowledge post decision, and the Prevention-DA group had lower decisional regret at follow-up. CONCLUSIONS: This was the first study to evaluate a DA in the clinical trial setting. The results suggest DAs can potentially increase knowledge and reduce decisional regret about clinical trial participation. FAU - Juraskova, I AU - Juraskova I AD - Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney 2006, Australia. FAU - Butow, P AU - Butow P AD - Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney 2006, Australia. FAU - Bonner, C AU - Bonner C AD - Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney 2006, Australia. FAU - Bell, M L AU - Bell ML AD - Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney 2006, Australia. FAU - Smith, A B AU - Smith AB AD - Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney 2006, Australia. FAU - Seccombe, M AU - Seccombe M AD - Australia and New Zealand Breast Cancer Trials Group, Australia University of Newcastle, Newcastle 2306, Australia. FAU - Boyle, F AU - Boyle F AD - 1] Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney 2006, Australia [2] Australia and New Zealand Breast Cancer Trials Group, Australia University of Newcastle, Newcastle 2306, Australia [3] Pam McLean Centre, The University of Sydney, Sydney 2006, Australia. FAU - Reaby, L AU - Reaby L AD - Australia and New Zealand Breast Cancer Trials Group, Australia University of Newcastle, Newcastle 2306, Australia. FAU - Cuzick, J AU - Cuzick J AD - Cancer Research UK, Department of Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Queen Mary College, University of London, London E1 4NS, UK. FAU - Forbes, J F AU - Forbes JF AD - Australia and New Zealand Breast Cancer Trials Group, Australia University of Newcastle, Newcastle 2306, Australia. LA - eng SI - ANZCTR/ACTRN12605000216617 SI - ANZCTR/ACTRN12605000282684 SI - ANZCTR/ACTRN12605000506695 PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20140603 PL - England TA - Br J Cancer JT - British journal of cancer JID - 0370635 SB - IM MH - Breast Neoplasms/*prevention & control MH - *Decision Making MH - *Decision Support Techniques MH - Female MH - Humans MH - Middle Aged MH - Patient Participation/*psychology MH - Patient Satisfaction MH - Randomized Controlled Trials as Topic/*methods/*psychology MH - Surveys and Questionnaires MH - Treatment Outcome PMC - PMC4090720 OID - NLM: PMC4090720 EDAT- 2014/06/04 06:00 MHDA- 2014/11/07 06:00 CRDT- 2014/06/04 06:00 PHST- 2013/11/24 [received] PHST- 2013/02/11 [revised] PHST- 2014/02/24 [accepted] AID - bjc2014144 [pii] AID - 10.1038/bjc.2014.144 [doi] PST - ppublish SO - Br J Cancer. 2014 Jul 8;111(1):1-7. doi: 10.1038/bjc.2014.144. Epub 2014 Jun 3. PMID- 24816579 OWN - NLM STAT- MEDLINE DA - 20140609 DCOM- 20140724 LR - 20140609 IS - 1878-0539 (Electronic) IS - 1748-6815 (Linking) VI - 67 IP - 7 DP - 2014 Jul TI - A feasible computer-based evaluation tool for reduction mammaplasty patients: indications for operation and monitoring of guidelines. PG - 927-31 LID - 10.1016/j.bjps.2014.03.028 [doi] LID - S1748-6815(14)00139-9 [pii] AB - In Sweden, evidence-based national guidelines for the indication for reduction mammaplasty in the public health-care system have been developed by a group of experts. They were defined as breast volume>/=800 ml at normal weight. Furthermore, a volume asymmetry of 25% or at least 200 ml or an extreme ptosis may be an indication in some cases. The aim of the present paper was to describe an easy-to-use computer-based tool that has been developed to assure that patients with mammary hyperplasia are evaluated and offered care in a standardized fashion and that the adherence to the guidelines is monitored. Included variables were based on a model for priority grouping originally presented by Strombeck and Malm in 1986 and comprise body mass index (BMI), BMI-corrected breast volume, ptosis, asymmetry, and general breast-related factors preoperatively and 1 year postoperatively and complications postoperatively. Between June 2007 and January 2013, 377 patients were evaluated. Of which, 275 qualified for operation. With the help of the computer-based tool, compliance to the indications for operation can be easily followed, and hence the intended patients offered a reduction mammaplasty in the public health-care system. CI - Copyright (c) 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. FAU - Hansson, Emma AU - Hansson E AD - Department of Plastic and Reconstructive Surgery, Skane University Hospital, Malmo, Sweden; Department of Clinical Sciences, Lund University, Malmo, Sweden. Electronic address: emma.hansson@med.lu.se. FAU - Manjer, Jonas AU - Manjer J AD - Department of Plastic and Reconstructive Surgery, Skane University Hospital, Malmo, Sweden; Department of Clinical Sciences, Lund University, Malmo, Sweden. FAU - Borren, Jerker AU - Borren J AD - Department of Biomedical Engineering, Skane University Hospital, Malmo, Sweden. FAU - Levin, Malin AU - Levin M AD - Department of Plastic and Reconstructive Surgery, Skane University Hospital, Malmo, Sweden. FAU - Mulder, Lotta AU - Mulder L AD - Department of Plastic and Reconstructive Surgery, Skane University Hospital, Malmo, Sweden. FAU - Ringberg, Anita AU - Ringberg A AD - Department of Plastic and Reconstructive Surgery, Skane University Hospital, Malmo, Sweden; Department of Clinical Sciences, Lund University, Malmo, Sweden. LA - eng PT - Journal Article DEP - 20140401 PL - Netherlands TA - J Plast Reconstr Aesthet Surg JT - Journal of plastic, reconstructive & aesthetic surgery : JPRAS JID - 101264239 SB - IM MH - Body Mass Index MH - Breast/anatomy & histology/*pathology/surgery MH - *Decision Making, Computer-Assisted MH - Decision Support Techniques MH - Female MH - *Guideline Adherence MH - Humans MH - Hyperplasia/surgery MH - *Mammaplasty MH - National Health Programs MH - Organ Size MH - *Patient Selection MH - Practice Guidelines as Topic MH - Sweden OTO - NOTNLM OT - Breast reduction OT - Breast surgery OT - Computer-based evaluation tool OT - Follow-up OT - Indication OT - Reduction mammaplasty EDAT- 2014/05/13 06:00 MHDA- 2014/07/25 06:00 CRDT- 2014/05/13 06:00 PHST- 2013/06/27 [received] PHST- 2013/12/18 [revised] PHST- 2014/03/15 [accepted] AID - S1748-6815(14)00139-9 [pii] AID - 10.1016/j.bjps.2014.03.028 [doi] PST - ppublish SO - J Plast Reconstr Aesthet Surg. 2014 Jul;67(7):927-31. doi: 10.1016/j.bjps.2014.03.028. Epub 2014 Apr 1. PMID- 24814422 OWN - NLM STAT- MEDLINE DA - 20140827 DCOM- 20141211 LR - 20151119 IS - 1529-4242 (Electronic) IS - 0032-1052 (Linking) VI - 134 IP - 3 DP - 2014 Sep TI - Individualized risk of surgical-site infection: an application of the breast reconstruction risk assessment score. PG - 351e-362e LID - 10.1097/PRS.0000000000000439 [doi] AB - BACKGROUND: Risk factors for surgical-site infection following beast reconstruction have been thoroughly investigated at a population level. However, traditional population-based measures may not always capture the nuances of individual patients. The authors aimed to develop a validated breast reconstruction risk assessment calculator for surgical-site infection that informs risk at an individual level. METHODS: Mastectomies with immediate reconstruction (n = 16,069) from 2005 to 2011 were identified from the National Surgical Quality Improvement Program database. A multiple logistic regression model was created for postoperative surgical-site infection. Hosmer-Lemeshow, C statistic, and Brier score were computed to assess model performance. Bootstrap analysis validated the model. RESULTS: A robust, validated risk model for surgical-site infection was developed using 11 covariates. The model Hosmer-Lemeshow p value was 0.371, the Brier score was 0.0357, and the C statistic was 0.682 (optimism-corrected C statistic, 0.678). The distribution of individual risks demonstrated a positive skew. Population-derived risk underestimated or overestimated individual risk by at least 1.5-fold in nearly one-fifth of all patients. CONCLUSIONS: The breast reconstruction risk assessment score risk calculator for surgical-site infection mitigates the potentially inaccurate interpolation of population-based risk to individual patients. The authors concomitantly developed an online interface-accessible by patients and surgeons alike-to quantify a patient's risk for surgical-site infection, better informing evidence-based decisions and managing patient expectations. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III. FAU - Kim, John Y S AU - Kim JY AD - Chicago, Ill.; Memphis, Tenn.; and Atlanta, Ga. From the Division of Plastic and Reconstructive Surgery and the Lynn Sage Comprehensive Breast Center, Northwestern University, Feinberg School of Medicine; the Department of Plastic and Reconstructive Surgery, Baptist Cancer Center/Vanderbilt Ingram Cancer Center; and the Division of Plastic and Reconstructive Surgery, Emory University Hospital. FAU - Khavanin, Nima AU - Khavanin N FAU - Jordan, Sumanas W AU - Jordan SW FAU - ver Halen, Jon P AU - ver Halen JP FAU - Mlodinow, Alexei S AU - Mlodinow AS FAU - Bethke, Kevin P AU - Bethke KP FAU - Khan, Seema A AU - Khan SA FAU - Hansen, Nora M AU - Hansen NM FAU - Losken, Albert AU - Losken A FAU - Fine, Neil A AU - Fine NA LA - eng PT - Evaluation Studies PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Plast Reconstr Surg JT - Plastic and reconstructive surgery JID - 1306050 SB - AIM SB - IM MH - Adult MH - Aged MH - Databases, Factual MH - *Decision Support Techniques MH - Female MH - Humans MH - Logistic Models MH - *Mammaplasty MH - Mastectomy MH - Middle Aged MH - *Precision Medicine MH - ROC Curve MH - Reproducibility of Results MH - Risk Assessment MH - Risk Factors MH - Surgical Wound Infection/etiology/*prevention & control EDAT- 2014/05/13 06:00 MHDA- 2014/12/17 06:00 CRDT- 2014/05/13 06:00 AID - 10.1097/PRS.0000000000000439 [doi] PST - ppublish SO - Plast Reconstr Surg. 2014 Sep;134(3):351e-362e. doi: 10.1097/PRS.0000000000000439. PMID- 24772626 OWN - NLM STAT- MEDLINE DA - 20140429 DCOM- 20140529 LR - 20151119 IS - 0507-3758 (Print) IS - 0507-3758 (Linking) VI - 60 IP - 1 DP - 2014 TI - [Adjuvant chemotherapy for breast cancer: search for new ways of planning]. PG - 102-8 AB - A decision regarding adjuvant chemotherapy in early (operable) breast cancer in the past was made entirely on the basis of clinical and pathological features. However with the growing awareness of tumor biology and the possibility of the genomic analysis to determine the molecular subtypes of breast cancer it is getting real to identify patients whose tumors are resistant to chemotherapy or vice versa benefit from its addition. Despite the fact that genomic analysis allows some patients avoiding chemotherapy (especially patients with localized breast cancer), such studies do not indicate the most appropriate chemotherapy regimens. Therefore treatment decisions should be based on a combination of biological features of the tumor, its stage and signs that characterize the patient such as age and tolerance to the side effects of therapy. FAU - Semiglazov, V F AU - Semiglazov VF FAU - Semiglazov, V V AU - Semiglazov VV FAU - Paltuev, P M AU - Paltuev PM FAU - Dashian, G A AU - Dashian GA FAU - Donskikh, R V AU - Donskikh RV FAU - Komiakhov, A V AU - Komiakhov AV FAU - Krivorot'ko, P V AU - Krivorot'ko PV FAU - Nikolaev, K S AU - Nikolaev KS FAU - Nikitina, I V AU - Nikitina IV FAU - Semiglazova, T Iu AU - Semiglazova TIu LA - rus PT - English Abstract PT - Journal Article PL - Russia (Federation) TA - Vopr Onkol JT - Voprosy onkologii JID - 0413775 RN - 0 (Antineoplastic Agents) RN - 0 (Biomarkers, Tumor) RN - 0 (MicroRNAs) RN - EC 2.7.10.1 (ERBB2 protein, human) RN - EC 2.7.10.1 (Receptor, ErbB-2) SB - IM MH - Age Factors MH - Antineoplastic Agents/administration & dosage/adverse effects/*therapeutic use MH - Biomarkers, Tumor/*metabolism MH - Breast Neoplasms/*drug therapy/genetics/metabolism/*pathology/surgery MH - Carcinoma, Ductal, Breast/drug therapy/metabolism MH - *Chemotherapy, Adjuvant MH - Decision Support Techniques MH - Female MH - Humans MH - Mastectomy, Segmental MH - MicroRNAs/metabolism MH - Neoplasm Staging MH - Receptor, ErbB-2/metabolism MH - Risk Assessment MH - Risk Factors EDAT- 2014/04/30 06:00 MHDA- 2014/05/30 06:00 CRDT- 2014/04/30 06:00 PST - ppublish SO - Vopr Onkol. 2014;60(1):102-8. PMID- 24667879 OWN - NLM STAT- MEDLINE DA - 20140417 DCOM- 20141216 LR - 20140417 IS - 1536-3708 (Electronic) IS - 0148-7043 (Linking) VI - 72 Suppl 1 DP - 2014 May TI - Management of mastectomy skin flap necrosis in autologous breast reconstruction. PG - S31-4 LID - 10.1097/SAP.0000000000000174 [doi] AB - INTRODUCTION: Mastectomy skin flap necrosis is a significant problem in the autologous breast reconstruction. The necrosis may create unsightly scarring, produce contour irregularities, and deform the breast mound. This may lead to a poor reconstruction and patient satisfaction. Most importantly, the development and treatment of mastectomy skin flap necrosis can delay further oncologic treatment.We performed a retrospective chart review of all patients undergoing autologous breast reconstruction in the past 5 years to examine our incidence and treatment of mastectomy skin flap necrosis. We then used these data to create a management algorithm for mastectomy skin flap necrosis. The goals of this algorithm were as follows: (1) to not delay further oncologic treatment, (2) to expedite the healing time while minimizing patient risk, and (3) to create an aesthetically pleasing breast reconstruction. MATERIALS AND METHODS: A retrospective chart review from 2008 to 2013 was performed of all autologous breast reconstruction at our institution. We then analyzed our data and patient outcomes and developed a treatment algorithm. RESULTS: We identified 204 patients who underwent autologous free flap breast reconstruction that was performed by the senior author (G.K.L.). Our incidence of mastectomy skin necrosis was 30%. There was no delay in adjuvant oncologic treatment for any of our patients. The development of mastectomy skin necrosis was significant for patients with diabetes (P=0.03), current tobacco use (P=0.04), and body mass index (P=0.01). The time for wound healing was prolonged in patients with a high body mass index (P=0.04). Regression analysis of wound size showed full-thickness wounds greater than 6 cm benefited from operative closure. CONCLUSIONS: Our incidence of mastectomy skin necrosis was 30%. Despite our high incidence mastectomy skin necrosis, we had no delays in adjuvant oncologic treatment. Retrospective data analysis allowed us to then develop a management algorithm for mastectomy skin necrosis. We feel it is advantageous to the patient and the reconstructive outcome to heal the breast wounds in the acute phase (within 3 weeks); and with regression analysis, we found full-thickness wounds greater than 6 cm benefit from operative intervention. Finally, patients requiring adjuvant oncologic treatment should be healed as quickly as possible so they may continue on with their oncologic care. FAU - Nykiel, Matthew AU - Nykiel M AD - From the Division of Plastic Surgery, Stanford University, Stanford, CA. FAU - Sayid, Zahra AU - Sayid Z FAU - Wong, Ryan AU - Wong R FAU - Lee, Gordon K AU - Lee GK LA - eng PT - Evaluation Studies PT - Journal Article PL - United States TA - Ann Plast Surg JT - Annals of plastic surgery JID - 7805336 SB - IM MH - Adult MH - Algorithms MH - Breast/*pathology/surgery MH - Breast Neoplasms/*surgery MH - Debridement MH - Decision Support Techniques MH - Female MH - Free Tissue Flaps/*transplantation MH - Humans MH - Mammaplasty/*methods MH - *Mastectomy MH - Middle Aged MH - Necrosis/epidemiology/etiology/surgery MH - Postoperative Complications/epidemiology/*surgery MH - Retrospective Studies MH - Skin Transplantation MH - Transplantation, Autologous MH - Treatment Outcome MH - Wound Closure Techniques EDAT- 2014/03/29 06:00 MHDA- 2014/12/17 06:00 CRDT- 2014/03/27 06:00 AID - 10.1097/SAP.0000000000000174 [doi] PST - ppublish SO - Ann Plast Surg. 2014 May;72 Suppl 1:S31-4. doi: 10.1097/SAP.0000000000000174. PMID- 24645229 OWN - NLM STAT- MEDLINE DA - 20140320 DCOM- 20140407 LR - 20140320 IS - 1565-1088 (Print) VI - 16 IP - 2 DP - 2014 Feb TI - Tumor-to-breast volume ratio as measured on MRI: a possible predictor of breast-conserving surgery versus mastectomy. PG - 101-5 AB - BACKGROUND: The surgical approach to breast cancer changed dramatically in the past 20 years. The surgical objective today is to remove the tumor, ensuring negative margins and good cosmetic results, and preserving the breast when possible. Magnetic resonance imaging of the breast has become an essential imaging tool prior to surgery, diagnosing additional tumors and assessing tumor extent. Tumor-to-breast volume ratio, an important predictor of breast conservation, can be measured with MRI and may change the surgical decision. OBJECTIVES: To measure the tumor-to-breast volume ratio using MRI in order to assess whether there is a correlation between this ratio and the type of surgery selected (breast-conserving or mastectomy). METHODS: The volumes of the tumor and the breast and the tumor-to-breast volume ratio were retrospectively calculated using preoperative breast MRI in 76 patients who underwent breast-conserving surgery or mastectomy. RESULTS: Breast-conserving surgery (lumpectomy) was performed in 64 patients and mastectomy in 12. The average tumor-to-breast volume ratio was 0.06 (6%) in the lumpectomy group and 0.30 (30%) in the mastectomy group (P < 0.0001). CONCLUSION: The tumor-to-breast volume ratio correlated with the type of surgery. As measured on MRI, this ratio is an accurate means of determining the type of surgery best suited for a given patient. It is recommended that MRI-determined tumor-to-breast volume ratio become part of the surgical planning protocol for patients diagnosed with breast cancer. FAU - Faermann, Renata AU - Faermann R FAU - Sperber, Fani AU - Sperber F FAU - Schneebaum, Schlomo AU - Schneebaum S FAU - Barsuk, Daphna AU - Barsuk D LA - eng PT - Journal Article PL - Israel TA - Isr Med Assoc J JT - The Israel Medical Association journal : IMAJ JID - 100930740 SB - IM MH - Adult MH - Aged MH - *Breast/pathology/surgery MH - *Breast Neoplasms/diagnosis/surgery MH - Decision Support Techniques MH - Female MH - Humans MH - *Magnetic Resonance Imaging/methods/statistics & numerical data MH - *Mastectomy, Segmental/methods/statistics & numerical data MH - *Mastectomy, Simple/methods/statistics & numerical data MH - Middle Aged MH - Organ Size MH - Organ Sparing Treatments MH - Patient Care Planning MH - Predictive Value of Tests MH - Retrospective Studies MH - Statistics as Topic MH - Tumor Burden EDAT- 2014/03/22 06:00 MHDA- 2014/04/08 06:00 CRDT- 2014/03/21 06:00 PST - ppublish SO - Isr Med Assoc J. 2014 Feb;16(2):101-5. PMID- 24611803 OWN - NLM STAT- MEDLINE DA - 20141117 DCOM- 20150708 LR - 20141117 IS - 2000-6764 (Electronic) IS - 2000-6764 (Linking) VI - 48 IP - 6 DP - 2014 Dec TI - Improved results after implementation of the Ghent algorithm for subcutaneous mastectomy in female-to-male transsexuals. PG - 362-7 LID - 10.3109/2000656X.2014.893887 [doi] AB - The subcutaneous mastectomy is an important step in the treatment of female-to-male transsexual patients. At the Sahlgrenska University Hospital, a two-step procedure was used for mastectomies through 2002-2011. With this procedure, all patients were operated on with a concentric circular incision in the first session of surgery, followed by a second session 7-12 months later. From July 2011, a new approach was adopted, which consists of treating patients according to the algorithm and methods described by Monstrey et al. The aim of this study is to evaluate these two different approaches and determine if similar results, possibly with fewer surgeries and overall lower complication rate, can be achieved by using multiple techniques and a decision-making algorithm as compared to the two-step approach where only a concentric circular technique was used. All female-to-male transsexuals who had mastectomy at Sahlgrenska between 2002-2012 were included in the study. These were divided in two groups: those who were treated according to the single-step, algorithm based, approach (16 patients, 32 mastectomies), and those who were treated with the two-step, concentric circular approach (14 patients, 28 mastectomies). Within the single-step, algorithm based, group the following techniques were used: 6% transareolar technique, 6% semicircular, 13% free nipple graft, 31% extended concentric circular, and 44% concentric circular. Data including type of surgical technique used, complications, and number of surgeries were collected and compared. Complications (e.g., haematoma, nipple necrosis, seroma, wound dehiscence, and infection) occurred in 50% of the patients following the first surgery in the two-step, concentric-circular approach group, for a total of 71.43% of patients with complications following either the first- or the second-step surgery; complications occurred only in 25% of the patients in the one-step, algorithm-based group. The mean number of surgeries per breast was 2.5 for the two-step concentric circular approach, and 1.25 for the single step, algorithm-based approach; particularly, when the concentric circular technique was chosen for the single step, algorithm-based approach, only two of the patients required revision surgery to improve the cosmetic outcome. This study shows that the number of complications and the total number of surgeries performed to satisfy patients were lower after Monstrey's algorithm for mastectomies was implemented as routine practice at the Sahlgrenska University Hospital. FAU - Bjerrome Ahlin, Henrik AU - Bjerrome Ahlin H AD - Department of Plastic Surgery, Sahlgrenska University Hospital , Gothenburg , Sweden. FAU - Kolby, Lars AU - Kolby L FAU - Elander, Anna AU - Elander A FAU - Selvaggi, Gennaro AU - Selvaggi G LA - eng PT - Journal Article DEP - 20140311 PL - Sweden TA - J Plast Surg Hand Surg JT - Journal of plastic surgery and hand surgery JID - 101534130 SB - IM MH - Adult MH - Body Mass Index MH - Cicatrix/surgery MH - *Decision Support Techniques MH - Female MH - Humans MH - Male MH - *Mastectomy, Subcutaneous MH - Sex Reassignment Surgery/*methods MH - Transsexualism/*surgery MH - Treatment Outcome OTO - NOTNLM OT - Transsexualism OT - female-to-male OT - gender dysphoria OT - gender reassignment surgery OT - mastectomy EDAT- 2014/03/13 06:00 MHDA- 2015/07/15 06:00 CRDT- 2014/03/12 06:00 AID - 10.3109/2000656X.2014.893887 [doi] PST - ppublish SO - J Plast Surg Hand Surg. 2014 Dec;48(6):362-7. doi: 10.3109/2000656X.2014.893887. Epub 2014 Mar 11. PMID- 24580970 OWN - NLM STAT- MEDLINE DA - 20140303 DCOM- 20150406 LR - 20140303 IS - 1440-172X (Electronic) IS - 1322-7114 (Linking) VI - 20 IP - 1 DP - 2014 Feb TI - Women's decision satisfaction and psychological distress following early breast cancer treatment: a treatment decision support role for nurses. PG - 8-16 LID - 10.1111/ijn.12243 [doi] AB - This prospective cross-sectional study investigated Australian women's (n = 104) decision satisfaction with cancer treatment decision for early breast cancer as well as their psychological distress 3-4 months following surgery. Women's satisfaction was surveyed using the Treatment Decision Satisfaction Questionnaire, and the Brief Symptom Inventory-18 was used to measure psychological distress. Women who were living alone, who worked as professionals and who were not involved in the decision-making process by their doctors were less likely to be satisfied with their decision process, outcome and their overall treatment decision. Following treatment, 26.0% of women were distressed; 18.3% experienced anxiety; 19.2% somatization; and 27.9% depression. Women who experienced somatization were more likely to be dissatisfied with the treatment decision (P = 0.003) as were those who reported psychological distress (P = 0.020). Women who were involved in choosing their treatment were more satisfied with their decision. Many women experienced distress following breast cancer treatment and might have required referral for psychological assessment, management and long-term support. Women who experienced distress were more likely to be dissatisfied with the treatment decision (or vice versa). CI - (c) 2014 Wiley Publishing Asia Pty Ltd. FAU - Budden, Lea M AU - Budden LM AD - School of Nursing, Midwifery & Nutrition, James Cook University, Townsville, Queensland, Australia. FAU - Hayes, Barbara A AU - Hayes BA FAU - Buettner, Petra G AU - Buettner PG LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - Australia TA - Int J Nurs Pract JT - International journal of nursing practice JID - 9613615 SB - N MH - Aged MH - Breast Neoplasms/nursing/*psychology/therapy MH - *Decision Support Techniques MH - Female MH - Humans MH - Middle Aged MH - *Nurse's Role MH - *Patient Satisfaction MH - *Stress, Psychological OTO - NOTNLM OT - breast cancer OT - cancer treatment OT - decision satisfaction OT - decision-making OT - patient satisfaction OT - psychological distress EDAT- 2014/03/04 06:00 MHDA- 2015/04/07 06:00 CRDT- 2014/03/04 06:00 AID - 10.1111/ijn.12243 [doi] PST - ppublish SO - Int J Nurs Pract. 2014 Feb;20(1):8-16. doi: 10.1111/ijn.12243. PMID- 24576583 OWN - NLM STAT- MEDLINE DA - 20140505 DCOM- 20140626 LR - 20151119 IS - 1879-1883 (Electronic) IS - 0002-9610 (Linking) VI - 207 IP - 5 DP - 2014 May TI - Evaluating population-based breast cancer surgical practice in real time with a web-based synoptic operative reporting system. PG - 693-6; discussion 696-7 LID - 10.1016/j.amjsurg.2013.12.013 [doi] LID - S0002-9610(14)00072-5 [pii] AB - BACKGROUND: A Web-based synoptic operative reporting system (WebSMR) incorporates implicit guidelines and real-time feedback of a surgeon's practice compared with provincial data. This study compares rates of total mastectomy (TM) between the overall provincial and WebSMR patients and examines decision-making factors in WebSMR patients. METHODS: Patients treated for invasive breast cancer (2007 to 2011) were identified from WebSMR and the Alberta Cancer Registry. Reports include surgery type and reasons for TM. RESULTS: Among 5,787 patients in WebSMR (2007 to 2011), TM rate decreased from 48% to 42% (P < .001). In 2011, the provincial cancer registry recorded a 56% TM rate compared to 42% in WebSMR patients. Patient preference accounted for 36% in the latter group. CONCLUSIONS: In WebSMR patients, TM rates were lower than the overall provincial rate and decreased significantly during the study period. Reasons are unclear, but guidelines and real-time feedback likely plays a role. CI - Copyright (c) 2014 Elsevier Inc. All rights reserved. FAU - Temple, Walley J AU - Temple WJ AD - Department of Surgery and Oncology, University of Calgary, Calgary, AB, Canada. FAU - Chin-Lenn, Laura AU - Chin-Lenn L AD - Department of Surgery and Oncology, University of Calgary, Calgary, AB, Canada. FAU - Mack, Lloyd A AU - Mack LA AD - Department of Surgery and Oncology, University of Calgary, Calgary, AB, Canada. Electronic address: lloyd.mack@albertahealthservices.ca. CN - Cancer Surgery Alberta LA - eng PT - Evaluation Studies PT - Journal Article DEP - 20140205 PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 SB - AIM SB - IM MH - Alberta MH - Breast Neoplasms/*surgery MH - Carcinoma, Ductal, Breast/*surgery MH - Decision Support Techniques MH - Female MH - Guideline Adherence/*statistics & numerical data/trends MH - Humans MH - *Internet MH - Mastectomy, Segmental/statistics & numerical data/trends/utilization MH - Mastectomy, Simple/statistics & numerical data/trends/*utilization MH - *Medical Records Systems, Computerized MH - Patient Preference MH - Practice Guidelines as Topic MH - Practice Patterns, Physicians'/*statistics & numerical data/trends MH - Registries OTO - NOTNLM OT - Breast cancer OT - Population-based OT - Web-based synoptic operative reporting EDAT- 2014/03/01 06:00 MHDA- 2014/06/27 06:00 CRDT- 2014/03/01 06:00 PHST- 2013/11/02 [received] PHST- 2013/12/16 [revised] PHST- 2013/12/16 [accepted] AID - S0002-9610(14)00072-5 [pii] AID - 10.1016/j.amjsurg.2013.12.013 [doi] PST - ppublish SO - Am J Surg. 2014 May;207(5):693-6; discussion 696-7. doi: 10.1016/j.amjsurg.2013.12.013. Epub 2014 Feb 5. PMID- 24508194 OWN - NLM STAT- MEDLINE DA - 20140317 DCOM- 20140428 LR - 20140317 IS - 1878-0539 (Electronic) IS - 1748-6815 (Linking) VI - 67 IP - 4 DP - 2014 Apr TI - The cost effectiveness of acellular dermal matrix in expander-implant immediate breast reconstruction. PG - 468-76 LID - 10.1016/j.bjps.2013.12.035 [doi] LID - S1748-6815(13)00699-2 [pii] AB - BACKGROUND: Expander-implant breast reconstruction is often supplemented with acellular dermal matrix (ADM). The use of acellular dermal matrix has allowed for faster, less painful expansions and improved aesthetics, but with increased cost. Our goal was to provide the first cost utility analysis of using acellular dermal matrix in two-stage, expander-implant immediate breast reconstruction following mastectomy. METHODS: A comprehensive literature review was conducted to identify complication rates for two-stage, expander-implant immediate breast reconstruction with and without acellular dermal matrix. The probabilities of the most common complications were combined with Medicare Current Procedural Terminology reimbursement codes and expert utility estimates to fit into a decision model. The decision model evaluated the cost effectiveness of acellular dermal matrix relative to reconstructions without it. Retail costs for ADM were derived from the LifeCell 2012 company catalogue for Alloderm. RESULTS: The overall complication rates were 30% and 34.5% with and without ADM. The decision model revealed a baseline cost increase of $361.96 when acellular dermal matrix is used. The increase in Quality-Adjusted Life Years (QALYs) is 1.37 in the population with acellular dermal matrix. This yields a cost effective incremental cost-utility ratio (ICUR) of $264.20/QALY. Univariate sensitivity analysis confirmed that using acellular dermal matrix is cost effective even when using retail costs for unilateral and bilateral reconstructions. CONCLUSIONS: Our study shows that, despite an increased cost, acellular dermal matrix is a cost effective technology for patients undergoing two-stage, expander-implant immediate breast reconstruction due to its increased utility in successful procedures. CI - Crown Copyright (c) 2013. Published by Elsevier Ltd. All rights reserved. FAU - Krishnan, Naveen M AU - Krishnan NM AD - Geisel School of Medicine at Dartmouth, Hanover, NH, USA. Electronic address: Naveen.Krishnan07@gmail.com. FAU - Chatterjee, Abhishek AU - Chatterjee A AD - Division of Plastic Surgery, Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. FAU - Rosenkranz, Kari M AU - Rosenkranz KM AD - Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. FAU - Powell, Stephen G AU - Powell SG AD - Tuck School of Business at Dartmouth, Hanover, NH, USA. FAU - Nigriny, John F AU - Nigriny JF AD - Division of Plastic Surgery, Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. FAU - Vidal, Dale C AU - Vidal DC AD - Division of Plastic Surgery, Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20140123 PL - Netherlands TA - J Plast Reconstr Aesthet Surg JT - Journal of plastic, reconstructive & aesthetic surgery : JPRAS JID - 101264239 SB - IM MH - *Acellular Dermis MH - Breast Implantation/*economics/methods MH - Breast Implants/*economics MH - *Cost-Benefit Analysis MH - Decision Support Techniques MH - Female MH - Humans MH - Mastectomy MH - Middle Aged MH - Tissue Expansion/*economics/methods OTO - NOTNLM OT - Acellular dermal matrix OT - Cost effectiveness analysis EDAT- 2014/02/11 06:00 MHDA- 2014/04/29 06:00 CRDT- 2014/02/11 06:00 PHST- 2013/02/08 [received] PHST- 2013/10/26 [revised] PHST- 2013/12/21 [accepted] AID - S1748-6815(13)00699-2 [pii] AID - 10.1016/j.bjps.2013.12.035 [doi] PST - ppublish SO - J Plast Reconstr Aesthet Surg. 2014 Apr;67(4):468-76. doi: 10.1016/j.bjps.2013.12.035. Epub 2014 Jan 23. PMID- 24460266 OWN - NLM STAT- MEDLINE DA - 20140127 DCOM- 20150106 LR - 20170308 IS - 2476-762X (Electronic) IS - 1513-7368 (Linking) VI - 14 IP - 12 DP - 2013 TI - The decision-making journey of malaysian women with early breast cancer: a qualitative study. PG - 7143-7 AB - BACKGROUND: The survival outcomes for women presenting with early breast cancer are influenced by treatment decisions. In Malaysia, survival outcome is generally poor due to late presentation. Of those who present early, many refuse treatment for complementary therapy. OBJECTIVE: This study aimed to explore the decision making experiences of women with early breast cancer. MATERIALS AND METHODS: A qualitative study using individual in-depth interviews was conducted to capture the decision making process of women with early breast cancer in Malaysia. We used purposive sampling to recruit women yet to undergo surgical treatment. A total of eight participants consented and were interviewed using a semi-structured interview guide. These women were recruited from a period of one week after they were informed of their diagnoses. A topic guide, based on the Ottawa decision support framework (ODSF), was used to facilitate the interviews, which were audio recorded, transcribed and analysed using a thematic approach. RESULTS: We identified four phases in the decision-making process of women with early breast cancer: discovery (pre-diagnosis); confirmatory ('receiving bad news'); deliberation; and decision (making a decision). These phases ranged from when women first discovered abnormalities in their breasts to them making final surgical treatment decisions. Information was vital in guiding these women. Support from family members, friends, healthcare professionals as well as survivors also has an influencing role. However, the final say on treatment decision was from themselves. CONCLUSIONS: The treatment decision for women with early breast cancer in Malaysia is a result of information they gather on their decision making journey. This journey starts with diagnosis. The women's spouses, friends, family members and healthcare professionals play different roles as information providers and supporters at different stages of treatment decisions. However, the final treatment decision is influenced mainly by women's own experiences, knowledge and understanding. FAU - Abdullah, Adina AU - Abdullah A AD - Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia E-mail : adina@ummc.edu.my. FAU - Abdullah, Khatijah Lim AU - Abdullah KL FAU - Yip, Cheng Har AU - Yip CH FAU - Teo, Soo-Hwang AU - Teo SH FAU - Taib, Nur Aishah AU - Taib NA FAU - Ng, Chirk Jenn AU - Ng CJ LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - Thailand TA - Asian Pac J Cancer Prev JT - Asian Pacific journal of cancer prevention : APJCP JID - 101130625 SB - IM MH - Adult MH - Breast Neoplasms/diagnosis/*psychology/therapy MH - Complementary Therapies MH - *Decision Making MH - Family MH - Female MH - Follow-Up Studies MH - Humans MH - Malaysia MH - Middle Aged MH - *Patient Participation MH - Prognosis MH - *Qualitative Research MH - Survivors MH - Women's Health EDAT- 2014/01/28 06:00 MHDA- 2015/01/07 06:00 CRDT- 2014/01/28 06:00 PST - ppublish SO - Asian Pac J Cancer Prev. 2013;14(12):7143-7. PMID- 24422989 OWN - NLM STAT- MEDLINE DA - 20140124 DCOM- 20141021 LR - 20170505 IS - 1472-6947 (Electronic) IS - 1472-6947 (Linking) VI - 14 DP - 2014 Jan 14 TI - Development of a personalized decision aid for breast cancer risk reduction and management. PG - 4 LID - 10.1186/1472-6947-14-4 [doi] AB - BACKGROUND: Breast cancer risk reduction has the potential to decrease the incidence of the disease, yet remains underused. We report on the development a web-based tool that provides automated risk assessment and personalized decision support designed for collaborative use between patients and clinicians. METHODS: Under Institutional Review Board approval, we evaluated the decision tool through a patient focus group, usability testing, and provider interviews (including breast specialists, primary care physicians, genetic counselors). This included demonstrations and data collection at two scientific conferences (2009 International Shared Decision Making Conference, 2009 San Antonio Breast Cancer Symposium). RESULTS: Overall, the evaluations were favorable. The patient focus group evaluations and usability testing (N = 34) provided qualitative feedback about format and design; 88% of these participants found the tool useful and 94% found it easy to use. 91% of the providers (N = 23) indicated that they would use the tool in their clinical setting. CONCLUSION: BreastHealthDecisions.org represents a new approach to breast cancer prevention care and a framework for high quality preventive healthcare. The ability to integrate risk assessment and decision support in real time will allow for informed, value-driven, and patient-centered breast cancer prevention decisions. The tool is being further evaluated in the clinical setting. FAU - Ozanne, Elissa M AU - Ozanne EM AD - Department of Surgery, Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA, USA. elissa.m.ozanne@dartmouth.edu. FAU - Howe, Rebecca AU - Howe R FAU - Omer, Zehra AU - Omer Z FAU - Esserman, Laura J AU - Esserman LJ LA - eng GR - R21CA141097/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20140114 PL - England TA - BMC Med Inform Decis Mak JT - BMC medical informatics and decision making JID - 101088682 SB - IM MH - Adult MH - Aged MH - Breast Neoplasms/*prevention & control/therapy MH - *Decision Making MH - Decision Support Systems, Clinical/instrumentation/*standards MH - *Decision Support Techniques MH - Disease Management MH - Female MH - Focus Groups MH - Humans MH - Internet/utilization MH - Male MH - Middle Aged MH - Patient-Centered Care/standards MH - Risk Assessment MH - Risk Reduction Behavior PMC - PMC3899602 OID - NLM: PMC3899602 EDAT- 2014/01/16 06:00 MHDA- 2014/10/22 06:00 CRDT- 2014/01/16 06:00 PHST- 2013/05/08 [received] PHST- 2014/01/02 [accepted] AID - 1472-6947-14-4 [pii] AID - 10.1186/1472-6947-14-4 [doi] PST - epublish SO - BMC Med Inform Decis Mak. 2014 Jan 14;14:4. doi: 10.1186/1472-6947-14-4. PMID- 24401804 OWN - NLM STAT- MEDLINE DA - 20150416 DCOM- 20160104 LR - 20150416 IS - 1536-3708 (Electronic) IS - 0148-7043 (Linking) VI - 74 IP - 5 DP - 2015 May TI - Vascular variations of the transverse upper gracilis flap in consideration for breast reconstruction. PG - 528-31 LID - 10.1097/01.sap.0000435501.19566.75 [doi] AB - PURPOSE: The transverse upper gracilis (TUG) myocutaneous flap has served as an alternative to abdominally based autologous breast reconstruction since its introduction by Yousif et al in 1992. The reliability of the overlying skin paddle of the gracilis myocutaneous flap depends on the perforator anatomy as well as the vascular pedicle. Although much attention recently has been given to variations in the septocutaneous as well as myocutaneous perforators, we believe that relevant variations in pedicle anatomy have been underappreciated. We would like to report our experience with pedicle variability. METHODS: A retrospective review of records was performed on patients undergoing a TUG flap for autologous breast reconstruction from July 2006 and November 2011 by a single surgeon (L.C.W.). RESULTS: A total of 36 TUG flaps were performed on 24 patients. Twelve patients underwent bilateral simultaneous TUG reconstruction, and 12 patients underwent unilateral TUG reconstruction. Pedicle variability was found in 6 (17%) of 36 dissections. In 5.5% of dissections, there was a split pedicle and 11% were found to have a double main pedicle. There was 1 partial flap loss that resulted in a failed breast reconstruction. Four limbs had some degree of resultant lymphedema as a consequence of flap harvest. CONCLUSIONS: Although still a viable alternative to abdominally based autologous reconstruction, we find that the variability of the main pedicle has been quite underestimated in earlier reports. We also present a logical algorithm for flap dissection when the microsurgeon encounters such aberrancies. FAU - Natoli, Noel Blythe AU - Natoli NB AD - From the Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA. FAU - Wu, Liza C AU - Wu LC LA - eng PT - Case Reports PT - Journal Article PL - United States TA - Ann Plast Surg JT - Annals of plastic surgery JID - 7805336 SB - IM MH - Adult MH - Algorithms MH - Decision Support Techniques MH - Female MH - Femoral Artery/*abnormalities/surgery MH - Humans MH - Mammaplasty/*methods MH - Middle Aged MH - Myocutaneous Flap/*blood supply MH - Retrospective Studies MH - Thigh/*blood supply EDAT- 2014/01/10 06:00 MHDA- 2016/01/05 06:00 CRDT- 2014/01/10 06:00 AID - 10.1097/01.sap.0000435501.19566.75 [doi] PST - ppublish SO - Ann Plast Surg. 2015 May;74(5):528-31. doi: 10.1097/01.sap.0000435501.19566.75. PMID- 24395277 OWN - NLM STAT- MEDLINE DA - 20140221 DCOM- 20141009 LR - 20140221 IS - 1534-6277 (Electronic) IS - 1534-6277 (Linking) VI - 15 IP - 1 DP - 2014 Mar TI - What is a clear margin in breast conserving cancer surgery? PG - 79-85 LID - 10.1007/s11864-013-0270-4 [doi] AB - OPINION STATEMENT: Team work is the key to successful breast conservation therapy. Patient education and the informed consent process should include a discussion about the importance of margin status. Specimen management is critically important to obtain the highest quality information about margins. Operating technique should avoid trauma to or disruption of the specimen surface. The specimen should be oriented for the pathologist using standard techniques including sutures, clips, or colored inks. Specimen radiography is mandatory to confirm complete resection of the target tissues and can be used to direct additional margin resections during the initial procedure. With a well-designed and oriented specimen, the pathologist can give an accurate description of the margin distance for both the invasive and in situ components of the cancer. In most cases, decision-making about margins will be straightforward. Positive margins should be re-excised or the treatment is converted to mastectomy. Clear margins (>5 mm) require no further surgical therapy. "Close" margins (1-4 mm) will remain a point of controversy because of conflicting reports from clinical series. At UAB, decision for re-excision is made on a case-by-case basis. Routinely 2 mm is considered adequate, however, volume of disease and intraductal component are important considerations when making recommendations. FAU - Krontiras, Helen AU - Krontiras H AD - Department of Surgery, University of Alabama School of Medicine, Birmingham, AL, USA, hkrontir@uabmc.edu. FAU - Lancaster, Rachael B AU - Lancaster RB FAU - Urist, Marshall M AU - Urist MM LA - eng PT - Journal Article PT - Review PL - United States TA - Curr Treat Options Oncol JT - Current treatment options in oncology JID - 100900946 SB - IM MH - Breast Neoplasms/mortality/*pathology/*surgery MH - Female MH - Humans MH - *Mastectomy, Segmental MH - Neoplasm Recurrence, Local MH - Treatment Outcome EDAT- 2014/01/08 06:00 MHDA- 2014/10/10 06:00 CRDT- 2014/01/08 06:00 AID - 10.1007/s11864-013-0270-4 [doi] PST - ppublish SO - Curr Treat Options Oncol. 2014 Mar;15(1):79-85. doi: 10.1007/s11864-013-0270-4. PMID- 24393589 OWN - NLM STAT- MEDLINE DA - 20140107 DCOM- 20140912 LR - 20140107 IS - 2245-1919 (Electronic) IS - 2245-1919 (Linking) VI - 61 IP - 1 DP - 2014 Jan TI - Measurement of breast volume is a useful supplement to select candidates for surgical breast reduction. PG - A4760 AB - INTRODUCTION: The indication for breast reduction in a public welfare or an insurance paid setting depends on the severity of the subjective symptoms and the clinical evaluation. The purpose of this study was to evaluate the use of breast volume as an objective criterion to establish the indication for breast reduction surgery, thus establishing a standard decision basis that can be shared by surgeons and departments to secure patients fair and equal treatment opportunities. MATERIAL AND METHODS: A total of 427 patients who were referred to three Danish public hospitals with breast hypertrophy in the period from January 2007 to March 2011 were included prospectively in the study. The patients' subjective complaints, height, weight and standard breast measurements were registered as well as the decision for or against surgery. Breast volume was measured using transparent plastic cups. RESULTS: Cut-off values for breast volume were calculated based on whether or not the patients were offered reduction surgery. Most patients (93%) with a breast volume below 800 cc were not offered surgery, while most with a volume exceeding 900 cc were offered surgery (94%). In the grey zone between 800 and 900 cc, the indication seemed to be less clear-cut, and additional parameters need to be included. CONCLUSION: Breast volume can be used as an objective criterion in addition to the presently used criteria. Breast volume can easily be measured and has become appreciated by plastic surgeons dealing with patients with breast hypertrophy as a tool which facilitates their decision-making and patients' acceptance of the decisions made. FUNDING: not relevant. TRIAL REGISTRATION: not relevant. FAU - Ikander, Peder AU - Ikander P AD - Kirurgisk Afdeling, Sydvestjysk Sygehus, Esbjerg, Finsensgade 35, 6700 Esbjerg, Denmark. peder.ikander@gmail.com. FAU - Drejoe, Jennifer Berg AU - Drejoe JB FAU - Lumholt, Pavia AU - Lumholt P FAU - Sjostrand, Helle AU - Sjostrand H FAU - Matzen, Steen AU - Matzen S FAU - Quirinia, Anne AU - Quirinia A FAU - Siersen, Hans Erik AU - Siersen HE FAU - Ringberg, Anita AU - Ringberg A FAU - Lambaa, Susanne AU - Lambaa S FAU - Holmich, Lisbet Rosenkrantz AU - Holmich LR LA - eng PT - Clinical Trial PT - Journal Article PT - Multicenter Study PL - Denmark TA - Dan Med J JT - Danish medical journal JID - 101576205 RN - Gigantomastia SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Breast/*abnormalities/*pathology/surgery MH - Decision Support Techniques MH - Female MH - Humans MH - Hypertrophy/pathology/*surgery MH - *Mammaplasty MH - Middle Aged MH - Organ Size MH - Patient Acceptance of Health Care/statistics & numerical data MH - *Patient Selection MH - Prospective Studies MH - Young Adult EDAT- 2014/01/08 06:00 MHDA- 2014/09/13 06:00 CRDT- 2014/01/08 06:00 AID - A4760 [pii] PST - ppublish SO - Dan Med J. 2014 Jan;61(1):A4760. PMID- 24378846 OWN - NLM STAT- MEDLINE DA - 20140304 DCOM- 20140501 LR - 20161019 IS - 2168-6114 (Electronic) IS - 2168-6106 (Linking) VI - 174 IP - 3 DP - 2014 Mar TI - Development and evaluation of a decision aid on mammography screening for women 75 years and older. PG - 417-24 LID - 10.1001/jamainternmed.2013.13639 [doi] AB - IMPORTANCE: Guidelines recommend that women 75 years and older should be informed of the benefits and risks of mammography before being screened. However, few are adequately informed. OBJECTIVES: To develop and evaluate a mammography screening decision aid (DA) for women 75 years and older. DESIGN: We designed the DA using international standards. Between July 14, 2010, and April 10, 2012, participants completed a pretest survey and read the DA before an appointment with their primary care physician. They completed a posttest survey after their appointment. Medical records were reviewed for follow-up information. SETTING AND PARTICIPANTS: Boston, Massachusetts, academic primary care practice. Eligible women were aged 75 to 89 years, English speaking, had not had a mammogram in 9 months but had been screened within the past 3 years, and did not have a history of dementia or invasive or noninvasive breast cancer. Of 84 women approached, 27 declined to participate, 12 were unable to complete the study for logistical reasons, and 45 participated. INTERVENTIONS: The DA includes information on breast cancer risk, life expectancy, competing mortality risks, possible outcomes of screening, and a values clarification exercise. MAIN OUTCOMES AND MEASURES: Knowledge of the benefits and risks of screening, decisional conflict, and screening intentions; documentation in the medical record of a discussion of the risks and benefits of mammography with a primary care physician within 6 months; and the receipt of screening within 15 months. We used the Wilcoxon signed rank test and McNemar test to compare pretest-posttest information. RESULTS: The median age of participants was 79 years, 69% (31 of 45) were of non-Hispanic white race/ethnicity, and 60% (27 of 45) had attended at least some college. Comparison of posttest results with pretest results demonstrated 2 findings. First, knowledge of the benefits and risks of screening improved (P < .001). Second, fewer participants intended to be screened (56% [25 of 45] afterward compared with 82% [37 of 45] before, P = .03). Decisional conflict declined but not significantly (P = .10). In the following 6 months, 53% (24 of 45) of participants had a primary care physician note that documented the discussion of the risks and benefits of screening compared with 11% (5 of 45) in the previous 5 years (P < .001). While 84% (36 of 43) had been screened within 2 years of participating, 60% (26 of 43) were screened within 15 months after participating (>/= 2 years since their last mammogram) (P = .01). Overall, 93% (42 of 45) found the DA helpful. CONCLUSIONS AND RELEVANCE: A DA may improve older women's decision making about mammography screening. FAU - Schonberg, Mara A AU - Schonberg MA AD - Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts. FAU - Hamel, Mary Beth AU - Hamel MB AD - Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts. FAU - Davis, Roger B AU - Davis RB AD - Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts. FAU - Griggs, M Cecilia AU - Griggs MC AD - Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts. FAU - Wee, Christina C AU - Wee CC AD - Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts. FAU - Fagerlin, Angela AU - Fagerlin A AD - Center for Bioethics and Social Sciences in Medicine, Departments of Internal Medicine and Psychology, University of Michigan, and Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan. FAU - Marcantonio, Edward R AU - Marcantonio ER AD - Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts. LA - eng GR - K23 AG030964/AG/NIA NIH HHS/United States GR - K24 AG035075/AG/NIA NIH HHS/United States GR - K23AG028584/AG/NIA NIH HHS/United States GR - K23 AG028584/AG/NIA NIH HHS/United States GR - UL1 RR025758/RR/NCRR NIH HHS/United States GR - K24DK087932/DK/NIDDK NIH HHS/United States GR - UL1 RR 025758/RR/NCRR NIH HHS/United States GR - K24 DK087932/DK/NIDDK NIH HHS/United States PT - Evaluation Studies PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - United States TA - JAMA Intern Med JT - JAMA internal medicine JID - 101589534 SB - AIM SB - IM MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/*diagnosis/prevention & control MH - Decision Making MH - *Decision Support Techniques MH - *Early Detection of Cancer MH - Female MH - Health Knowledge, Attitudes, Practice MH - Humans MH - *Mammography MH - *Patient Participation MH - Women's Health PMC - PMC4017368 MID - NIHMS569183 OID - NLM: NIHMS569183 OID - NLM: PMC4017368 EDAT- 2014/01/01 06:00 MHDA- 2014/05/03 06:00 CRDT- 2014/01/01 06:00 AID - 1792914 [pii] AID - 10.1001/jamainternmed.2013.13639 [doi] PST - ppublish SO - JAMA Intern Med. 2014 Mar;174(3):417-24. doi: 10.1001/jamainternmed.2013.13639. PMID- 24368235 OWN - NLM STAT- MEDLINE DA - 20131225 DCOM- 20140818 LR - 20170220 IS - 1538-0688 (Electronic) IS - 0190-535X (Linking) VI - 41 IP - 1 DP - 2014 Jan 01 TI - Racial and ethnic variation in partner perspectives about the breast cancer treatment decision-making experience. PG - 13-20 LID - 10.1188/14.ONF.13-20 [doi] AB - PURPOSE/OBJECTIVES: To characterize the perspectives of partners (husbands or significant others) of patients with breast cancer in the treatment decision-making process and to evaluate racial and ethnic differences in decision outcomes. DESIGN: A cross-sectional survey. SETTING: Los Angeles, CA, and Detroit, MI. SAMPLE: 517 partners of a population-based sample of patients with breast cancer four years post-treatment. METHODS: A self-administered mailed questionnaire. Chi-square tests and logistic regression were used to assess associations between race and ethnicity and decision outcomes. MAIN RESEARCH VARIABLES: Decision regret and three elements of the decision process: information received, actual involvement, and desired involvement. FINDINGS: Most partners reported receiving sufficient information (77%), being involved in treatment decisions (74%), and having sufficient involvement (73%). Less-acculturated Hispanic partners were more likely than their Caucasian counterparts to report high decision regret (45% versus 14%, p<0.001). Factors significantly associated (p<0.05) with high decision regret were insufficient receipt of treatment information, low involvement in decision making, and a desire for more involvement. CONCLUSIONS: Partners were generally positive regarding their perspectives about participating in the breast cancer treatment decision-making process. However, less acculturated Hispanic partners were most vulnerable to decision regret. In addition, high decision regret was associated with modifiable elements of the decision-making process. IMPLICATIONS FOR NURSING: Attention should be paid to ensuring racial and ethnic minority partners are sufficiently involved in breast cancer treatment decisions and receive decision support. FAU - Lillie, Sarah E AU - Lillie SE AD - Minneapolis Veterans Affairs Medical Center in Minnesota. FAU - Janz, Nancy K AU - Janz NK AD - Department of Health Behavior and Health Education, University of Michigan in Ann Arbor. FAU - Friese, Christopher R AU - Friese CR AD - School of Nursing, University of Michigan in Ann Arbor. FAU - Graff, John J AU - Graff JJ AD - Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ. FAU - Schwartz, Kendra AU - Schwartz K AD - Department of Family Medicine, Wayne State University, Detroit, MI. FAU - Hamilton, Ann S AU - Hamilton AS AD - Department of Preventive Medicine, University of Southern California in Los Angeles. FAU - Gay, Brittany Bartol AU - Gay BB AD - Department of Internal Medicine, University of Michigan. FAU - Katz, Steven J AU - Katz SJ AD - Department of Internal Medicine, University of Michigan and Ann Arbor Veterans Affairs Healthcare System. FAU - Hawley, Sarah T AU - Hawley ST AD - Department of Internal Medicine, University of Michigan and Ann Arbor Veterans Affairs Healthcare System. LA - eng GR - R00 NR010750/NR/NINR NIH HHS/United States GR - R01 CA088370/CA/NCI NIH HHS/United States GR - R01 CA109696/CA/NCI NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Multicenter Study PL - United States TA - Oncol Nurs Forum JT - Oncology nursing forum JID - 7809033 SB - IM SB - N MH - Acculturation MH - African Americans/psychology MH - Attitude to Health MH - Breast Neoplasms/*ethnology/psychology/therapy MH - Chemotherapy, Adjuvant/psychology MH - Cross-Sectional Studies MH - *Decision Making MH - *Emotions MH - European Continental Ancestry Group/psychology MH - Female MH - Health Care Surveys MH - Hispanic Americans/psychology MH - Humans MH - Indians, North American/psychology MH - Informed Consent MH - Los Angeles MH - Male MH - Mastectomy/methods/psychology MH - Michigan MH - Patient Education as Topic MH - *Patient Participation/psychology MH - Radiotherapy, Adjuvant/psychology MH - SEER Program MH - Sexual Partners/*psychology MH - Surveys and Questionnaires PMC - PMC5058443 MID - NIHMS560810 OTO - NOTNLM OT - breast cancer OT - decision making OT - family and caregivers EDAT- 2013/12/26 06:00 MHDA- 2014/08/19 06:00 CRDT- 2013/12/26 06:00 AID - 1237673254N7126K [pii] AID - 10.1188/14.ONF.13-20 [doi] PST - ppublish SO - Oncol Nurs Forum. 2014 Jan 1;41(1):13-20. doi: 10.1188/14.ONF.13-20. PMID- 24345424 OWN - NLM STAT- MEDLINE DA - 20131218 DCOM- 20140813 LR - 20170220 IS - 1438-8871 (Electronic) IS - 1438-8871 (Linking) VI - 15 IP - 12 DP - 2013 Dec 17 TI - The effect of patient narratives on information search in a web-based breast cancer decision aid: an eye-tracking study. PG - e273 LID - 10.2196/jmir.2784 [doi] AB - BACKGROUND: Previous research has examined the impact of patient narratives on treatment choices, but to our knowledge, no study has examined the effect of narratives on information search. Further, no research has considered the relative impact of their format (text vs video) on health care decisions in a single study. OBJECTIVE: Our goal was to examine the impact of video and text-based narratives on information search in a Web-based patient decision aid for early stage breast cancer. METHODS: Fifty-six women were asked to imagine that they had been diagnosed with early stage breast cancer and needed to choose between two surgical treatments (lumpectomy with radiation or mastectomy). Participants were randomly assigned to view one of four versions of a Web decision aid. Two versions of the decision aid included videos of interviews with patients and physicians or videos of interviews with physicians only. To distinguish between the effect of narratives and the effect of videos, we created two text versions of the Web decision aid by replacing the patient and physician interviews with text transcripts of the videos. Participants could freely browse the Web decision aid until they developed a treatment preference. We recorded participants' eye movements using the Tobii 1750 eye-tracking system equipped with Tobii Studio software. A priori, we defined 24 areas of interest (AOIs) in the Web decision aid. These AOIs were either separate pages of the Web decision aid or sections within a single page covering different content. RESULTS: We used multilevel modeling to examine the effect of narrative presence, narrative format, and their interaction on information search. There was a significant main effect of condition, P=.02; participants viewing decision aids with patient narratives spent more time searching for information than participants viewing the decision aids without narratives. The main effect of format was not significant, P=.10. However, there was a significant condition by format interaction on fixation duration, P<.001. When comparing the two video decision aids, participants viewing the narrative version spent more time searching for information than participants viewing the control version of the decision aid. In contrast, participants viewing the narrative version of the text decision aid spent less time searching for information than participants viewing the control version of the text decision aid. Further, narratives appear to have a global effect on information search; these effects were not limited to specific sections of the decision aid that contained topics discussed in the patient stories. CONCLUSIONS: The observed increase in fixation duration with video patient testimonials is consistent with the idea that the vividness of the video content could cause greater elaboration of the message, thereby encouraging greater information search. Conversely, because reading requires more effortful processing than watching, reading patient narratives may have decreased participant motivation to engage in more reading in the remaining sections of the Web decision aid. These findings suggest that the format of patient stories may be equally as important as their content in determining their effect on decision making. More research is needed to understand why differences in format result in fundamental differences in information search. FAU - Shaffer, Victoria A AU - Shaffer VA AD - University of Missouri, Department of Health Sciences, School of Health Professions, Department of Psychological Sciences, College of Arts & Science, Columbia, MO, United States. shafferv@health.missouri.edu. FAU - Owens, Justin AU - Owens J FAU - Zikmund-Fisher, Brian J AU - Zikmund-Fisher BJ LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20131217 PL - Canada TA - J Med Internet Res JT - Journal of medical Internet research JID - 100959882 SB - IM MH - Adult MH - Aged MH - Breast Neoplasms/psychology/*surgery MH - Decision Making MH - *Decision Support Techniques MH - Eye Movements MH - Female MH - Humans MH - Information Seeking Behavior MH - *Internet MH - Middle Aged MH - Patient Participation MH - *Telemedicine MH - Video Recording PMC - PMC3875892 OID - NLM: PMC3875892 OTO - NOTNLM OT - breast cancer OT - decision aids OT - eye tracking OT - personal narratives EDAT- 2013/12/19 06:00 MHDA- 2014/08/15 06:00 CRDT- 2013/12/19 06:00 PHST- 2013/06/19 [received] PHST- 2013/10/13 [accepted] PHST- 2013/09/12 [revised] AID - v15i12e273 [pii] AID - 10.2196/jmir.2784 [doi] PST - epublish SO - J Med Internet Res. 2013 Dec 17;15(12):e273. doi: 10.2196/jmir.2784. PMID- 24325874 OWN - NLM STAT- MEDLINE DA - 20140127 DCOM- 20150515 LR - 20151119 IS - 1873-5134 (Electronic) IS - 0738-3991 (Linking) VI - 94 IP - 2 DP - 2014 Feb TI - Treatment decision-making in the medical encounter: comparing the attitudes of French surgeons and their patients in breast cancer care. PG - 230-7 LID - 10.1016/j.pec.2013.07.011 [doi] LID - S0738-3991(13)00287-5 [pii] AB - OBJECTIVES: To explore attitudes of French surgeons and their patients towards treatment decision-making (TDM) in the medical encounter. METHODS: Surgeons involved in early stage breast cancer and their patients treated in a French cancer care network received a cross-sectional survey questionnaire containing examples of four different approaches to TDM: paternalistic, "some sharing", informed TDM and, shared TDM. RESULTS: Surgeons' interaction styles were clearly distributed among paternalistic, shared and mixed. The paternalistic approach seemed to be associated with private rather than public practice and with less professional experience. Patients reported a rather low level of participation in TDM, varying by socio-demographic characteristics. One third of patients were dissatisfied with the way their treatment decision had been made. CONCLUSION: Most surgeons reported adopting the "some sharing" approach. However, one patient out of three reported that they would have liked to participate more in the TDM process. PRACTICE IMPLICATIONS: Surgeons need to ask patients what their preferences for involvement in TDM are and then think about ways to accommodate both their own and patients' preferences regarding the TDM process to be used in each encounter. In addition, decision aids could be offered to surgeons to help them discuss treatment options with their patients. CI - Copyright (c) 2013 Elsevier Ireland Ltd. All rights reserved. FAU - Nguyen, Florence AU - Nguyen F AD - Lyon University, F-69622 Lyon, France; Lyon 1 University, Villeurbanne, France; CNRS, UMR5824, Groupe d'Analyse et de Theorie Economique Lyon Saint-Etienne, France; Centre Leon Berard, F-69008 Lyon, France. FAU - Moumjid, Nora AU - Moumjid N AD - Lyon University, F-69622 Lyon, France; Lyon 1 University, Villeurbanne, France; CNRS, UMR5824, Groupe d'Analyse et de Theorie Economique Lyon Saint-Etienne, France; Centre Leon Berard, F-69008 Lyon, France. Electronic address: nora.moumjid@univ-lyon1.fr. FAU - Charles, Cathy AU - Charles C AD - CHEPA (Center for Health Economics and Policy Analysis), Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. FAU - Gafni, Amiram AU - Gafni A AD - CHEPA (Center for Health Economics and Policy Analysis), Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. FAU - Whelan, Tim AU - Whelan T AD - Juravinski Cancer Centre, Hamilton, Ontario, Canada. FAU - Carrere, Marie-Odile AU - Carrere MO AD - Lyon University, F-69622 Lyon, France; Lyon 1 University, Villeurbanne, France; CNRS, UMR5824, Groupe d'Analyse et de Theorie Economique Lyon Saint-Etienne, France; Centre Leon Berard, F-69008 Lyon, France. LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20131208 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Adult MH - Aged MH - *Attitude of Health Personnel MH - Breast Neoplasms/*surgery MH - Cross-Sectional Studies MH - *Decision Making MH - Female MH - Health Care Surveys MH - Humans MH - Middle Aged MH - *Patient Participation MH - Patient Preference MH - *Patient Satisfaction MH - *Physician-Patient Relations MH - Surgeons/*psychology MH - Surveys and Questionnaires OTO - NOTNLM OT - Breast cancer OT - Medical encounter OT - Patient participation OT - Treatment decision-making EDAT- 2013/12/12 06:00 MHDA- 2015/05/16 06:00 CRDT- 2013/12/12 06:00 PHST- 2011/11/28 [received] PHST- 2013/07/12 [revised] PHST- 2013/07/18 [accepted] AID - S0738-3991(13)00287-5 [pii] AID - 10.1016/j.pec.2013.07.011 [doi] PST - ppublish SO - Patient Educ Couns. 2014 Feb;94(2):230-7. doi: 10.1016/j.pec.2013.07.011. Epub 2013 Dec 8. PMID- 24316055 OWN - NLM STAT- MEDLINE DA - 20140127 DCOM- 20150515 LR - 20151119 IS - 1873-5134 (Electronic) IS - 0738-3991 (Linking) VI - 94 IP - 2 DP - 2014 Feb TI - Does the use of shared decision-making consultation behaviors increase treatment decision-making satisfaction among Chinese women facing decision for breast cancer surgery? PG - 243-9 LID - 10.1016/j.pec.2013.11.006 [doi] LID - S0738-3991(13)00505-3 [pii] AB - OBJECTIVE: To assess the extent to which breast surgical consultations used shared decision making (SDM), identify factors associated with use of SDM, and assess if using SDM increases decision-making satisfaction. METHODS: Two hundred and eighty-three video-recorded diagnostic-treatment decision consultations between breast surgeons and women with breast cancer were assessed using the Decision Analysis System for Oncology (DAS-O) coding system designed for assessing SDM behaviors. Women completed a questionnaire at pre-consultation, one-week post-consultation and one-month post-surgery. Patient outcomes included decision conflict, patient satisfaction with medical consultation, and decision regret. RESULTS: Overall, the level of SDM behaviors was low. The extent of SDM behavior within consultation was related to greater consultation duration (p<0.001), more than one treatment being offered (p<0.001), and fewer questions raised by patients/companions (p<0.05). While use of SDM consultation did not influence post-consultation decision conflict, it increased satisfaction with information given and explained, patients' feelings of trust and confidence in their surgeons, and reduced post-surgical decision regret. CONCLUSION: These breast surgical consultations mostly adopted informed treatment decision-making approaches. Using SDM improved patient consultation and decision satisfaction. PRACTICE IMPLICATIONS: The study findings highlight a need to reinforce the importance of SDM in consultations among breast surgeons. CI - Copyright (c) 2013 Elsevier Ireland Ltd. All rights reserved. FAU - Lam, Wendy W T AU - Lam WW AD - School of Public Health, The University of Hong Kong, Hong Kong. Electronic address: wwtlam@hku.hk. FAU - Kwok, Marie AU - Kwok M AD - School of Public Health, The University of Hong Kong, Hong Kong. FAU - Chan, Miranda AU - Chan M AD - The Breast Centre, Department of Surgery, Kwong Wah Hospital, Hong Kong. FAU - Hung, Wai Ka AU - Hung WK AD - The Breast Centre, Department of Surgery, Kwong Wah Hospital, Hong Kong. FAU - Ying, Marcus AU - Ying M AD - The Breast Centre, Department of Surgery, Kwong Wah Hospital, Hong Kong. FAU - Or, Amy AU - Or A AD - The Breast Centre, Department of Surgery, Kwong Wah Hospital, Hong Kong. FAU - Kwong, Ava AU - Kwong A AD - Breast Surgery Division, Department of Surgery, The University of Hong Kong, Hong Kong. FAU - Suen, Dacita AU - Suen D AD - Breast Surgery Division, Department of Surgery, The University of Hong Kong, Hong Kong. FAU - Yoon, Sungwon AU - Yoon S AD - School of Public Health, The University of Hong Kong, Hong Kong. FAU - Fielding, Richard AU - Fielding R AD - School of Public Health, The University of Hong Kong, Hong Kong. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20131128 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Adult MH - Asian Continental Ancestry Group/*psychology MH - Breast Neoplasms/ethnology/*psychology/surgery MH - China MH - *Decision Making MH - Female MH - Health Care Surveys MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Middle Aged MH - *Outcome and Process Assessment (Health Care) MH - *Patient Participation MH - Patient Satisfaction/*ethnology MH - Personal Satisfaction MH - Physician-Patient Relations MH - Referral and Consultation MH - Surveys and Questionnaires MH - Tape Recording OTO - NOTNLM OT - Breast cancer OT - Breast surgical consultation OT - Chinese OT - Shared decision making EDAT- 2013/12/10 06:00 MHDA- 2015/05/16 06:00 CRDT- 2013/12/10 06:00 PHST- 2013/05/22 [received] PHST- 2013/10/24 [revised] PHST- 2013/11/19 [accepted] AID - S0738-3991(13)00505-3 [pii] AID - 10.1016/j.pec.2013.11.006 [doi] PST - ppublish SO - Patient Educ Couns. 2014 Feb;94(2):243-9. doi: 10.1016/j.pec.2013.11.006. Epub 2013 Nov 28. PMID- 24188788 OWN - NLM STAT- MEDLINE DA - 20131105 DCOM- 20140710 LR - 20151119 IS - 1743-8942 (Electronic) IS - 0167-482X (Linking) VI - 34 IP - 4 DP - 2013 Dec TI - Development of a Decision Aid about fertility preservation for women with breast cancer in The Netherlands. PG - 170-8 LID - 10.3109/0167482X.2013.851663 [doi] AB - OBJECTIVES: To improve information provision about fertility preservation for breast cancer patients in the Netherlands, a web-based Decision Aid (DA) with additional values clarification exercise was developed according to the International Patient Decision Aid Standards criteria. This study reports on development of the DA. METHODS: Development consisted of four stages: (I) development of a draft DA, (II) acceptability of the draft DA to patients, (III) understanding (knowledge) in healthy populations, (IV) acceptability of the revised DA among patients and physicians. The study population consisted of 185 participants: 20 patients, 17 physicians and 148 healthy volunteers. RESULTS: The draft DA was considered to be relevant and understandable by patients, physicians and healthy volunteers. The values clarification exercise needed adaptation in explanation and navigation, which was done after stage II. Knowledge scores improved by 18% for lower educated women (from 4.1 (41%) to 5.9 (59%) correct answers), and by 34% for higher educated women after viewing the website (from 3.9 (39%) to 7.3 (73%) correct answers). Design of the DA was evaluated to be clear, but not always very appealing. CONCLUSIONS: The DA was regarded as a relevant source of information that seemed coherent and understandable. FAU - Garvelink, Mirjam M AU - Garvelink MM AD - Department of Gynecology, Leiden University Medical Center (LUMC) , Leiden , the Netherlands . FAU - ter Kuile, Moniek M AU - ter Kuile MM FAU - Fischer, Maarten J AU - Fischer MJ FAU - Louwe, Leoni A AU - Louwe LA FAU - Hilders, Carina G J M AU - Hilders CG FAU - Kroep, Judith R AU - Kroep JR FAU - Stiggelbout, Anne M AU - Stiggelbout AM LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - J Psychosom Obstet Gynaecol JT - Journal of psychosomatic obstetrics and gynaecology JID - 8308648 SB - IM MH - Adult MH - Breast Neoplasms/*surgery MH - Decision Making MH - *Decision Support Techniques MH - Female MH - Fertility Preservation/*psychology MH - Humans MH - Netherlands MH - Surveys and Questionnaires MH - Women EDAT- 2013/11/06 06:00 MHDA- 2014/07/11 06:00 CRDT- 2013/11/06 06:00 AID - 10.3109/0167482X.2013.851663 [doi] PST - ppublish SO - J Psychosom Obstet Gynaecol. 2013 Dec;34(4):170-8. doi: 10.3109/0167482X.2013.851663. PMID- 24142513 OWN - NLM STAT- MEDLINE DA - 20140211 DCOM- 20141021 LR - 20151119 IS - 1543-0154 (Electronic) IS - 0885-8195 (Linking) VI - 29 IP - 1 DP - 2014 Mar TI - Informational needs of patients with metastatic breast cancer: what questions do they ask, and are physicians answering them? PG - 175-80 LID - 10.1007/s13187-013-0566-x [doi] AB - In the setting of breast oncology consultations, we sought to understand communication patterns between patients with advanced breast cancer and their oncologists during visits with Decision Support Services. This is a descriptive study analyzing themes and their frequencies of premeditated question lists of patients with metastatic breast cancer. We identified topics physicians most commonly discussed among themes previously found, documenting questions patients with metastatic breast cancer prepare for physician consultations and oncologists' response. Inclusion criteria were as follows: diagnosis of metastatic breast cancer, completion of a question list before meeting with an oncologist, and receipt of a summary of the consultation. We identified 59 women with metastatic breast cancer who received both documents. We reviewed the question lists and consultation summaries of these patients. Of the 59 patients whose documents we reviewed, patients most often asked about prognosis (38), symptom management (31), clinical trials (43), and quality of life (38). Physicians answered questions about prognosis infrequently (37% of the time); other questions that were answered more than commonly are the following: symptom management (81%), clinical trials (79%), and quality of life (66%). Breast cancer patients have many questions regarding their disease, its treatment, and symptoms, which were facilitated in this setting by Decision Support Services. Question lists may be insufficient to bridge the divide between physicians and patient information needs in the setting of metastatic breast cancer, particularly regarding prognosis. Patients may need additional assistance defining question lists, and physicians may benefit from training in communication, particularly regarding discussions of prognosis and end of life. FAU - Danesh, M AU - Danesh M AD - 1233 Arguello Blvd, San Francisco, CA 94122, USA. melissa.danesh@ucsf.edu FAU - Belkora, J AU - Belkora J FAU - Volz, S AU - Volz S FAU - Rugo, H S AU - Rugo HS LA - eng PT - Journal Article PL - England TA - J Cancer Educ JT - Journal of cancer education : the official journal of the American Association for Cancer Education JID - 8610343 SB - IM MH - Breast Neoplasms/*psychology/secondary/therapy MH - Decision Making MH - Female MH - *Health Services Needs and Demand MH - Humans MH - Male MH - Middle Aged MH - Palliative Care MH - Patient Education as Topic/*methods MH - Patient Participation MH - *Physician-Patient Relations MH - Physicians/*psychology MH - Prognosis MH - Quality of Life MH - Surveys and Questionnaires EDAT- 2013/10/22 06:00 MHDA- 2014/10/22 06:00 CRDT- 2013/10/22 06:00 AID - 10.1007/s13187-013-0566-x [doi] PST - ppublish SO - J Cancer Educ. 2014 Mar;29(1):175-80. doi: 10.1007/s13187-013-0566-x. PMID- 24092532 OWN - NLM STAT- MEDLINE DA - 20140211 DCOM- 20141021 LR - 20151119 IS - 1543-0154 (Electronic) IS - 0885-8195 (Linking) VI - 29 IP - 1 DP - 2014 Mar TI - Decisional support throughout the cancer journey for older women diagnosed with early stage breast cancer: a single institutional study. PG - 129-35 LID - 10.1007/s13187-013-0558-x [doi] AB - To determine if older women with early stage breast cancer have sufficient decisional support during their breast cancer journey, a questionnaire-based study was conducted at the Sunnybrook Odette Cancer Centre, in Toronto, Ontario, Canada. Women with stages I and II breast cancer, >/=60 years, were contacted upon completion of their adjuvant treatment. A questionnaire was developed based on focus groups, the literature, and consultation with patients and a multidisciplinary team of experts. The questionnaire was divided into six domains as follows: (1) information support surrounding diagnosis, (2) impact of cancer diagnosis on the patient, (3) quality of interaction with healthcare team, (4) decisional support from the healthcare team, (5) additional information needs surrounding treatment decision, and (6) information support during radiation treatment. Ninety-two of 137 patients approached were included in the analysis. Ninety percent were > 60 years at the time of diagnosis and 65% had stage I invasive breast cancer. The majority of women received adequate decisional support during their cancer journey. Approximately 90% of women indicated that they received a high level of support during their cancer diagnosis. We found no significant differences in overall decisional support based on age at diagnosis, education level, ethnicity, or the presence of co-morbidities. However, participants desired additional educational resources such as a worksheet, consultation summary, or workbook to assist in making a treatment decision. The majority of participants felt that they had sufficient support while making a treatment decision for breast cancer. FAU - Presutti, Roseanna AU - Presutti R AD - Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada, M4N 3M5. FAU - D'Alimonte, Laura AU - D'Alimonte L FAU - McGuffin, Merrylee AU - McGuffin M FAU - Chen, Hanbert AU - Chen H FAU - Chow, Edward AU - Chow E FAU - Pignol, Jean-Philippe AU - Pignol JP FAU - Di Prospero, Lisa AU - Di Prospero L FAU - Doherty, Mary AU - Doherty M FAU - Kiss, Alex AU - Kiss A FAU - Wong, Jennifer AU - Wong J FAU - Lee, Justin AU - Lee J FAU - Liu, Stanley AU - Liu S FAU - Warner, Ellen AU - Warner E FAU - Trudeau, Maureen AU - Trudeau M FAU - Feldman-Stewart, Deb AU - Feldman-Stewart D FAU - Harth, Tamara AU - Harth T FAU - Szumacher, Ewa AU - Szumacher E LA - eng PT - Clinical Trial PT - Journal Article PL - England TA - J Cancer Educ JT - Journal of cancer education : the official journal of the American Association for Cancer Education JID - 8610343 SB - IM MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/diagnosis/*psychology MH - *Decision Making MH - *Decision Support Techniques MH - Female MH - Follow-Up Studies MH - Humans MH - Middle Aged MH - *Patient Care Planning MH - Patient Education as Topic MH - Physician-Patient Relations MH - *Stress, Psychological MH - Surveys and Questionnaires EDAT- 2013/10/05 06:00 MHDA- 2014/10/22 06:00 CRDT- 2013/10/05 06:00 AID - 10.1007/s13187-013-0558-x [doi] PST - ppublish SO - J Cancer Educ. 2014 Mar;29(1):129-35. doi: 10.1007/s13187-013-0558-x. PMID- 24079102 OWN - NLM STAT- MEDLINE DA - 20131001 DCOM- 20131101 LR - 20131001 IS - 0098-1486 (Print) IS - 0098-1486 (Linking) VI - 45 IP - 4 DP - 2013 Jul-Aug TI - Risk management: Jolie's decision sparks debate, need for more education. PG - 1, 6 FAU - Trossman, Susan AU - Trossman S LA - eng PT - Journal Article PL - United States TA - Am Nurse JT - The American nurse JID - 7506499 SB - N MH - Decision Making MH - Female MH - Humans MH - Mastectomy/*methods MH - *Patient Education as Topic MH - *Risk Management MH - United States EDAT- 2013/10/02 06:00 MHDA- 2013/11/02 06:00 CRDT- 2013/10/02 06:00 PST - ppublish SO - Am Nurse. 2013 Jul-Aug;45(4):1, 6. PMID- 24025652 OWN - NLM STAT- MEDLINE DA - 20130912 DCOM- 20140425 LR - 20130912 IS - 1536-3708 (Electronic) IS - 0148-7043 (Linking) VI - 71 IP - 4 DP - 2013 Oct TI - Predictors of readmission after breast reconstruction: a multi-institutional analysis of 5012 patients. PG - 335-41 LID - 10.1097/SAP.0b013e3182a0df25 [doi] AB - BACKGROUND: Recent health care legislation institutes penalties for surgical readmissions secondary to complications. There is a paucity of evidence describing risk factors for readmission after breast reconstruction procedures. METHODS: Patients undergoing breast reconstruction in 2011 were identified in the National Surgical Quality Improvement Program database. Patients were grouped as purely immediate implant/tissue-expander reconstructions or purely autologous reconstruction for analysis. Reconstructions involving multiple types of procedures were excluded due to difficulty with classification. Perioperative variables were analyzed using chi and Student t test as appropriate. Multivariate regression modeling was used to identify risk factors for readmission. RESULTS: Of 5012 patients meeting inclusion criteria, 3960 and 1052 underwent implant/expander and autologous reconstructions, respectively. Implant/expander and autologous cohorts experienced similar readmission rates (4.34% vs 5.32%, respectively; P = 0.18). However, autologous reconstructions experienced a higher rate of overall complications than implant/expander reconstructions (19.96% vs 5.86%, respectively; P < 0.05), as well as higher rates of reoperation (9.7% vs 6.5%, respectively; P < 0.05). Common predictors of readmission for implant/expander and autologous cohorts included operative time, American Society of Anesthesiologist class 3 and 4, and superficial surgical site infection. Smoking, sepsis, deep wound infection, organ space infection, and wound disruption were predictive of readmission for implant/expander reconstruction only, whereas hypertension was predictive of readmission after autologous reconstruction only. CONCLUSIONS: This is the first study of readmission rates after breast reconstruction. Knowledge of specific risk factors for readmission may improve patient outcomes, steer strategies for optimizing reconstructive outcomes, and minimize readmissions. FAU - Mlodinow, Alexei S AU - Mlodinow AS AD - From the *Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL; daggerDepartment of Plastic Surgery, University of Tennessee Health Science Center, Memphis, TN; and double daggerRosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, IL. FAU - Ver Halen, Jon P AU - Ver Halen JP FAU - Lim, Seokchun AU - Lim S FAU - Nguyen, Khang T AU - Nguyen KT FAU - Gaido, Jessica A AU - Gaido JA FAU - Kim, John Y S AU - Kim JY LA - eng PT - Evaluation Studies PT - Journal Article PT - Multicenter Study PL - United States TA - Ann Plast Surg JT - Annals of plastic surgery JID - 7805336 SB - IM EIN - Ann Plast Surg. 2013 Nov;71(5):627. Lim, Seokchum [corrected to Lim, Seokchun] MH - Adult MH - Breast Implantation/instrumentation MH - Breast Implants MH - Breast Neoplasms/surgery MH - Databases, Factual MH - Decision Support Techniques MH - Female MH - Humans MH - Logistic Models MH - *Mammaplasty/instrumentation/methods MH - Mastectomy MH - Middle Aged MH - Multivariate Analysis MH - Patient Readmission/*statistics & numerical data MH - Postoperative Complications/epidemiology/surgery MH - Reoperation/statistics & numerical data MH - Retrospective Studies MH - Risk Factors MH - Surgical Flaps/transplantation MH - Tissue Expansion Devices MH - Treatment Outcome EDAT- 2013/09/13 06:00 MHDA- 2014/04/26 06:00 CRDT- 2013/09/13 06:00 AID - 10.1097/SAP.0b013e3182a0df25 [doi] AID - 00000637-201310000-00006 [pii] PST - ppublish SO - Ann Plast Surg. 2013 Oct;71(4):335-41. doi: 10.1097/SAP.0b013e3182a0df25. PMID- 23973103 OWN - NLM STAT- MEDLINE DA - 20131119 DCOM- 20140113 LR - 20131119 IS - 1879-1190 (Electronic) IS - 1072-7515 (Linking) VI - 217 IP - 6 DP - 2013 Dec TI - Risk analysis of early implant loss after immediate breast reconstruction: a review of 14,585 patients. PG - 983-90 LID - 10.1016/j.jamcollsurg.2013.07.389 [doi] LID - S1072-7515(13)00898-3 [pii] AB - BACKGROUND: Early prosthesis loss is an infrequent but serious complication after breast reconstruction. We assessed perioperative risk factors associated with early device loss after immediate breast reconstruction (IBR) using the ACS-NSQIP datasets. STUDY DESIGN: We reviewed the 2005 to 2011 ACS-NSQIP databases identifying encounters for CPT codes 19357 and 19340. Patients were identified as experiencing a "loss of graft/prosthetic" based on a standard dataset variable. Patients who experienced a device loss were compared with those who did not with respect to perioperative characteristics. RESULTS: We identified 14,585 patients with an average age of 50.9 +/- 10.6 years. A multivariate regression analysis determined that age (>55 years) (odds ratio [OR] 1.66, p = 0.013) (risk score = 1), class II obesity (OR 3.17, p < 0.001) (risk score = 3), class III obesity (OR 2.41, p = 0.014) (risk score = 3), active smoking (OR 2.95, p < 0.001) (risk score = 3), bilateral reconstruction (OR 1.67, p = 0.007) (risk score = 1), and direct-to-implant (DTI) reconstruction (OR 1.69, p = 0.024) (risk score = 1) were associated with early device loss. Odds ratios were used to assign weighted risk scores to each patient, and risk categories were broken into low risk (0 to 1, n = 9,349), intermediate risk (2 to 5, n = 5,001), and high risk (>/= 6, n = 233) groups. The risk of device loss was significantly higher with increased risk score (0.39% vs 1.48% vs 3.86%, p < 0.001). CONCLUSIONS: Early device loss following IBR is a complex multifactorial process related to identifiable preoperative risk factors. This study demonstrated that age, obesity, smoking, bilateral procedures, and DTI reconstructions are associated with increased risk of implant loss. CI - Copyright (c) 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Fischer, John P AU - Fischer JP AD - Divisions of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA. Electronic address: John.Fischer2@uphs.upenn.edu. FAU - Wes, Ari M AU - Wes AM FAU - Tuggle, Charles T 3rd AU - Tuggle CT 3rd FAU - Serletti, Joseph M AU - Serletti JM FAU - Wu, Liza C AU - Wu LC LA - eng PT - Evaluation Studies PT - Journal Article DEP - 20130821 PL - United States TA - J Am Coll Surg JT - Journal of the American College of Surgeons JID - 9431305 SB - AIM SB - IM MH - Adult MH - Breast Implantation/*instrumentation MH - *Breast Implants MH - Databases, Factual MH - *Decision Support Techniques MH - Female MH - Follow-Up Studies MH - Humans MH - Logistic Models MH - Mastectomy MH - Middle Aged MH - Multivariate Analysis MH - Odds Ratio MH - Outcome Assessment (Health Care) MH - Prosthesis Failure/*etiology MH - Risk Assessment MH - Risk Factors OTO - NOTNLM OT - BMI OT - CPT OT - Current Procedural Terminology OT - DTI OT - IBR OT - OR OT - TE OT - body mass index OT - direct-to-implant OT - immediate breast reconstruction OT - odds ratio OT - tissue expander EDAT- 2013/08/27 06:00 MHDA- 2014/01/15 06:00 CRDT- 2013/08/27 06:00 PHST- 2013/06/06 [received] PHST- 2013/07/10 [revised] PHST- 2013/07/10 [accepted] AID - S1072-7515(13)00898-3 [pii] AID - 10.1016/j.jamcollsurg.2013.07.389 [doi] PST - ppublish SO - J Am Coll Surg. 2013 Dec;217(6):983-90. doi: 10.1016/j.jamcollsurg.2013.07.389. Epub 2013 Aug 21. PMID- 23972534 OWN - NLM STAT- MEDLINE DA - 20131125 DCOM- 20140217 LR - 20131125 IS - 1878-0539 (Electronic) IS - 1748-6815 (Linking) VI - 66 IP - 12 DP - 2013 Dec TI - Patient preferences in an online breast reconstruction resource. PG - e380-1 LID - 10.1016/j.bjps.2013.07.016 [doi] LID - S1748-6815(13)00431-2 [pii] FAU - Joyce, C W AU - Joyce CW AD - Department of Plastic and Reconstructive Surgery, St. Vincent's University Hospital, Dublin, Ireland. Electronic address: cjoyce78@hotmail.com. FAU - Morrison, C M AU - Morrison CM FAU - Sgarzani, R AU - Sgarzani R FAU - Blondeel, P N AU - Blondeel PN LA - eng PT - Letter DEP - 20130822 PL - Netherlands TA - J Plast Reconstr Aesthet Surg JT - Journal of plastic, reconstructive & aesthetic surgery : JPRAS JID - 101264239 SB - IM MH - Breast Neoplasms/surgery MH - Databases, Bibliographic MH - *Databases, Factual MH - Decision Making MH - Female MH - Humans MH - *Information Dissemination MH - *Internet MH - *Mammaplasty MH - Middle Aged MH - *Patient Education as Topic MH - Physician's Role MH - Surgery, Plastic EDAT- 2013/08/27 06:00 MHDA- 2014/02/18 06:00 CRDT- 2013/08/27 06:00 PHST- 2013/06/04 [received] PHST- 2013/07/02 [revised] PHST- 2013/07/07 [accepted] AID - S1748-6815(13)00431-2 [pii] AID - 10.1016/j.bjps.2013.07.016 [doi] PST - ppublish SO - J Plast Reconstr Aesthet Surg. 2013 Dec;66(12):e380-1. doi: 10.1016/j.bjps.2013.07.016. Epub 2013 Aug 22. PMID- 23962673 OWN - NLM STAT- MEDLINE DA - 20131018 DCOM- 20140826 LR - 20131018 IS - 1873-5134 (Electronic) IS - 0738-3991 (Linking) VI - 93 IP - 2 DP - 2013 Nov TI - The effects of process-focused versus experience-focused narratives in a breast cancer treatment decision task. PG - 255-64 LID - 10.1016/j.pec.2013.07.013 [doi] LID - S0738-3991(13)00289-9 [pii] AB - OBJECTIVE: To examine the effect of patient narratives that discuss decision processes versus patient experiences on decisions about treatments for early stage breast cancer. METHODS: We recruited 300 women with no previous history of breast cancer to imagine that they had been diagnosed with early stage breast cancer and to choose between mastectomy and lumpectomy with radiation. Before learning about their treatment options, participants were randomly assigned to one of four conditions with videotaped stories from fictitious cancer survivors, using a 2 (content: experience versus process) x 2 (emotional valence: positive only vs. positive and negative) factorial design, or a control condition with no stories. We measured information search, treatment intentions, and decision satisfaction. RESULTS: Participants viewing process narratives spent more time searching for information. Participants viewing experience narratives reported a greater ability to imagine what it was like to experience the treatments; they also evaluated their decision more positively on several dimensions. CONCLUSIONS: Process narratives appeared to guide information search, and experience narratives improved evaluations of the decision process. PRACTICE IMPLICATIONS: There is no evidence that process and experience narratives 'bias' decisions in the same manner as outcome narratives. Further, their potential to focus patient attention on key information and increase patient confidence in decision making appears significant. CI - Copyright (c) 2013 Elsevier Ireland Ltd. All rights reserved. FAU - Shaffer, Victoria A AU - Shaffer VA AD - Department of Health Sciences and Department of Psychological Sciences, University of Missouri, Columbia, USA. Electronic address: shafferv@health.missouri.edu. FAU - Hulsey, Lukas AU - Hulsey L FAU - Zikmund-Fisher, Brian J AU - Zikmund-Fisher BJ LA - eng PT - Journal Article PT - Randomized Controlled Trial DEP - 20130817 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Breast Neoplasms/*psychology/*surgery MH - *Decision Making MH - Decision Support Techniques MH - Female MH - Humans MH - Information Seeking Behavior MH - Mastectomy/psychology MH - Mastectomy, Segmental/psychology MH - Middle Aged MH - *Narration MH - Patient Satisfaction MH - United States MH - Videotape Recording OTO - NOTNLM OT - Breast cancer OT - Decision making OT - Decision support OT - Narratives OT - Patient decision aids EDAT- 2013/08/22 06:00 MHDA- 2014/08/27 06:00 CRDT- 2013/08/22 06:00 PHST- 2013/02/15 [received] PHST- 2013/07/09 [revised] PHST- 2013/07/23 [accepted] AID - S0738-3991(13)00289-9 [pii] AID - 10.1016/j.pec.2013.07.013 [doi] PST - ppublish SO - Patient Educ Couns. 2013 Nov;93(2):255-64. doi: 10.1016/j.pec.2013.07.013. Epub 2013 Aug 17. PMID- 23962230 OWN - NLM STAT- MEDLINE DA - 20131115 DCOM- 20140714 LR - 20170505 IS - 1472-6947 (Electronic) IS - 1472-6947 (Linking) VI - 13 DP - 2013 Aug 20 TI - Factors influencing the surgery intentions and choices of women with early breast cancer: the predictive utility of an extended theory of planned behaviour. PG - 92 LID - 10.1186/1472-6947-13-92 [doi] AB - BACKGROUND: Women diagnosed with early breast cancer (stage I or II) can be offered the choice between mastectomy or breast conservation surgery with radiotherapy due to equivalence in survival rates. A wide variation in the surgical management of breast cancer and a lack of theoretically guided research on this issue highlight the need for further research into the factors influencing women's choices. An extended Theory of Planned Behaviour (TPB) could provide a basis to understand and predict women's surgery choices. The aims of this study were to understand and predict the surgery intentions and choices of women newly diagnosed with early breast cancer, examining the predictive utility of an extended TPB. METHODS: Sixty-two women recruited from three UK breast clinics participated in the study; 48 women, newly diagnosed with early breast cancer, completed online questionnaires both before their surgery and after accessing an online decision support intervention (BresDex). Questionnaires assessed views about breast cancer and the available treatment options using items designed to measure constructs of an extended TPB (i.e., attitudes, subjective norms, perceived behavioural control, and anticipated regret), and women's intentions to choose mastectomy or BCS. Objective data were collected on women's choice of surgery via the clinical breast teams. Multiple and logistic regression analyses examined predictors of surgery intentions and subsequent choice of surgery. RESULTS: The extended TPB accounted for 69.9% of the variance in intentions (p <.001); attitudes and subjective norms were significant predictors. Including additional variables revealed anticipated regret to be a more important predictor than subjective norms. Surgery intentions significantly predicted surgery choices (p <.01). CONCLUSIONS: These findings demonstrate the utility of an extended TPB in predicting and understanding women's surgery intentions and choices for early breast cancer. Understanding these factors should help to identify key components of interventions to support women while considering their surgery options. FAU - Sivell, Stephanie AU - Sivell S AD - Marie Curie Palliative Care Research Centre, Wales Cancer Trials Unit, Cardiff University School of Medicine, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK. sivells2@cf.ac.uk. FAU - Elwyn, Glyn AU - Elwyn G FAU - Edwards, Adrian AU - Edwards A FAU - Manstead, Antony S R AU - Manstead AS CN - BresDex group LA - eng GR - MCCC-FCO-11-C/Marie Curie/United Kingdom GR - C6475/A7053/Cancer Research UK/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20130820 PL - England TA - BMC Med Inform Decis Mak JT - BMC medical informatics and decision making JID - 101088682 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/*psychology/radiotherapy/*surgery MH - Choice Behavior/physiology MH - Female MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Intention MH - Mastectomy/*psychology MH - Mastectomy, Segmental/psychology MH - Middle Aged MH - Neoplasm Staging MH - Patient Preference/*psychology MH - Psychological Theory PMC - PMC3849725 OID - NLM: PMC3849725 IR - Caldon L FIR - Caldon, Lisa IR - Collins K FIR - Collins, Karen IR - Day TJ FIR - Day, T J IR - Donald A FIR - Donald, Anne IR - Evans R FIR - Evans, Rhodri IR - Patnick J FIR - Patnick, Julietta IR - Reed MW FIR - Reed, Malcolm W R IR - Rogers V FIR - Rogers, Veronica EDAT- 2013/08/22 06:00 MHDA- 2014/07/16 06:00 CRDT- 2013/08/22 06:00 PHST- 2013/02/01 [received] PHST- 2013/08/06 [accepted] AID - 1472-6947-13-92 [pii] AID - 10.1186/1472-6947-13-92 [doi] PST - epublish SO - BMC Med Inform Decis Mak. 2013 Aug 20;13:92. doi: 10.1186/1472-6947-13-92. PMID- 23945529 OWN - NLM STAT- MEDLINE DA - 20130815 DCOM- 20140411 LR - 20161125 IS - 1536-3708 (Electronic) IS - 0148-7043 (Linking) VI - 71 IP - 3 DP - 2013 Sep TI - Optimizing the fascial closure: an analysis of 1261 abdominally based free flap reconstructions. PG - 255-60 LID - 10.1097/SAP.0b013e318286380e [doi] AB - BACKGROUND: Donor-site morbidity continues to be a significant complication in patients undergoing abdominally based breast reconstruction. The purposes of our study were to critically examine abdominal donor-site morbidity and to present our algorithm for optimizing donor site closure to reduce these complications. METHODS: We performed a retrospective cohort study examining all patients undergoing abdominally based free tissue transfer for breast reconstruction from 2005 to 2011 at our institution. Data were analyzed for overall donor site morbidity, as defined by hernia/bulge or reoperation for debridement and/or mesh removal and for hernia/bulge alone. RESULTS: A total of 812 patients underwent 1261 free tissue transfers. Fifty-three patients (6.5%) experienced donor-site morbidity, including 27 hernias/bulges (3.3%). No significant difference in overall abdominal morbidity was found between unilateral and bilateral reconstructions (P = 0.39) or the use of muscle in the flap (P = 0.11 unilateral msfTRAM, P = 0.76 bilateral). Prior lower abdominal surgery was associated with higher rates of donor-site morbidity (P = 0.04); hypertension (P = 0.012) and multiple medical comorbidities (P < 0.001) were also significantly more common in these patients. Obesity was the only patient characteristic associated with higher rates of hernia/bulge (P = 0.04). Delayed abdominal would healing was associated with hernia/bulge (P < 0.001); these patients were significantly more likely to develop this complication (odds ratio = 6.3, P < 0.001). CONCLUSIONS: Particular attention must be provided to donor-site closure in obese patients and those with hypertension and multiple medical comorbidities. Low rates of abdominal wall morbidity result from meticulous fascial reconstruction and reinforcement and careful attention to tension-free soft tissue closure. FAU - Cleveland, Emily C AU - Cleveland EC AD - Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. FAU - Fischer, John P AU - Fischer JP FAU - Nelson, Jonas A AU - Nelson JA FAU - Sieber, Brady AU - Sieber B FAU - Low, David W AU - Low DW FAU - Kovach, Stephen J 3rd AU - Kovach SJ 3rd FAU - Wu, Liza C AU - Wu LC FAU - Serletti, Joseph M AU - Serletti JM LA - eng PT - Evaluation Studies PT - Journal Article PL - United States TA - Ann Plast Surg JT - Annals of plastic surgery JID - 7805336 SB - IM MH - *Abdominal Wound Closure Techniques/instrumentation MH - Algorithms MH - Decision Support Techniques MH - *Fasciotomy MH - Female MH - *Free Tissue Flaps MH - Humans MH - Logistic Models MH - Mammaplasty/*methods MH - Middle Aged MH - Multivariate Analysis MH - Outcome Assessment (Health Care) MH - Postoperative Complications/prevention & control MH - Reoperation MH - Retrospective Studies MH - Surgical Mesh EDAT- 2013/08/16 06:00 MHDA- 2014/04/12 06:00 CRDT- 2013/08/16 06:00 AID - 10.1097/SAP.0b013e318286380e [doi] AID - 00000637-201309000-00003 [pii] PST - ppublish SO - Ann Plast Surg. 2013 Sep;71(3):255-60. doi: 10.1097/SAP.0b013e318286380e. PMID- 23886556 OWN - NLM STAT- MEDLINE DA - 20131008 DCOM- 20131223 LR - 20131008 IS - 1878-0539 (Electronic) IS - 1748-6815 (Linking) VI - 66 IP - 11 DP - 2013 Nov TI - Delayed autologous breast reconstruction: factors which influence patient decision making. PG - 1513-20 LID - 10.1016/j.bjps.2013.06.020 [doi] LID - S1748-6815(13)00357-4 [pii] AB - BACKGROUND: Autologous breast reconstruction timing continues to be controversial. The purpose of this study was to examine delayed autologous breast reconstruction at a center favouring immediate reconstruction to better understand factors driving the decision to delay reconstruction. METHODS: We performed a retrospective cohort study of all free autologous breast reconstruction patients between 2005 and 2009, focussing on ethnicity, cancer stage, unilateral or bilateral reconstructions, initial management, distance from the institution, and average income. Delayed reconstructions were compared to immediate reconstructions. All delayed reconstructions were surveyed to examine treatment and reconstruction decisions and satisfaction. RESULTS: Of 709 patients, 169 (24%) underwent delayed treatment. Delayed reconstruction patients had higher cancer stages (p < 0.001), higher rates of pre-reconstruction radiation therapy (64% vs. 20%, p < 0.0001) and higher rates of unilateral reconstruction (64% vs. 48%, p < 0.001). Seventy delayed patients responded to the survey (41%), with 75% having had their initial mastectomy at an outside health system. Only 51% discussed immediate reconstruction prior to electing delayed treatment and 41% had no discussion regarding advantages or disadvantages to reconstructive options. Approximately 30% noted no choice in their reconstructive timing. Forty five percent would elect immediate reconstruction if given the option. CONCLUSIONS: This study demonstrates that women may not be receiving all available information prior to undergoing mastectomy for initial breast cancer treatment. As a significant portion of women electing delayed reconstruction would elect immediate autologous reconstruction if given the option again, there is room for improvement in pre-operative patient education and in the education of our oncology colleagues. CI - Copyright (c) 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. FAU - Nelson, Jonas A AU - Nelson JA AD - Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States. Electronic address: jonas.nelson@uphs.upenn.edu. FAU - Fischer, John P AU - Fischer JP FAU - Radecki, M Anne AU - Radecki MA FAU - Pasick, Christina AU - Pasick C FAU - McGrath, Jennifer AU - McGrath J FAU - Serletti, Joseph M AU - Serletti JM FAU - Wu, Liza C AU - Wu LC LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20130722 PL - Netherlands TA - J Plast Reconstr Aesthet Surg JT - Journal of plastic, reconstructive & aesthetic surgery : JPRAS JID - 101264239 SB - IM MH - Breast Neoplasms/pathology/radiotherapy/*surgery MH - *Decision Making MH - Delivery of Health Care, Integrated MH - Female MH - Health Services Accessibility MH - Humans MH - Income MH - Mammaplasty/*psychology MH - Mastectomy MH - Middle Aged MH - Neoplasm Staging MH - Patient Education as Topic MH - *Patient Participation MH - Patient Satisfaction MH - Retrospective Studies MH - Time Factors OTO - NOTNLM OT - Autologous OT - Breast reconstruction OT - Decision making OT - Delayed reconstruction OT - Free flap OT - Survey EDAT- 2013/07/28 06:00 MHDA- 2013/12/24 06:00 CRDT- 2013/07/27 06:00 PHST- 2012/12/14 [received] PHST- 2013/03/20 [revised] PHST- 2013/06/04 [accepted] AID - S1748-6815(13)00357-4 [pii] AID - 10.1016/j.bjps.2013.06.020 [doi] PST - ppublish SO - J Plast Reconstr Aesthet Surg. 2013 Nov;66(11):1513-20. doi: 10.1016/j.bjps.2013.06.020. Epub 2013 Jul 22. PMID- 23881944 OWN - NLM STAT- MEDLINE DA - 20130724 DCOM- 20130916 LR - 20161125 IS - 1756-1833 (Electronic) IS - 0959-535X (Linking) VI - 347 DP - 2013 Jul 23 TI - An introduction to patient decision aids. PG - f4147 LID - 10.1136/bmj.f4147 [doi] LID - bmj.f4147 [pii] CN - Drug and Therapeutics Bulletin LA - eng PT - Journal Article PT - Review DEP - 20130723 PL - England TA - BMJ JT - BMJ (Clinical research ed.) JID - 8900488 RN - 0 (Anti-Bacterial Agents) SB - AIM SB - IM MH - Anti-Bacterial Agents/adverse effects/therapeutic use MH - Breast Neoplasms/surgery MH - Child MH - *Decision Making MH - Decision Making, Computer-Assisted MH - *Decision Support Techniques MH - Diarrhea/chemically induced MH - Evidence-Based Medicine MH - Exanthema/chemically induced MH - Female MH - Humans MH - Mastectomy MH - Mastectomy, Segmental MH - Otitis Media/drug therapy MH - Patient Education as Topic MH - *Patient Participation MH - *Physician-Patient Relations MH - Referral and Consultation MH - Risk MH - State Medicine MH - United Kingdom MH - Vomiting/chemically induced EDAT- 2013/07/25 06:00 MHDA- 2013/09/17 06:00 CRDT- 2013/07/25 06:00 PST - epublish SO - BMJ. 2013 Jul 23;347:f4147. doi: 10.1136/bmj.f4147. PMID- 23835709 OWN - NLM STAT- MEDLINE DA - 20130809 DCOM- 20131204 LR - 20151119 IS - 1527-7755 (Electronic) IS - 0732-183X (Linking) VI - 31 IP - 23 DP - 2013 Aug 10 TI - Reducing treatment decision conflict difficulties in breast cancer surgery: a randomized controlled trial. PG - 2879-85 LID - 10.1200/JCO.2012.45.1856 [doi] AB - PURPOSE: Breast cancer (BC) decision aid (DA) randomized studies are limited to DA use in consultations among Western populations and for primary surgery. Their effectiveness beyond consultations, for reconstructive surgery and in other populations, has not been evaluated. We developed a DA administered after consultation for Chinese women deciding on BC surgery and, where relevant, immediate breast reconstruction, which was evaluated in this randomized controlled trial (RCT). PATIENTS AND METHODS: Overall, 276 women considering BC surgery for early-stage BC were randomly assigned to receive a DA (take-home booklet) or the standard information booklet (control condition) after the initial consultation, wherein surgeons disclosed the diagnosis and discussed treatment options with patients. Using block random assignment by week, 138 women were assigned to the DA arm and 138 to the control arm. Participants completed interview-based questionnaires 1 week after consultation and then 1, 4, and 10 months after surgery. Primary outcome measures were decisional conflict, decision-making difficulties, BC knowledge 1 week after consultation, and decision regret 1 month after surgery. Secondary outcome measures were treatment decision, decision regret 4 and 10 months after surgery, and postsurgical anxiety and depression. RESULTS: The DA group reported significantly lower decisional conflict scores 1 week after consultation (P = .016) compared with women in the control arm. Women receiving the DA had significantly lower decision regret scores 4 (P = .026) and 10 months (P = .014) after surgery and lower depression scores 10 months after surgery (P = .001). CONCLUSION: This RCT demonstrated DAs may benefit Chinese patients in Hong Kong by reducing decisional conflict and subsequent regret and enhance clinical services for this population. FAU - Lam, Wendy W T AU - Lam WW AD - Centre for Psycho-Oncological Research and Training, Department of Community Medicine and Unit for Behavioural Sciences, School of Public Health, The University of Hong Kong, 5/F, WMW Mong Block, Faculty of Medicine Building, 21 Sassoon Rd, Pokfulam, Hong Kong; Special Administrative Region, People's Republic of China. wwtlam@hku.hk FAU - Chan, Miranda AU - Chan M FAU - Or, Amy AU - Or A FAU - Kwong, Ava AU - Kwong A FAU - Suen, Dacita AU - Suen D FAU - Fielding, Richard AU - Fielding R LA - eng PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20130708 PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 SB - IM MH - Breast Neoplasms/pathology/psychology/*surgery MH - *Decision Making MH - *Decision Support Techniques MH - Female MH - Humans MH - Middle Aged MH - Neoplasm Staging MH - Patient Education as Topic/*methods MH - Patient Satisfaction MH - Surveys and Questionnaires MH - Treatment Outcome EDAT- 2013/07/10 06:00 MHDA- 2013/12/16 06:00 CRDT- 2013/07/10 06:00 AID - JCO.2012.45.1856 [pii] AID - 10.1200/JCO.2012.45.1856 [doi] PST - ppublish SO - J Clin Oncol. 2013 Aug 10;31(23):2879-85. doi: 10.1200/JCO.2012.45.1856. Epub 2013 Jul 8. PMID- 23829442 OWN - NLM STAT- MEDLINE DA - 20130711 DCOM- 20131017 LR - 20161215 IS - 1745-6215 (Electronic) IS - 1745-6215 (Linking) VI - 14 DP - 2013 Jul 06 TI - Pre-consultation educational group intervention to improve shared decision-making in postmastectomy breast reconstruction: study protocol for a pilot randomized controlled trial. PG - 199 LID - 10.1186/1745-6215-14-199 [doi] AB - BACKGROUND: The Pre-Consultation Educational Group INTERVENTION pilot study seeks to assess the feasibility and inform the optimal design for a definitive randomized controlled trial that aims to improve the quality of decision-making in postmastectomy breast reconstruction patients. METHODS/DESIGN: This is a mixed-methods pilot feasibility randomized controlled trial that will follow a single-center, 1:1 allocation, two-arm parallel group superiority design. SETTING: The University Health Network, a tertiary care cancer center in Toronto, Canada. PARTICIPANTS: Adult women referred to one of three plastic and reconstructive surgeons for delayed breast reconstruction or prophylactic mastectomy with immediate breast reconstruction. INTERVENTION: We designed a multi-disciplinary educational group workshop that incorporates the key components of shared decision-making, decision-support, and psychosocial support for cancer survivors prior to the initial surgical consult. The intervention consists of didactic lectures by a plastic surgeon and nurse specialist on breast reconstruction choices, pre- and postoperative care; a value-clarification exercise led by a social worker; and discussions with a breast reconstruction patient. CONTROL: Usual care includes access to an informational booklet, website, and patient volunteer if desired. OUTCOMES: Expected pilot outcomes include feasibility, recruitment, and retention targets. Acceptability of intervention and full trial outcomes will be established through qualitative interviews. Trial outcomes will include decision-quality measures, patient-reported outcomes, and service outcomes, and the treatment effect estimate and variability will be used to inform the sample size calculation for a full trial. DISCUSSION: Our pilot study seeks to identify the (1) feasibility, acceptability, and design of a definitive RCT and (2) the optimal content and delivery of our proposed educational group intervention. Thirty patients have been recruited to date (8 April 2013), of whom 15 have been randomized to one of three decision support workshops. The trial will close as planned in May 2013. TRIAL REGISTRATION: NCT01857882. FAU - Platt, Jennica AU - Platt J AD - UHN Breast Restoration Program, Division of Plastic and Reconstructive Surgery, 8N 871, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada. FAU - Baxter, Nancy AU - Baxter N FAU - Jones, Jennifer AU - Jones J FAU - Metcalfe, Kelly AU - Metcalfe K FAU - Causarano, Natalie AU - Causarano N FAU - Hofer, Stefan O P AU - Hofer SO FAU - O'Neill, Anne AU - O'Neill A FAU - Cheng, Terry AU - Cheng T FAU - Starenkyj, Elizabeth AU - Starenkyj E FAU - Zhong, Toni AU - Zhong T LA - eng SI - ClinicalTrials.gov/NCT01857882 GR - Canadian Institutes of Health Research/Canada PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20130706 PL - England TA - Trials JT - Trials JID - 101263253 SB - IM MH - *Breast Implantation MH - Breast Neoplasms/diagnosis/psychology/*surgery MH - Clinical Protocols MH - *Decision Making MH - Feasibility Studies MH - Female MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - *Mastectomy MH - Ontario MH - *Patient Education as Topic MH - Patient Participation MH - Patient Satisfaction MH - Pilot Projects MH - *Referral and Consultation MH - *Research Design MH - Self Efficacy MH - Treatment Outcome PMC - PMC3708760 OID - NLM: PMC3708760 EDAT- 2013/07/09 06:00 MHDA- 2013/10/18 06:00 CRDT- 2013/07/09 06:00 PHST- 2013/05/18 [received] PHST- 2013/06/26 [accepted] AID - 1745-6215-14-199 [pii] AID - 10.1186/1745-6215-14-199 [doi] PST - epublish SO - Trials. 2013 Jul 6;14:199. doi: 10.1186/1745-6215-14-199. PMID- 23724453 OWN - NLM STAT- MEDLINE DA - 20130603 DCOM- 20130712 LR - 20151119 IS - 0125-2208 (Print) IS - 0125-2208 (Linking) VI - 96 Suppl 1 DP - 2013 Jan TI - Development and validation of the body image scale among Thai breast cancer patients. PG - S30-9 AB - OBJECTIVE: To examine the psychometric property of the Thai version of the Body Image Scale (BIS) in breast cancer patients in Thailand. MATERIAL AND METHOD: The authors conducted a cross-culture translation of the BIS into the Thai language and administered it to 242 breast cancer patients who had surgery and had completed chemo-radiation for more than one year. RESULTS: The present study confirmed a good reliability and validity of Thai version of BIS. The questionnaire has high internal and external consistency; Cronbach's alpha was above 0.8 and test-retest reliability was more than 0.7. Content validity was confirmed by expert opinion and cognitive interview with breast cancer patients. Construct validity was examined though factor analysis showed a single-factor solution which excludes one item from the original 10-item scale. Discriminant validity which confirmed by different score between mastectomy and breast conserving surgery group and good response prevalence also supported the clinical validity of the test. CONCLUSION: Thai version of the BIS showed a good psychometric property and can be used as a patient-physician communication and quality of life evaluation tool after breast cancer treatment in Thai women. FAU - Songtish, Dolrudee AU - Songtish D AD - Department of Surgery, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand. dsongtish@yahoo.com FAU - Hirunwiwatkul, Prakobkiat AU - Hirunwiwatkul P LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Validation Studies PL - Thailand TA - J Med Assoc Thai JT - Journal of the Medical Association of Thailand = Chotmaihet thangphaet JID - 7507216 SB - IM MH - *Body Image MH - Breast Neoplasms/*psychology MH - Data Interpretation, Statistical MH - Female MH - Humans MH - Middle Aged MH - Psychometrics MH - Reproducibility of Results MH - *Surveys and Questionnaires MH - Thailand EDAT- 2013/06/04 06:00 MHDA- 2013/07/16 06:00 CRDT- 2013/06/04 06:00 PST - ppublish SO - J Med Assoc Thai. 2013 Jan;96 Suppl 1:S30-9. PMID- 23709173 OWN - NLM STAT- MEDLINE DA - 20130829 DCOM- 20140514 LR - 20161017 IS - 1569-8041 (Electronic) IS - 0923-7534 (Linking) VI - 24 IP - 9 DP - 2013 Sep TI - Trade-off preferences regarding adjuvant endocrine therapy among women with estrogen receptor-positive breast cancer. PG - 2324-9 LID - 10.1093/annonc/mdt195 [doi] AB - BACKGROUND: There is substantial nonadherence to effective adjuvant endocrine therapy for breast cancer prevention. We therefore examined patients' trade-offs between the efficacy, side-effects, and regimen duration, and whether trade-offs predicted nonadherence. PATIENTS AND METHODS: Trade-offs from 241 women were assessed with an Adaptive Conjoint Analysis (ACA) choice task that was customized to each individual patient. From the estimated ACA utilities, the relative importance of each treatment property was calculated and a benefit/drawback ratio between the importance of the efficacy versus that of the side-effects and other treatment properties. Nonadherence was assessed through composites of validated self-report measures. RESULTS: Efficacy was most important. The side-effects joint and muscle pain and risk of endometrial cancer were almost as important. The benefit/drawback ratio showed 16% of the women to value the efficacy less than the side-effects and other treatment properties. A higher benefit/drawback ratio was associated with decreased nonadherence [adjusted odds ratio (OR) 0.1, 95% confidence interval 0.03-0.3]. CONCLUSIONS: One in six women do not consider the efficacy of endocrine therapy to outweigh its drawbacks. Knowing women's trade-offs is likely to identify women at risk for nonadherence and to help clinicians in tailoring their communication and care to different needs of individual women. FAU - Wouters, H AU - Wouters H AD - Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht. j.wouters@uu.nl FAU - Maatman, G A AU - Maatman GA FAU - Van Dijk, L AU - Van Dijk L FAU - Bouvy, M L AU - Bouvy ML FAU - Vree, R AU - Vree R FAU - Van Geffen, E C G AU - Van Geffen EC FAU - Nortier, J W AU - Nortier JW FAU - Stiggelbout, A M AU - Stiggelbout AM LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20130523 PL - England TA - Ann Oncol JT - Annals of oncology : official journal of the European Society for Medical Oncology JID - 9007735 RN - 0 (Antineoplastic Agents, Hormonal) RN - 0 (Receptors, Estrogen) RN - 094ZI81Y45 (Tamoxifen) SB - IM MH - Aged MH - Antineoplastic Agents, Hormonal/therapeutic use MH - Breast Neoplasms/*drug therapy MH - Chemotherapy, Adjuvant/*adverse effects MH - Female MH - Humans MH - Medication Adherence/*psychology MH - Middle Aged MH - *Patient Preference MH - Receptors, Estrogen/*metabolism MH - Tamoxifen/therapeutic use OTO - NOTNLM OT - breast cancer OT - decision aids OT - endocrine therapy OT - patient adherence OT - patient centered care OT - patient preferences EDAT- 2013/05/28 06:00 MHDA- 2014/05/16 06:00 CRDT- 2013/05/28 06:00 AID - mdt195 [pii] AID - 10.1093/annonc/mdt195 [doi] PST - ppublish SO - Ann Oncol. 2013 Sep;24(9):2324-9. doi: 10.1093/annonc/mdt195. Epub 2013 May 23. PMID- 23642795 OWN - NLM STAT- MEDLINE DA - 20130708 DCOM- 20130910 LR - 20130708 IS - 1878-0539 (Electronic) IS - 1748-6815 (Linking) VI - 66 IP - 8 DP - 2013 Aug TI - Improving outcomes in microsurgical breast reconstruction: lessons learnt from 406 consecutive DIEP/TRAM flaps performed by a single surgeon. PG - 1032-8 LID - 10.1016/j.bjps.2013.04.021 [doi] LID - S1748-6815(13)00224-6 [pii] AB - BACKGROUND: Multiple preoperative, intraoperative and postoperative decisions can influence the outcome of microsurgical breast reconstruction. We have simplified the decision-making process by incorporating a number of algorithms into our microsurgical breast reconstruction practice and critically review our results in this study. METHODS: Prospectively maintained databases for all microsurgical breast reconstructions performed by a single surgeon over a nine-year period were examined to determine: patient demographics; operative details including flap choice, donor and recipient vessel selection; and, details of intraoperative and early postoperative (/= 3, body mass index > 30 kg/m(2), recent surgery, delayed reconstruction, and prolonged operative times are significant predictors of increased complications in autologous reconstructions. Rates of complications, flap failure, and reoperation were highest in the free tissue transfer group (p < 0.001). Latissimus flaps showed significantly lower rates of complications than other autologous methods (p < 0.001). Pedicled TRAM patients had the highest incidences of venous thromboembolic disease and SSI. CONCLUSIONS: This large-scale, multicenter evaluation of outcomes in autologous breast reconstruction found that free flaps have the highest captured 30-day complication and reoperation rates of any autologous reconstructive method; complications in latissimus flaps were surprisingly few. Pedicled TRAM and latissimus flaps remain the most commonly used autologous reconstructive methods. In addition to providing statistically robust outcomes data, this study contributes significantly to patient education and preoperative planning discussions. CI - Copyright (c) 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Gart, Michael S AU - Gart MS AD - Northwestern Memorial Hospital, Department of Surgery, Division of Plastic and Reconstructive Surgery, Chicago, IL, USA. FAU - Smetona, John T AU - Smetona JT FAU - Hanwright, Philip J AU - Hanwright PJ FAU - Fine, Neil A AU - Fine NA FAU - Bethke, Kevin P AU - Bethke KP FAU - Khan, Seema A AU - Khan SA FAU - Wang, Edward AU - Wang E FAU - Kim, John Y S AU - Kim JY LA - eng PT - Comparative Study PT - Journal Article PT - Multicenter Study DEP - 20121202 PL - United States TA - J Am Coll Surg JT - Journal of the American College of Surgeons JID - 9431305 SB - AIM SB - IM CIN - J Am Coll Surg. 2013 Jul;217(1):172-4. PMID: 23791293 CIN - J Am Coll Surg. 2013 Jul;217(1):174-5. PMID: 23791294 EIN - J Am Coll Surg. 2013 May;216(5):1034-5 MH - Analysis of Variance MH - Breast Neoplasms/*surgery MH - Decision Making MH - Female MH - Humans MH - Logistic Models MH - Mammaplasty/*methods MH - Mastectomy MH - Middle Aged MH - *Outcome and Process Assessment (Health Care) MH - Postoperative Complications/epidemiology MH - Quality Improvement MH - Reoperation/statistics & numerical data MH - Retrospective Studies MH - Societies, Medical MH - *Surgical Flaps MH - Transplantation, Autologous MH - United States/epidemiology EDAT- 2012/12/06 06:00 MHDA- 2013/03/13 06:00 CRDT- 2012/12/06 06:00 PHST- 2012/09/11 [received] PHST- 2012/11/02 [revised] PHST- 2012/11/05 [accepted] AID - S1072-7515(12)01311-7 [pii] AID - 10.1016/j.jamcollsurg.2012.11.003 [doi] PST - ppublish SO - J Am Coll Surg. 2013 Feb;216(2):229-38. doi: 10.1016/j.jamcollsurg.2012.11.003. Epub 2012 Dec 2. PMID- 23190819 OWN - NLM STAT- MEDLINE DA - 20121129 DCOM- 20130128 LR - 20151119 IS - 1529-4242 (Electronic) IS - 0032-1052 (Linking) VI - 130 IP - 6 DP - 2012 Dec TI - Preoperative assessment preferences and reported reoperation rates for size change in primary breast augmentation: a survey of ASPS members. PG - 1352-9 LID - 10.1097/PRS.0b013e31826d9f66 [doi] AB - BACKGROUND: The purpose of this study was to determine the current preferences of plastic surgeons regarding preoperative assessment and their effect on clinical outcome in primary breast augmentation. METHODS: An eight-question online survey was sent to members of the American Society of Plastic Surgeons. Data collected online were analyzed using Student's t test or Pearson's chi-square test. A value of p < 0.05 was considered statistically significant. RESULTS: The response rate was 20.1 percent (604 respondents). Breast base diameter [n = 286 (47.4 percent)] was ranked the most important consideration vital in choosing implants. Most surgeons chose to reeducate their patients to resolve a conflict between their patient's implant size request and the surgeon's clinical judgment [n = 385 (63.7 percent)], whereas 151 (25 percent) would proceed anyway. Those surgeons who chose reeducation ranked breast base diameter as a vital consideration significantly higher than those who would accommodate their patients (2.03 +/- 1.41 versus 2.31 +/- 1.41; p = 0.041). Similarly, surgeons who reeducated their patients ranked implant volume as the vital consideration significantly lower than those who accommodated their patients (2.90 +/- 1.67 versus 2.44 +/- 1.47; p = 0.002). Regarding size change, 332 surgeons (55 percent) reported their rate was 5 percent or less, whereas 272 (45 percent) reported it was greater than 5 percent. Surgeons who reported a 5 percent or less rate ranked implant volume significantly lower than those with reoperation rates greater than 5 percent (2.93 +/- 1.71 versus 2.55 +/- 1.53; p = 0.004). CONCLUSIONS: Breast base diameter and implant volume were the two most important considerations in choosing an implant for breast augmentation. Reported reoperation rates for size change were significantly lower for surgeons who regarded breast base diameter as more vital than those who valued implant volume more. FAU - Choudry, Umar AU - Choudry U AD - Division of Plastic Surgery, University of Minnesota, Minneapolis, Minn 55455, USA. choud008@umn.edu FAU - Kim, Nicholas AU - Kim N LA - eng PT - Evaluation Studies PT - Journal Article PL - United States TA - Plast Reconstr Surg JT - Plastic and reconstructive surgery JID - 1306050 SB - AIM SB - IM MH - *Attitude of Health Personnel MH - Breast/anatomy & histology MH - Breast Implantation/*instrumentation/methods/statistics & numerical data MH - *Breast Implants MH - *Decision Support Techniques MH - Dissent and Disputes MH - Female MH - Health Care Surveys MH - Humans MH - Outcome Assessment (Health Care) MH - Patient Education as Topic MH - Physician-Patient Relations MH - Physicians/*psychology MH - Practice Patterns, Physicians'/*statistics & numerical data MH - Preoperative Care/*methods/statistics & numerical data MH - Reoperation/statistics & numerical data MH - Societies, Medical MH - Surgery, Plastic MH - Surveys and Questionnaires MH - United States EDAT- 2012/11/30 06:00 MHDA- 2013/01/29 06:00 CRDT- 2012/11/30 06:00 AID - 10.1097/PRS.0b013e31826d9f66 [doi] AID - 00006534-201212000-00032 [pii] PST - ppublish SO - Plast Reconstr Surg. 2012 Dec;130(6):1352-9. doi: 10.1097/PRS.0b013e31826d9f66. PMID- 23079561 OWN - NLM STAT- MEDLINE DA - 20121119 DCOM- 20130501 LR - 20121119 IS - 1532-3080 (Electronic) IS - 0960-9776 (Linking) VI - 21 IP - 6 DP - 2012 Dec TI - A formula for implant volume choice in breast reconstruction after nipple sparing mastectomy. PG - 781-2 LID - 10.1016/j.breast.2012.09.007 [doi] LID - S0960-9776(12)00193-2 [pii] AB - Implant choice after Nipple Sparing Mastectomy (NSM) is a problematic perioperative issue. In this retrospective study, the authors searched for a correlation between mastectomy weight and implant volume choice after NSM. A mathematical expression of this correlation was found that might help surgeons decide implant volume after NSM. CI - Copyright (c) 2012 Elsevier Ltd. All rights reserved. FAU - Georgiou, Charalambos A AU - Georgiou CA AD - Breast Cancer and Reconstructive Surgery Unit, Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06189 Nice cedex 2, France. char.georgiou@gmail.com FAU - Ihrai, Tarik AU - Ihrai T FAU - Chamorey, Emmanuel AU - Chamorey E FAU - Flipo, Bernard AU - Flipo B FAU - Chignon-Sicard, Berengere AU - Chignon-Sicard B LA - eng PT - Evaluation Studies PT - Journal Article DEP - 20121016 PL - Netherlands TA - Breast JT - Breast (Edinburgh, Scotland) JID - 9213011 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Breast Implantation/*instrumentation MH - *Breast Implants MH - Breast Neoplasms/pathology/*surgery MH - Carcinoma, Ductal, Breast/pathology/surgery MH - Carcinoma, Intraductal, Noninfiltrating/pathology/surgery MH - *Decision Support Techniques MH - Female MH - Humans MH - Linear Models MH - *Mastectomy, Subcutaneous MH - Middle Aged MH - Retrospective Studies MH - *Tumor Burden EDAT- 2012/10/20 06:00 MHDA- 2013/05/02 06:00 CRDT- 2012/10/20 06:00 PHST- 2012/03/26 [received] PHST- 2012/09/22 [accepted] AID - S0960-9776(12)00193-2 [pii] AID - 10.1016/j.breast.2012.09.007 [doi] PST - ppublish SO - Breast. 2012 Dec;21(6):781-2. doi: 10.1016/j.breast.2012.09.007. Epub 2012 Oct 16. PMID- 23051022 OWN - NLM STAT- MEDLINE DA - 20121210 DCOM- 20130628 LR - 20150222 IS - 1472-6874 (Electronic) IS - 1472-6874 (Linking) VI - 12 DP - 2012 Oct 10 TI - Patient understanding of the revised USPSTF screening mammogram guidelines: need for development of patient decision aids. PG - 36 LID - 10.1186/1472-6874-12-36 [doi] AB - BACKGROUND: The purpose of the study was to examine patients' understanding of the revised screening mammogram guidelines released by the United States Preventive Services Task Force (USPSTF) in 2009 addressing age at initiation and frequency of screening mammography. METHODS: Patients from the Departments of Family Medicine, Internal Medicine, and Obstetrics and Gynecology (n = 150) at a tertiary care medical center in the United States completed a survey regarding their understanding of the revised USPSTF guidelines following their release, within four to six months of their scheduled mammogram (March 2010 to May 2010). RESULTS: Of the patients surveyed, 97/147 (67%) indicated increased confusion regarding the age and frequency of screening mammography, 61/148 (41%) reported increased anxiety about mammograms, and 58/146 (40%) reported anxiety about their own health status following the release of the revised screening guidelines. Most of the patients surveyed, 111/148 (75%), did not expect to change their timing or frequency of screening mammograms in the future. CONCLUSION: Results from this survey suggested increased confusion and possibly an increase in patients' anxiety related to screening mammography and their own health status following the release of the revised USPSTF screening mammogram guidelines to the public and subsequent media portrayal of the revised guidelines. Although the study did not specifically address causality for these findings, the results highlight the need for improvements in the communication of guidelines to patients and the public. Development of shared decision-making tools and outcomes should be considered to address the communication challenge. FAU - Allen, Summer V AU - Allen SV AD - Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. FAU - Solberg Nes, Lise AU - Solberg Nes L FAU - Marnach, Mary L AU - Marnach ML FAU - Polga, Kristen AU - Polga K FAU - Jenkins, Sarah M AU - Jenkins SM FAU - Files, Julia A AU - Files JA FAU - Croghan, Ivana T AU - Croghan IT FAU - Ghosh, Karthik AU - Ghosh K FAU - Pruthi, Sandhya AU - Pruthi S LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20121010 PL - England TA - BMC Womens Health JT - BMC women's health JID - 101088690 SB - IM MH - Adult MH - Advisory Committees MH - Aged MH - Breast Neoplasms/diagnosis/*prevention & control/psychology MH - Centers for Disease Control and Prevention (U.S.) MH - Early Detection of Cancer/*psychology MH - Female MH - Humans MH - Mammography/psychology/*standards MH - Mass Screening/psychology/*standards MH - Middle Aged MH - Patient Acceptance of Health Care/*psychology MH - *Practice Guidelines as Topic MH - United States MH - Young Adult PMC - PMC3517367 OID - NLM: PMC3517367 EDAT- 2012/10/12 06:00 MHDA- 2013/07/03 06:00 CRDT- 2012/10/12 06:00 PHST- 2012/01/12 [received] PHST- 2012/10/01 [accepted] AID - 1472-6874-12-36 [pii] AID - 10.1186/1472-6874-12-36 [doi] PST - epublish SO - BMC Womens Health. 2012 Oct 10;12:36. doi: 10.1186/1472-6874-12-36. PMID- 22940522 OWN - NLM STAT- MEDLINE DA - 20120903 DCOM- 20130211 LR - 20151119 IS - 1538-0688 (Electronic) IS - 0190-535X (Linking) VI - 39 IP - 5 DP - 2012 Sep TI - Exploration of how women make treatment decisions after a breast cancer diagnosis. PG - E425-33 LID - 10.1188/12.ONF.E425-E433 [doi] AB - PURPOSE/OBJECTIVES: To examine the information needs of women after receiving a diagnosis of breast cancer, investigate how decisions about treatment options are made, and assess personal responses to the decisions made. DESIGN: Mixed-methods approach using quantitative and qualitative data. SETTING: The University of Kansas Medical Center and Quinn Plastic Surgery Center, both in the midwestern United States. SAMPLE: 102 breast cancer survivors who had completed all forms of treatment for at least three months and less than five years. METHODS: Phase I participants completed five questionnaires about informational needs, confidence and satisfaction with the decision, decisional regret, and conflict. In phase II, 15 participants were purposively sampled from the 102 survivors to participate in a focus group session. Data analysis included frequencies and multiple regression for phase I and qualitative content analysis for phase II. MAIN RESEARCH VARIABLES: Informational needs, confidence and satisfaction with the decision, and decisional regret and conflict. FINDINGS: The variables (widowed, confidence and satisfaction with decision, and decisional conflict and regret) significantly (p = 0.01) accounted for 14% of the variance in informational needs. Two themes emerged from the study: (a) feelings, thoughts, and essential factors that impact treatment considerations, and (b) tips for enhancing treatment consideration options. CONCLUSIONS: The study's results show that women viewed informational needs as very important in making treatment decisions after being diagnosed with breast cancer. IMPLICATIONS FOR NURSING: The treatment team should provide the information, with consideration of the patient's personal preferences, that will assist women to make informed, confident, and satisfied decisions about treatment choices. FAU - Spittler, Cheryl A AU - Spittler CA AD - Quinn Plastic Surgery Center, Overland Park, KS, USA. cherylaspittler@aol.com FAU - Pallikathayil, Leonie AU - Pallikathayil L FAU - Bott, Marjorie AU - Bott M LA - eng PT - Journal Article PL - United States TA - Oncol Nurs Forum JT - Oncology nursing forum JID - 7809033 SB - IM SB - N MH - Anxiety/psychology MH - Breast Neoplasms/diagnosis/nursing/*psychology MH - *Choice Behavior MH - Data Collection MH - *Decision Making MH - Educational Status MH - Emotions MH - Fear MH - Female MH - Focus Groups MH - Health Services Needs and Demand MH - Humans MH - Marital Status MH - Mastectomy/psychology MH - Patient Education as Topic MH - Patient Preference MH - Patient Satisfaction MH - Stress, Psychological/psychology MH - Surveys and Questionnaires MH - Survivors/*psychology MH - United States MH - Women/*psychology EDAT- 2012/09/04 06:00 MHDA- 2013/02/12 06:00 CRDT- 2012/09/04 06:00 AID - 8701N73L24G0V2M5 [pii] AID - 10.1188/12.ONF.E425-E433 [doi] PST - ppublish SO - Oncol Nurs Forum. 2012 Sep;39(5):E425-33. doi: 10.1188/12.ONF.E425-E433. PMID- 22901975 OWN - NLM STAT- MEDLINE DA - 20121119 DCOM- 20130501 LR - 20151119 IS - 1532-3080 (Electronic) IS - 0960-9776 (Linking) VI - 21 IP - 6 DP - 2012 Dec TI - Practice patterns and perceptions of margin status for breast conserving surgery for breast carcinoma: National Survey of Canadian General Surgeons. PG - 730-4 LID - 10.1016/j.breast.2012.07.017 [doi] LID - S0960-9776(12)00168-3 [pii] AB - BACKGROUND: We surveyed Canadian General Surgeons to examine decision-making in early stage breast cancer. METHODS: A modified Dillman Method was used for this mail survey of 1443 surgeons. Practice patterns and factors that influence management choices for: preoperative assessment, definition of margin status, surgical techniques and recommendations for re-excision were assessed. RESULTS: The response rate was 51% with 41% treating breast cancer. Most (80%) were community surgeons, with equal distribution of low/medium/high volume and years of practice categories. Approximately 25% of surgeons "sometimes or frequently" performed diagnostic excisional biopsies while 90% report "frequently" or "always" performing preoperative core biopsies. There was marked variation in defining negative and close margins, in the use of intra-operative margin assessment techniques and recommendations for re-excision. CONCLUSIONS: Responses revealed significant variation in attitudes and practices. These findings likely reflect an absence of consensus in the literature and potential gaps between best evidence and practice. CI - Copyright (c) 2012 Elsevier Ltd. All rights reserved. FAU - Lovrics, Peter J AU - Lovrics PJ AD - Department of Surgery, McMaster University, Canada. lovricsp@mcmaster.ca FAU - Gordon, Maggie AU - Gordon M FAU - Cornacchi, Sylvie D AU - Cornacchi SD FAU - Farrokhyar, Forough AU - Farrokhyar F FAU - Ramsaroop, Amanda AU - Ramsaroop A FAU - Hodgson, Nicole AU - Hodgson N FAU - Quan, May Lynn AU - Quan ML FAU - Wright, Francis AU - Wright F FAU - Porter, Geoffrey AU - Porter G LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20120816 PL - Netherlands TA - Breast JT - Breast (Edinburgh, Scotland) JID - 9213011 SB - IM MH - *Attitude of Health Personnel MH - Biopsy/methods/utilization MH - Breast/pathology MH - Breast Neoplasms/pathology/*surgery MH - Canada MH - Decision Support Techniques MH - Female MH - *General Surgery MH - Health Care Surveys MH - Humans MH - Mastectomy MH - Mastectomy, Segmental/methods/*statistics & numerical data MH - Practice Patterns, Physicians'/*statistics & numerical data MH - Preoperative Care/methods/statistics & numerical data MH - Referral and Consultation/utilization MH - Reoperation EDAT- 2012/08/21 06:00 MHDA- 2013/05/02 06:00 CRDT- 2012/08/21 06:00 PHST- 2012/01/24 [received] PHST- 2012/04/16 [revised] PHST- 2012/07/29 [accepted] AID - S0960-9776(12)00168-3 [pii] AID - 10.1016/j.breast.2012.07.017 [doi] PST - ppublish SO - Breast. 2012 Dec;21(6):730-4. doi: 10.1016/j.breast.2012.07.017. Epub 2012 Aug 16. PMID- 22874236 OWN - NLM STAT- MEDLINE DA - 20120809 DCOM- 20130122 LR - 20151119 IS - 0926-9630 (Print) IS - 0926-9630 (Linking) VI - 180 DP - 2012 TI - Elicitating patient patterns of physician non-compliance with breast cancer guidelines using formal concept analysis. PG - 477-81 AB - Because they provide patient-specific guideline-based recommendations, clinical decision support systems (CDSSs) are expected to promote the implementation of clinical practice guidelines (CPGs). OncoDoc2 is a CDSS applied to the management of breast cancer. However, despite it was routinely used during weekly multidisciplinary staff meetings (MSMs) at the Tenon Hospital (Paris, France), the compliance rate of MSMs' decisions with CPGs did not reach 100%. Formal Concept Analysis (FCA) has been applied to elicit formal concepts related to non-compliance. A statistical pre-treatment of attributes has been proposed to leverage FCA and discriminate between compliant and non-compliant decisions. Among the 1,889 decisions made over a 3 year-period, 199 decisions of recommended re-excisions have been considered for analysis. In this sample, non-compliance was explained by uncommon clinical profiles and specific patient-centred clinical criteria. FAU - Bouaud, Jacques AU - Bouaud J AD - AP-HP, STIM, Paris, France. jacques.bouaud@sap.aphp.fr FAU - Messai, Nizar AU - Messai N FAU - Laouenan, Cedric AU - Laouenan C FAU - Mentre, France AU - Mentre F FAU - Seroussi, Brigitte AU - Seroussi B LA - eng PT - Journal Article PL - Netherlands TA - Stud Health Technol Inform JT - Studies in health technology and informatics JID - 9214582 SB - T MH - Decision Support Systems, Clinical/*standards/statistics & numerical data MH - Female MH - France/epidemiology MH - Guideline Adherence/*statistics & numerical data MH - Humans MH - Medical Oncology/*standards MH - Neoplasms/epidemiology/*therapy MH - Patient Compliance/*statistics & numerical data MH - *Practice Guidelines as Topic MH - Practice Patterns, Physicians'/standards/*statistics & numerical data EDAT- 2012/08/10 06:00 MHDA- 2013/01/23 06:00 CRDT- 2012/08/10 06:00 PST - ppublish SO - Stud Health Technol Inform. 2012;180:477-81. PMID- 22866495 OWN - NLM STAT- MEDLINE DA - 20120807 DCOM- 20120920 LR - 20141120 IS - 0026-556X (Print) IS - 0026-556X (Linking) VI - 95 IP - 6 DP - 2012 Jun TI - Reshaping lives. PG - 20-4 FAU - Lowen, J Trout AU - Lowen JT LA - eng PT - Journal Article PL - United States TA - Minn Med JT - Minnesota medicine JID - 8000173 SB - IM MH - Adipose Tissue/transplantation MH - *Body Image MH - Breast Implants/psychology MH - Breast Neoplasms/psychology/*surgery MH - Cooperative Behavior MH - Decision Making MH - Female MH - Humans MH - Mammaplasty/methods/*psychology MH - Mastectomy/*psychology MH - Minimally Invasive Surgical Procedures/psychology MH - Minnesota MH - Patient Care Team MH - Patient Education as Topic MH - Quality of Life/*psychology EDAT- 2012/08/08 06:00 MHDA- 2012/09/21 06:00 CRDT- 2012/08/08 06:00 PST - ppublish SO - Minn Med. 2012 Jun;95(6):20-4. PMID- 22833001 OWN - NLM STAT- MEDLINE DA - 20120911 DCOM- 20130214 LR - 20151119 IS - 1534-4681 (Electronic) IS - 1068-9265 (Linking) VI - 19 IP - 10 DP - 2012 Oct TI - Fear of recurrence and perceived survival benefit are primary motivators for choosing mastectomy over breast-conservation therapy regardless of age. PG - 3246-50 LID - 10.1245/s10434-012-2525-x [doi] AB - INTRODUCTION: Recent studies have reported increases in the rate of mastectomy and contralateral prophylactic mastectomy (CPM). We hypothesized that there would be different reasons for choosing mastectomy for women aged <50 compared with those aged >/=50 years. METHODS: A questionnaire was administered to 332 patients who underwent unilateral or bilateral mastectomy for breast cancer from 2006 to 2010. The survey queried on demographics, surgical choices, and rationale for those choices. A retrospective chart review was performed to determine tumor characteristics. Responses and clinical characteristics were described by contingency tables and compared using Fisher exact test or chi(2) test, as appropriate. RESULTS: Of 332 patients surveyed, 310 were evaluable. Median age was 55 years, including 88 patients <50 (28 %) and 222 patients >/=50 (72 %) at time of diagnosis. Forty-four percent of women <50 and 41 % of women >/=50 were given the option of breast conservation and chose mastectomy (p > 0.63). The two groups did not differ in their reason for choosing mastectomy, with lower recurrence risk and improved survival cited as the two most common reasons. Younger patients were more likely to undergo reconstruction and CPM (p < 0.0001) as well as have estrogen receptor-negative tumors, undergo neoadjuvant chemotherapy, and have higher magnetic resonance imaging utilization (p < 0.05). CONCLUSIONS: Choosing mastectomy and the reasons for doing so were the same for women aged <50 and >/=50 years. Prospective studies are needed to determine whether patient education regarding perceived versus actual recurrence risk and survival would alter this decision-making process. FAU - Fisher, Carla S AU - Fisher CS AD - Department of Surgery, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. carla.fisher@uphs.upenn.edu FAU - Martin-Dunlap, Tonya AU - Martin-Dunlap T FAU - Ruppel, Megan Baker AU - Ruppel MB FAU - Gao, Feng AU - Gao F FAU - Atkins, Jordan AU - Atkins J FAU - Margenthaler, Julie A AU - Margenthaler JA LA - eng PT - Journal Article DEP - 20120726 PL - United States TA - Ann Surg Oncol JT - Annals of surgical oncology JID - 9420840 SB - IM MH - Breast Neoplasms/mortality/*psychology/surgery MH - *Choice Behavior MH - Decision Making MH - Fear/*psychology MH - Female MH - Follow-Up Studies MH - Humans MH - Mastectomy/mortality/*psychology MH - Mastectomy, Segmental/mortality/*psychology MH - Middle Aged MH - Motivation MH - Neoplasm Recurrence, Local/mortality/*psychology/surgery MH - *Perception MH - Prognosis MH - Retrospective Studies MH - Surveys and Questionnaires MH - Survival Rate EDAT- 2012/07/27 06:00 MHDA- 2013/02/15 06:00 CRDT- 2012/07/27 06:00 PHST- 2012/04/12 [received] AID - 10.1245/s10434-012-2525-x [doi] PST - ppublish SO - Ann Surg Oncol. 2012 Oct;19(10):3246-50. doi: 10.1245/s10434-012-2525-x. Epub 2012 Jul 26. PMID- 22789490 OWN - NLM STAT- MEDLINE DA - 20121231 DCOM- 20130530 LR - 20161125 IS - 1532-3080 (Electronic) IS - 0960-9776 (Linking) VI - 22 IP - 1 DP - 2013 Feb TI - Pre-operative factors indicating risk of multiple operations versus a single operation in women undergoing surgery for screen detected breast cancer. PG - 78-82 LID - 10.1016/j.breast.2012.06.011 [doi] LID - S0960-9776(12)00129-4 [pii] AB - We aim to identify preoperative factors at diagnosis which could predict whether women undergoing wide local excision (WLE) would require further operations. 1593 screen-detected invasive and non-invasive breast cancers were reviewed. Age, presence of ductal carcinoma in situ (DCIS), invasive cancer size on mammography, mammographic sign, tumour type, grade and confidence of the radiologist in malignancy were compared. 83%(1315/1593) of women had a WLE. Of these, 70%(919/1315) had a single operation, and 30%(396/1315) multiple operations. These included repeat WLE to clear margins (60%(238/396)), mastectomy (34%(133/396)) and axillary dissection (6%(25/396)). The presence of mammographic microcalcification, lobular carcinoma and grade 2 malignancy on core biopsy were independent risk factors for multiple operations on multivariate analysis. Women with mammographic DCIS >30 mm were 3.4 times more likely to undergo repeat surgery than those with smaller foci. The multidisciplinary team should pay particular attention to these factors when planning surgery. CI - Copyright (c) 2012 Elsevier Ltd. All rights reserved. FAU - O'Flynn, E A M AU - O'Flynn EA AD - Department of Radiology, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom. lizoflynn@doctors.org.uk FAU - Currie, R J AU - Currie RJ FAU - Mohammed, K AU - Mohammed K FAU - Allen, S D AU - Allen SD FAU - Michell, M J AU - Michell MJ LA - eng PT - Evaluation Studies PT - Journal Article DEP - 20120710 PL - Netherlands TA - Breast JT - Breast (Edinburgh, Scotland) JID - 9213011 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Biopsy, Large-Core Needle MH - Breast/pathology MH - Breast Neoplasms/diagnosis/*surgery MH - Carcinoma, Ductal, Breast/diagnostic imaging/pathology/*surgery MH - Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging/pathology/*surgery MH - Carcinoma, Lobular/diagnostic imaging/pathology/*surgery MH - Decision Support Techniques MH - Early Detection of Cancer MH - Female MH - Humans MH - Logistic Models MH - Lymph Node Excision/*statistics & numerical data MH - Mammography MH - Mastectomy/methods/*statistics & numerical data MH - Middle Aged MH - Multivariate Analysis MH - Neoplasm Grading MH - Reoperation/statistics & numerical data MH - Risk Factors MH - Tumor Burden EDAT- 2012/07/14 06:00 MHDA- 2013/06/01 06:00 CRDT- 2012/07/14 06:00 PHST- 2012/02/23 [received] PHST- 2012/05/31 [revised] PHST- 2012/06/20 [accepted] AID - S0960-9776(12)00129-4 [pii] AID - 10.1016/j.breast.2012.06.011 [doi] PST - ppublish SO - Breast. 2013 Feb;22(1):78-82. doi: 10.1016/j.breast.2012.06.011. Epub 2012 Jul 10. PMID- 22784391 OWN - NLM STAT- MEDLINE DA - 20120807 DCOM- 20121026 LR - 20161019 IS - 1873-5134 (Electronic) IS - 0738-3991 (Linking) VI - 88 IP - 3 DP - 2012 Sep TI - Development of a shared decision making coding system for analysis of patient-healthcare provider encounters. PG - 367-72 LID - 10.1016/j.pec.2012.06.011 [doi] AB - OBJECTIVES: To describe the development and refinement of a scheme, detail of essential elements and participants in shared decision making (DEEP-SDM), for coding shared decision making (SDM) while reporting on the characteristics of decisions in a sample of patients with metastatic breast cancer. METHODS: The evidence-based patient choice instrument was modified to reflect Makoul and Clayman's integrative model of SDM. Coding was conducted on video recordings of 20 women at the first visit with their medical oncologists after suspicion of disease progression. Noldus Observer XT v.8, a video coding software platform, was used for coding. RESULTS: The sample contained 80 decisions (range: 1-11), divided into 150 decision making segments. Most decisions were physician-led, although patients and physicians initiated similar numbers of decision-making conversations. CONCLUSION: DEEP-SDM facilitates content analysis of encounters between women with metastatic breast cancer and their medical oncologists. Despite the fractured nature of decision making, it is possible to identify decision points and to code each of the essential elements of shared decision making. Further work should include application of DEEP-SDM to non-cancer encounters. PRACTICE IMPLICATIONS: A better understanding of how decisions unfold in the medical encounter can help inform the relationship of SDM to patient-reported outcomes. CI - Copyright (c) 2012 Elsevier Ireland Ltd. All rights reserved. FAU - Clayman, Marla L AU - Clayman ML AD - Division of General Internal Medicine, Northwestern University, Chicago, IL, USA. m-clayman@northwestern.edu FAU - Makoul, Gregory AU - Makoul G FAU - Harper, Maya M AU - Harper MM FAU - Koby, Danielle G AU - Koby DG FAU - Williams, Adam R AU - Williams AR LA - eng GR - K12 HD055884/HD/NICHD NIH HHS/United States GR - R03 CA124202/CA/NCI NIH HHS/United States GR - R03CA123202/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20120709 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Aged MH - *Breast Neoplasms/psychology MH - Clinical Coding/*methods MH - Communication MH - *Decision Making MH - Decision Support Techniques MH - Evidence-Based Medicine MH - Female MH - Humans MH - Middle Aged MH - *Patient Participation/psychology MH - Patient-Centered Care MH - *Physician-Patient Relations MH - Reproducibility of Results MH - Self Efficacy MH - Surveys and Questionnaires MH - Videotape Recording PMC - PMC3417351 MID - NIHMS389338 OID - NLM: NIHMS389338 OID - NLM: PMC3417351 EDAT- 2012/07/13 06:00 MHDA- 2012/10/27 06:00 CRDT- 2012/07/13 06:00 PHST- 2012/02/02 [received] PHST- 2012/05/08 [revised] PHST- 2012/06/12 [accepted] AID - S0738-3991(12)00241-8 [pii] AID - 10.1016/j.pec.2012.06.011 [doi] PST - ppublish SO - Patient Educ Couns. 2012 Sep;88(3):367-72. doi: 10.1016/j.pec.2012.06.011. Epub 2012 Jul 9. PMID- 22748534 OWN - NLM STAT- MEDLINE DA - 20120703 DCOM- 20120904 LR - 20120703 IS - 1555-9823 (Electronic) IS - 0003-1348 (Linking) VI - 78 IP - 7 DP - 2012 Jul TI - Validation of the Louisville breast sentinel node prediction models and a proposed modification to guide management of the node positive axilla. PG - 761-5 AB - The ACOSOG Z11 trial is rapidly changing use of axillary dissection, but it is not known how generalizable the Z11 results are. This study compares characteristics of the Z11 patients with the larger group of sentinel node-positive patients and evaluates two previously described Louisville algorithms to determine whether they might still be useful to predict extent of axillary node involvement and guide management of the axilla. The Yale Breast Center database was queried to calculate the Louisville prediction points for patients with a positive sentinel node and to compare the predicted with actual results. Of 1215 sentinel node biopsies performed between 2004 and 2010, 282 (23%) had at least one positive node. Thirty-one per cent of these patients would have been eligible for Z11. This group had much less axillary node involvement than the 69 per cent who were ineligible. The Yale data confirmed the accuracy of the two Louisville models and showed that tumor size, number of positive sentinel nodes, and proportion of positive sentinel nodes were all significant predictors. However, these results were much more robust if at least three sentinel nodes had been removed. The Z11 patients were clearly a good risk group. The data validate the two Louisville models and suggest that the models may be useful to select patients to avoid axillary dissection, both among the currently Z11-eligible and -ineligible populations. A modified algorithm is proposed in which all patients with a positive sentinel node have at least three total nodes removed. FAU - Lannin, Donald R AU - Lannin DR AD - Department of Surgery and Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, Connecticut 06520, USA. donald.lannin@yale.edu FAU - Killelea, Brigid AU - Killelea B FAU - Horowitz, Nina AU - Horowitz N FAU - Chagpar, Anees B AU - Chagpar AB LA - eng PT - Journal Article PT - Validation Studies PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 SB - IM MH - Algorithms MH - Axilla MH - Breast Neoplasms/*pathology/surgery MH - *Decision Support Techniques MH - Female MH - Humans MH - Lymph Node Excision MH - Lymphatic Metastasis MH - Mastectomy MH - Middle Aged MH - Models, Biological MH - Patient Selection MH - Retrospective Studies MH - *Sentinel Lymph Node Biopsy/methods EDAT- 2012/07/04 06:00 MHDA- 2012/09/05 06:00 CRDT- 2012/07/04 06:00 PST - ppublish SO - Am Surg. 2012 Jul;78(7):761-5. PMID- 22747264 OWN - NLM STAT- MEDLINE DA - 20120703 DCOM- 20121107 LR - 20120703 IS - 1745-3062 (Electronic) IS - 1745-3054 (Linking) VI - 35 IP - 2 DP - 2012 Jun TI - BresDex: helping women make breast cancer surgery choices. PG - 59-64 LID - 10.3109/17453054.2012.690132 [doi] AB - Women diagnosed with early breast cancer face a difficult decision between mastectomy and breast conservation surgery with radiotherapy. BresDex is an interactive decision-making support tool, designed to go together with the assistance and information these women currently receive, to help them in making the right choices. This paper will discuss the concepts behind this decision-making tool, the development of the project and the role of clinical photography within it. FAU - Jones, Bolette AU - Jones B AD - Cardiff and Vale University Local Health Board, UK. bolette.jones@wales.nhs.uk LA - eng PT - Journal Article PL - England TA - J Vis Commun Med JT - Journal of visual communication in medicine JID - 101254059 SB - IM MH - Breast Neoplasms/psychology/*surgery MH - *Decision Making MH - Decision Support Techniques MH - Female MH - Humans MH - Mastectomy, Radical/*psychology MH - Mastectomy, Segmental/*psychology MH - Patient Satisfaction MH - *Women's Health EDAT- 2012/07/04 06:00 MHDA- 2012/11/08 06:00 CRDT- 2012/07/04 06:00 AID - 10.3109/17453054.2012.690132 [doi] PST - ppublish SO - J Vis Commun Med. 2012 Jun;35(2):59-64. doi: 10.3109/17453054.2012.690132. PMID- 22670237 OWN - NLM STAT- MEDLINE DA - 20120606 DCOM- 20120816 LR - 20161125 IS - 1533-7294 (Electronic) IS - 0094-3509 (Linking) VI - 61 IP - 6 DP - 2012 Jun TI - Reducing the risk of breast cancer: A personalized approach. PG - 340-7 FAU - Ko, Marcia G AU - Ko MG AD - Mayo Clinic, Scottsdale, AZ 85369, USA. ko.marcia@mayo.edu FAU - Files, Julia A AU - Files JA FAU - Pruthi, Sandhya AU - Pruthi S LA - eng PT - Journal Article PL - United States TA - J Fam Pract JT - The Journal of family practice JID - 7502590 RN - 0 (Antineoplastic Agents) SB - AIM SB - IM MH - Antineoplastic Agents/therapeutic use MH - Breast Neoplasms/diagnostic imaging/etiology/*prevention & control MH - Decision Support Techniques MH - Family Practice MH - Female MH - Humans MH - Mammography MH - Mastectomy MH - Practice Guidelines as Topic MH - *Precision Medicine MH - Risk Assessment MH - Risk Factors MH - Risk Reduction Behavior EDAT- 2012/06/07 06:00 MHDA- 2012/08/17 06:00 CRDT- 2012/06/07 06:00 AID - jfp_6106k [pii] PST - ppublish SO - J Fam Pract. 2012 Jun;61(6):340-7. PMID- 22658808 OWN - NLM STAT- MEDLINE DA - 20121015 DCOM- 20121221 LR - 20151119 IS - 1879-0852 (Electronic) IS - 0959-8049 (Linking) VI - 48 IP - 16 DP - 2012 Nov TI - A nomogram to predict individual prognosis in node-negative breast carcinoma. PG - 2954-61 LID - 10.1016/j.ejca.2012.04.018 [doi] LID - S0959-8049(12)00369-3 [pii] AB - BACKGROUND: Currently, the benefit of chemotherapy (CT) in node-negative breast carcinoma (NNBC) is discussed. The evaluation of classical clinical and histological factors is limited to assess individual outcome. A statistical model was developed to improve the prognostic accuracy of NNBC. METHODS: A total of 305 node-negative breast carcinomas who underwent surgery (+/- radiotherapy) but no adjuvant treatment were selected. Putative prognosis factors including age, tumour size, oestrogen receptor (ER), progesterone receptor (PgR), Scarff-Bloom-Richardon (SBR) grading, urokinase plasminogen activator (uPA), plasminogen activator inhibitor 1 (PAI-1) and thymidine kinase (TK) were evaluated. The developed model was internally validated using Harrell's concordance index. A prognosis index (PI) was proposed and compared with Adjuvant! Online program. RESULTS: Age (p < 0.001), pathological tumour size (pT) (p < 0.001), PgR (p = 0.02), and PAI-1 (p 0.05). The presence of atypia was also not correlated with any clinical or radiological features. CONCLUSION: In our study, 19% of patients with a benign papillary lesion diagnosed on core biopsy were found to have atypical ductal hyperplasia or malignancy following surgery. In view of this, together with the absence of reliable predictive factors for malignancy, we recommend surgical excision of all papillary lesions diagnosed on core biopsy. CI - (c) 2012 Tan Tock Seng Hospital. ANZ Journal of Surgery (c) 2012 Royal Australasian College of Surgeons. FAU - Lu, Qinghui AU - Lu Q AD - Department of General Surgery, Tan Tock Seng Hospital, Singapore. qinghui.lu@gmail.com FAU - Tan, Ern Yu AU - Tan EY FAU - Ho, Bernard AU - Ho B FAU - Chen, Juliana J C AU - Chen JJ FAU - Chan, Patrick M Y AU - Chan PM LA - eng PT - Evaluation Studies PT - Journal Article DEP - 20120117 PL - Australia TA - ANZ J Surg JT - ANZ journal of surgery JID - 101086634 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Biopsy, Needle MH - Breast Neoplasms/pathology/*surgery MH - *Decision Support Techniques MH - Female MH - Humans MH - *Mastectomy MH - Middle Aged MH - Papilloma, Intraductal/pathology/*surgery MH - Retrospective Studies EDAT- 2012/04/19 06:00 MHDA- 2012/08/21 06:00 CRDT- 2012/04/19 06:00 AID - 10.1111/j.1445-2197.2011.05969.x [doi] PST - ppublish SO - ANZ J Surg. 2012 Mar;82(3):168-72. doi: 10.1111/j.1445-2197.2011.05969.x. Epub 2012 Jan 17. PMID- 22472404 OWN - NLM STAT- MEDLINE DA - 20120404 DCOM- 20120727 LR - 20120404 IS - 1555-9823 (Electronic) IS - 0003-1348 (Linking) VI - 78 IP - 4 DP - 2012 Apr TI - Yield of selective magnetic resonance imaging in preoperative workup of newly diagnosed breast cancer patients planned for breast conserving surgery. PG - 451-5 AB - The role of routine preoperative magnetic resonance imaging (MRI) in newly diagnosed breast cancer patients planned for breast conserving surgery is presently being debated. In our medical center we practice selective use of preoperative MRI; we sought to examine the yield of MRI in this highly selected group of patients. A retrospective study of all newly diagnosed breast cancer patients presenting between January 2007 and July 2010 to the Tel Aviv Sourasky Medical Center (Tel Aviv, Israel) was completed. Patients planned for breast conserving surgery who underwent preoperative MRI were included in this study. Patients and tumor characteristics, indication for MRI, findings on MRI, consequent workup, and impact on surgical treatment were recorded. Association between preoperative characteristics and yield of MRI was examined. During the study period, 105 patients that were candidates for breast conserving surgery underwent preoperative evaluation with MRI. Use of breast MRI increased over time. Rates of mastectomy were stable throughout the study years. Dense mammogram was the most frequent (51, 68%) indication for MRI. Additional suspicious findings were found in 41 (39%) patients, prompting further workup including 36 biopsies in 25 patients, of which 22 (61%) were with cancer. These additional findings prompted a change in the surgical plan in a third of the patients. In most patients (92; 88%) clear margins were achieved. Limiting the use of MRI in the preoperative workup of breast cancer patients to a selected group of patients can increase the yield of MRI. FAU - Menes, Tehillah S AU - Menes TS AD - Department of Surgery, Sourasky Medical Center, Tel Aviv, Israel. tehillahm@tasmc.health.gov.il FAU - Zissman, Sivan AU - Zissman S FAU - Golan, Orit AU - Golan O FAU - Sperber, Fani AU - Sperber F FAU - Klausner, Joseph AU - Klausner J FAU - Schneebaum, Schlomo AU - Schneebaum S LA - eng PT - Evaluation Studies PT - Journal Article PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/*diagnosis/surgery MH - Decision Support Techniques MH - Female MH - Humans MH - *Magnetic Resonance Imaging MH - *Mastectomy, Segmental MH - Middle Aged MH - Neoplasms, Ductal, Lobular, and Medullary/*diagnosis/surgery MH - *Preoperative Care MH - Retrospective Studies MH - Treatment Outcome EDAT- 2012/04/05 06:00 MHDA- 2012/07/28 06:00 CRDT- 2012/04/05 06:00 PST - ppublish SO - Am Surg. 2012 Apr;78(4):451-5. PMID- 22458616 OWN - NLM STAT- MEDLINE DA - 20120330 DCOM- 20120726 LR - 20161025 IS - 1744-8379 (Electronic) IS - 1473-7167 (Linking) VI - 12 IP - 2 DP - 2012 Apr TI - Measuring and managing patient expectations for breast reconstruction: impact on quality of life and patient satisfaction. PG - 149-58 LID - 10.1586/erp.11.105 [doi] AB - The goal of postmastectomy breast reconstruction is to restore a woman's body image and to satisfy her personal expectations regarding the results of surgery. Studies in other surgical areas have shown that unrecognized or unfulfilled expectations may predict dissatisfaction more strongly than even the technical success of the surgery. Patient expectations play an especially critical role in elective procedures, such as cancer reconstruction, where the patient's primary motivation is improved health-related quality of life. In breast reconstruction, assessment of patient expectations is therefore vital to optimal patient care. This report summarizes the existing literature on patient expectations regarding breast reconstruction, and provides a viewpoint on how this field can evolve. Specifically, we consider how systematic measurement and management of patient expectations may improve patient education, shared medical decision-making and patient perception of outcomes. FAU - Pusic, Andrea L AU - Pusic AL AD - Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA. pusica@mskcc.org FAU - Klassen, Anne F AU - Klassen AF FAU - Snell, Laura AU - Snell L FAU - Cano, Stefan J AU - Cano SJ FAU - McCarthy, Colleen AU - McCarthy C FAU - Scott, Amie AU - Scott A FAU - Cemal, Yeliz AU - Cemal Y FAU - Rubin, Lisa R AU - Rubin LR FAU - Cordeiro, Peter G AU - Cordeiro PG LA - eng GR - R03 CA128476/CA/NCI NIH HHS/United States PT - Journal Article PT - Review PL - England TA - Expert Rev Pharmacoecon Outcomes Res JT - Expert review of pharmacoeconomics & outcomes research JID - 101132257 SB - IM MH - Breast/anatomy & histology/surgery MH - Breast Neoplasms/psychology/surgery MH - Female MH - Humans MH - Mammaplasty/*psychology MH - Mastectomy MH - Patient Education as Topic MH - Patient Satisfaction/*statistics & numerical data MH - Quality of Life/*psychology MH - Recovery of Function MH - Treatment Outcome PMC - PMC4182909 MID - NIHMS380935 OID - NLM: NIHMS380935 OID - NLM: PMC4182909 EDAT- 2012/03/31 06:00 MHDA- 2012/07/27 06:00 CRDT- 2012/03/31 06:00 AID - 10.1586/erp.11.105 [doi] PST - ppublish SO - Expert Rev Pharmacoecon Outcomes Res. 2012 Apr;12(2):149-58. doi: 10.1586/erp.11.105. PMID- 22415294 OWN - NLM STAT- MEDLINE DA - 20120314 DCOM- 20120516 LR - 20151119 IS - 1532-1827 (Electronic) IS - 0007-0920 (Linking) VI - 106 IP - 6 DP - 2012 Mar 13 TI - Making hard choices easier: a prospective, multicentre study to assess the efficacy of a fertility-related decision aid in young women with early-stage breast cancer. PG - 1053-61 LID - 10.1038/bjc.2012.61 [doi] AB - BACKGROUND: Fertility is a priority for many young women with breast cancer. Women need to be informed about interventions to retain fertility before chemotherapy so as to make good quality decisions. This study aimed to prospectively evaluate the efficacy of a fertility-related decision aid (DA). METHODS: A total of 120 newly diagnosed early-stage breast cancer patients from 19 Australian oncology clinics, aged 18-40 years and desired future fertility, were assessed on decisional conflict, knowledge, decision regret, and satisfaction about fertility-related treatment decisions. These were measured at baseline, 1 and 12 months, and were examined using linear mixed effects models. RESULTS: Compared with usual care, women who received the DA had reduced decisional conflict (beta=-1.51; 95%CI: -2.54 to 0.48; P=0.004) and improved knowledge (beta=0.09; 95%CI: 0.01-0.16; P=0.02), after adjusting for education, desire for children and baseline uncertainty. The DA was associated with reduced decisional regret at 1 year (beta=-3.73; 95%CI: -7.12 to -0.35; P=0.031), after adjusting for education. Women who received the DA were more satisfied with the information received on the impact of cancer treatment on fertility (P<0.001), fertility options (P=0.005), and rated it more helpful (P=0.002), than those who received standard care. CONCLUSION: These findings support widespread use of this DA shortly after diagnosis (before chemotherapy) among younger breast cancer patients who have not completed their families. FAU - Peate, M AU - Peate M AD - Prince of Wales Clinical School, University of NSW, Randwick, New South Wales, Australia. michelle.peate@sydney.edu.au FAU - Meiser, B AU - Meiser B FAU - Cheah, B C AU - Cheah BC FAU - Saunders, C AU - Saunders C FAU - Butow, P AU - Butow P FAU - Thewes, B AU - Thewes B FAU - Hart, R AU - Hart R FAU - Phillips, K-A AU - Phillips KA FAU - Hickey, M AU - Hickey M FAU - Friedlander, M AU - Friedlander M LA - eng PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't PL - England TA - Br J Cancer JT - British journal of cancer JID - 0370635 SB - IM MH - Adult MH - Anxiety MH - Breast Neoplasms/*pathology/psychology MH - Conflict (Psychology) MH - Decision Making MH - *Decision Support Techniques MH - Depression MH - Emotions MH - Female MH - *Fertility Preservation MH - Humans MH - Neoplasm Staging MH - Patient Education as Topic MH - Patient Satisfaction MH - Prospective Studies MH - Referral and Consultation MH - Surveys and Questionnaires PMC - PMC3304428 OID - NLM: PMC3304428 EDAT- 2012/03/15 06:00 MHDA- 2012/05/17 06:00 CRDT- 2012/03/15 06:00 AID - bjc201261 [pii] AID - 10.1038/bjc.2012.61 [doi] PST - ppublish SO - Br J Cancer. 2012 Mar 13;106(6):1053-61. doi: 10.1038/bjc.2012.61. PMID- 22331002 OWN - NLM STAT- MEDLINE DA - 20120820 DCOM- 20121026 LR - 20151119 IS - 1879-355X (Electronic) IS - 0360-3016 (Linking) VI - 84 IP - 1 DP - 2012 Sep 01 TI - Development of patients' decision aid for older women with stage I breast cancer considering radiotherapy after lumpectomy. PG - 30-8 LID - 10.1016/j.ijrobp.2011.11.028 [doi] AB - PURPOSE: To develop a patient decision aid (PtDA) for older women with Stage I, pathologically node negative, estrogen receptor-positive progesterone receptor-positive breast cancer who are considering adjuvant radiotherapy after lumpectomy and to examine its impact on patients' decision making. METHODS AND MATERIALS: A PtDA was developed and evaluated in three steps according to the Ottawa Decision Support Framework: (1) needs assessment (n = 16); (2) Pilot I to examine PtDA acceptability (n = 12); and (3) Pilot II, a pretest posttest (n = 38) with older women with estrogen receptor-positive progesterone receptor-positive breast cancer after lumpectomy who were receiving adjuvant radiation therapy. Measures included patients' satisfaction with the PtDA, self-reported decisional conflict, level of distress, treatment-related knowledge, and choice predisposition. RESULTS: The PtDA is a booklet that details each adjuvant treatment option's benefits, risks, and side effects tailored to the patient's clinical profile; includes a values clarification exercise; and includes steps to guide patients towards their decision. On the basis of qualitative comments and satisfaction ratings, all women thought that the PtDA was helpful and informative. In comparison with their baseline scores, patients had a statistically significant (p < 0.05) reduction in decisional conflict (adjusted mean difference [AMD], -7.18; 95% confidence interval [CI], -13.50 to 12.59); increased clarity of the benefits and risks (AMD, -10.86; CI, -20.33 to 21.49); and improved general treatment knowledge (AMD, 8.99; CI, 2.88-10.28) after using the PtDA. General trends were also reported in the patients' choice predisposition scores that suggested potential differences in treatment decision after PtDA use. CONCLUSIONS: This study provides evidence that this PtDA may be a helpful educational tool for this group of women. The quality of care for older breast cancer patients may be enhanced by the use of a tailored PtDA to help patients be better informed about their treatment options. CI - Copyright (c) 2012 Elsevier Inc. All rights reserved. FAU - Wong, Jennifer AU - Wong J AD - Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. FAU - D'Alimonte, Laura AU - D'Alimonte L FAU - Angus, Jan AU - Angus J FAU - Paszat, Larry AU - Paszat L FAU - Metcalfe, Kelly AU - Metcalfe K FAU - Whelan, Tim AU - Whelan T FAU - Llewellyn-Thomas, Hilary AU - Llewellyn-Thomas H FAU - Warner, Eiran AU - Warner E FAU - Franssen, Edmee AU - Franssen E FAU - Szumacher, Ewa AU - Szumacher E LA - eng PT - Evaluation Studies PT - Journal Article PT - Patient Education Handout PT - Research Support, Non-U.S. Gov't DEP - 20120211 PL - United States TA - Int J Radiat Oncol Biol Phys JT - International journal of radiation oncology, biology, physics JID - 7603616 RN - 0 (Receptors, Estrogen) SB - IM MH - Age Factors MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/chemistry/pathology/psychology/*radiotherapy/surgery MH - Choice Behavior MH - *Decision Support Techniques MH - Female MH - Humans MH - Mastectomy, Segmental MH - *Pamphlets MH - Patient Participation MH - Pilot Projects MH - Radiotherapy, Adjuvant/adverse effects/methods/psychology MH - Receptors, Estrogen/analysis MH - Surveys and Questionnaires EDAT- 2012/02/15 06:00 MHDA- 2012/10/27 06:00 CRDT- 2012/02/15 06:00 PHST- 2011/04/04 [received] PHST- 2011/11/04 [revised] PHST- 2011/11/07 [accepted] AID - S0360-3016(11)03539-5 [pii] AID - 10.1016/j.ijrobp.2011.11.028 [doi] PST - ppublish SO - Int J Radiat Oncol Biol Phys. 2012 Sep 1;84(1):30-8. doi: 10.1016/j.ijrobp.2011.11.028. Epub 2012 Feb 11. PMID- 22231042 OWN - NLM STAT- MEDLINE DA - 20120213 DCOM- 20120330 LR - 20161019 IS - 1527-7755 (Electronic) IS - 0732-183X (Linking) VI - 30 IP - 5 DP - 2012 Feb 10 TI - Online tool to guide decisions for BRCA1/2 mutation carriers. PG - 497-506 LID - 10.1200/JCO.2011.38.6060 [doi] AB - PURPOSE: Women with BRCA1 or BRCA2 (BRCA1/2) mutations must choose between prophylactic surgeries and screening to manage their high risks of breast and ovarian cancer, comparing options in terms of cancer incidence, survival, and quality of life. A clinical decision tool could guide these complex choices. METHODS: We built a Monte Carlo model for BRCA1/2 mutation carriers, simulating breast screening with annual mammography plus magnetic resonance imaging (MRI) from ages 25 to 69 years and prophylactic mastectomy (PM) and/or prophylactic oophorectomy (PO) at various ages. Modeled outcomes were cancer incidence, tumor features that shape treatment recommendations, overall survival, and cause-specific mortality. We adapted the model into an online tool to support shared decision making. RESULTS: We compared strategies on cancer incidence and survival to age 70 years; for example, PO plus PM at age 25 years optimizes both outcomes (incidence, 4% to 11%; survival, 80% to 83%), whereas PO at age 40 years plus MRI screening offers less effective prevention, yet similar survival (incidence, 36% to 57%; survival, 74% to 80%). To characterize patients' treatment and survivorship experiences, we reported the tumor features and treatments associated with risk-reducing interventions; for example, in most BRCA2 mutation carriers (81%), MRI screening diagnoses stage I, hormone receptor-positive breast cancers, which may not require chemotherapy. CONCLUSION: Cancer risk-reducing options for BRCA1/2 mutation carriers vary in their impact on cancer incidence, recommended treatments, quality of life, and survival. To guide decisions informed by multiple health outcomes, we provide an online tool for joint use by patients with their physicians (http://brcatool.stanford.edu). FAU - Kurian, Allison W AU - Kurian AW AD - Stanford University School of Medicine, Stanford, CA, USA. FAU - Munoz, Diego F AU - Munoz DF FAU - Rust, Peter AU - Rust P FAU - Schackmann, Elizabeth A AU - Schackmann EA FAU - Smith, Michael AU - Smith M FAU - Clarke, Lauren AU - Clarke L FAU - Mills, Meredith A AU - Mills MA FAU - Plevritis, Sylvia K AU - Plevritis SK LA - eng GR - R01 CA066785/CA/NCI NIH HHS/United States GR - U01 CA088248/CA/NCI NIH HHS/United States GR - R01 CA66785/CA/NCI NIH HHS/United States GR - R01 CA829040/CA/NCI NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20120109 PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 SB - IM CIN - J Clin Oncol. 2012 Feb 10;30(5):471-3. PMID: 22231044 MH - Breast Neoplasms/epidemiology/genetics/*prevention & control MH - *Computer Simulation MH - *Decision Support Techniques MH - Early Detection of Cancer/*methods MH - Female MH - *Genes, BRCA1 MH - *Genes, BRCA2 MH - Genetic Predisposition to Disease MH - Heterozygote MH - Humans MH - Incidence MH - Magnetic Resonance Imaging MH - Mammography MH - Mastectomy MH - Monte Carlo Method MH - *Mutation MH - Ovarian Neoplasms/epidemiology/genetics/*prevention & control MH - Ovariectomy MH - Quality of Life MH - Survival Analysis PMC - PMC3295552 OID - NLM: PMC3295552 EDAT- 2012/01/11 06:00 MHDA- 2012/03/31 06:00 CRDT- 2012/01/11 06:00 AID - JCO.2011.38.6060 [pii] AID - 10.1200/JCO.2011.38.6060 [doi] PST - ppublish SO - J Clin Oncol. 2012 Feb 10;30(5):497-506. doi: 10.1200/JCO.2011.38.6060. Epub 2012 Jan 9. PMID- 22160638 OWN - NLM STAT- MEDLINE DA - 20120314 DCOM- 20120622 LR - 20151119 IS - 1573-7217 (Electronic) IS - 0167-6806 (Linking) VI - 132 IP - 2 DP - 2012 Apr TI - Comparison of two nomograms to predict pathologic complete responses to neoadjuvant chemotherapy for breast cancer: evidence that HER2-positive tumors need specific predictors. PG - 601-7 LID - 10.1007/s10549-011-1897-0 [doi] AB - The aim of this study is to compare two published nomograms, the "Institut Gustave Roussy/M.D. Anderson Cancer Center" (IGR/MDACC) and the Colleoni nomograms, in predicting pathologic complete responses (pCR) to preoperative chemotherapy in an independent cohort and to assess the impact of HER2 status. Data from 200 patients with breast carcinoma treated with preoperative chemotherapy were collected. We calculated pCR rate predictions with the two nomograms and compared the predictions with the outcomes. Sixty percent of the patients with HER2-positive tumors received trastuzumab concomitantly with taxanes. Model performances were quantified with respect to discrimination and calibration. In the whole population, the area under the ROC curve (AUC) for the IGR/MDACC nomogram and the Colleoni nomogram were 0.74 and 0.75, respectively. Both of them underestimated the pCR rate (P = 0.026 and 0.0005). When patients treated with trastuzumab were excluded, the AUC were excellent: 0.78 for both nomograms with no significant difference between the predicted and the observed pCR (P = 0.14 and 0.15). When the specific population treated with trastuzumab preoperatively was analyzed, the AUC for the IGR/MDACC nomogram and the Colleoni nomogram were poor, 0.52 and 0.53, respectively. The IGR/MDACC and the Colleoni nomograms were accurate in predicting the probability of pCR after preoperative chemotherapy in the HER2-negative population but did not correctly predict pCR in the HER2-positive patients who received trastuzumab. This suggests that responses to preoperative chemotherapy, including trastuzumab, are biologically driven and that a specific nomogram or predictor for HER2-positive patients has to be developed. FAU - Frati, Albane AU - Frati A AD - Department of Obstetrics and Gynecology (Pole GYNORESP), Hopital Tenon, Assistance Publique Hopitaux de Paris, 4 rue de la Chine, 75020 Paris, France. FAU - Chereau, Elisabeth AU - Chereau E FAU - Coutant, Charles AU - Coutant C FAU - Bezu, Corinne AU - Bezu C FAU - Antoine, Martine AU - Antoine M FAU - Chopier, Jocelyne AU - Chopier J FAU - Darai, Emile AU - Darai E FAU - Uzan, Serge AU - Uzan S FAU - Gligorov, Joseph AU - Gligorov J FAU - Rouzier, Roman AU - Rouzier R LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20111209 PL - Netherlands TA - Breast Cancer Res Treat JT - Breast cancer research and treatment JID - 8111104 RN - 0 (Antibodies, Monoclonal, Humanized) RN - 0 (Biomarkers, Tumor) RN - 0 (Taxoids) RN - EC 2.7.10.1 (ERBB2 protein, human) RN - EC 2.7.10.1 (Receptor, ErbB-2) RN - P188ANX8CK (Trastuzumab) SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Antibodies, Monoclonal, Humanized/administration & dosage MH - Antineoplastic Combined Chemotherapy Protocols/*therapeutic use MH - Biomarkers, Tumor/*analysis MH - Breast Neoplasms/chemistry/*drug therapy/pathology/surgery MH - Chemotherapy, Adjuvant MH - Chi-Square Distribution MH - *Decision Support Techniques MH - Discriminant Analysis MH - Female MH - Humans MH - Logistic Models MH - Mastectomy MH - Middle Aged MH - Neoadjuvant Therapy MH - *Nomograms MH - Paris MH - Probability MH - ROC Curve MH - Receptor, ErbB-2/*analysis MH - Taxoids/administration & dosage MH - Trastuzumab MH - Treatment Outcome EDAT- 2011/12/14 06:00 MHDA- 2012/06/23 06:00 CRDT- 2011/12/14 06:00 PHST- 2011/09/05 [received] PHST- 2011/11/22 [accepted] AID - 10.1007/s10549-011-1897-0 [doi] PST - ppublish SO - Breast Cancer Res Treat. 2012 Apr;132(2):601-7. doi: 10.1007/s10549-011-1897-0. Epub 2011 Dec 9. PMID- 22056355 OWN - NLM STAT- MEDLINE DA - 20111223 DCOM- 20120213 LR - 20161118 IS - 1879-1190 (Electronic) IS - 1072-7515 (Linking) VI - 214 IP - 1 DP - 2012 Jan TI - Decision making about surgery for early-stage breast cancer. PG - 1-10 LID - 10.1016/j.jamcollsurg.2011.09.017 [doi] AB - BACKGROUND: Practice variation in breast cancer surgery has raised concerns about the quality of treatment decisions. We sought to evaluate the quality of decisions about surgery for early-stage breast cancer by measuring patient knowledge, concordance between goals and treatments, and involvement in decisions. STUDY DESIGN: A mailed survey of stage I/II breast cancer survivors was conducted at 4 sites. The Decision Quality Instrument measured knowledge, goals, and involvement in decisions. A multivariable logistic regression model of treatment was developed. The model-predicted probability of mastectomy was compared with treatment received for each patient. Concordance was defined as having mastectomy and predicted probability >0.5 or partial mastectomy and predicted probability <0.5. Frequency of discussion about partial mastectomy was compared with discussion about mastectomy using chi-square tests. RESULTS: Four hundred and forty patients participated (59% response rate). Mean overall knowledge was 52.7%; 45.9% knew that local recurrence risk is higher after breast conservation and 55.7% knew that survival is equivalent for the 2 options. Most participants (89.0%) had treatment concordant with their goals. Participants preferring mastectomy had lower concordance (80.5%) than those preferring partial mastectomy (92.6%; p = 0.001). Participants reported more frequent discussion of partial mastectomy and its advantages than of mastectomy, and 48.6% reported being asked their preference. CONCLUSIONS: Breast cancer survivors had major knowledge deficits, and those preferring mastectomy were less likely to have treatment concordant with goals. Patients perceived that discussions focused on partial mastectomy, and many were not asked their preference. Improvements in the quality of decisions about breast cancer surgery are needed. CI - Copyright (c) 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Lee, Clara N AU - Lee CN AD - Division of Plastic and Reconstructive Surgery at the University of North Carolina, Chapel Hill, NC 27599-7195, USA. cnlee@med.unc.edu FAU - Chang, Yuchiao AU - Chang Y FAU - Adimorah, Nesochi AU - Adimorah N FAU - Belkora, Jeff K AU - Belkora JK FAU - Moy, Beverly AU - Moy B FAU - Partridge, Ann H AU - Partridge AH FAU - Ollila, David W AU - Ollila DW FAU - Sepucha, Karen R AU - Sepucha KR LA - eng GR - K07 CA154850/CA/NCI NIH HHS/United States GR - KL2 RR025746/RR/NCRR NIH HHS/United States GR - KL2 RR025746-02/RR/NCRR NIH HHS/United States GR - 1KL2RR025746/RR/NCRR NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20111106 PL - United States TA - J Am Coll Surg JT - Journal of the American College of Surgeons JID - 9431305 SB - AIM SB - IM MH - Breast Neoplasms/pathology/*surgery MH - Decision Making MH - Female MH - Humans MH - Middle Aged MH - Neoplasm Staging MH - Patient Education as Topic MH - Patient Participation MH - Retrospective Studies MH - Surveys and Questionnaires PMC - PMC3256735 MID - NIHMS337004 OID - NLM: NIHMS337004 OID - NLM: PMC3256735 EDAT- 2011/11/08 06:00 MHDA- 2012/02/14 06:00 CRDT- 2011/11/08 06:00 PHST- 2011/07/22 [received] PHST- 2011/09/15 [revised] PHST- 2011/09/21 [accepted] AID - S1072-7515(11)01115-X [pii] AID - 10.1016/j.jamcollsurg.2011.09.017 [doi] PST - ppublish SO - J Am Coll Surg. 2012 Jan;214(1):1-10. doi: 10.1016/j.jamcollsurg.2011.09.017. Epub 2011 Nov 6. PMID- 22004778 OWN - NLM STAT- MEDLINE DA - 20111018 DCOM- 20120827 LR - 20111018 IS - 1471-6348 (Electronic) IS - 0266-4623 (Linking) VI - 27 IP - 4 DP - 2011 Oct TI - Health technology assessment-based development of a Spanish breast cancer patient decision aid. PG - 363-8 LID - 10.1017/S0266462311000493 [doi] AB - OBJECTIVES: The aim of this study was to develop a breast cancer Patient Decision Aid (PDA), using a Health Technology Assessment (HTA) process, to assist patients in their choice of therapeutic options, and to promote shared decision making among patients, healthcare professionals, and other interested parties. METHODS: A systematic review (SR) was conducted of existing breast cancer patient Decision Aids encountered in the main scientific journal databases and on institutional Web sites that create PDAs, together with a Qualitative Research (QR) study, using semi-structured interviews and focus group with stakeholders (patients, family members, and health professionals), with the aim of developing a PDA for breast cancer. RESULTS: The SR shows that PDAs in breast cancer not only increase patient knowledge of the illness, leading to more realistic expectations of treatment outcomes, but also reduce passivity in the decision-making process and facilitate the appropriate choice of treatment options in accordance with patient medical and personal preferences. The analysis of QR shows that both breast cancer patients and healthcare professionals agree that surgery, adjuvant treatments, and breast reconstruction represent the most important decisions to be made. Worry, anxiety, optimism, and trust in healthcare professionals were determined as factors that most affected patients subjective experiences of the illness. This HTA was used as the basis for developing a PDA software program. CONCLUSIONS: The SR and QR used in the development of this PDA for breast cancer allowed patients to access information, gain additional knowledge of their illness, make shared treatment decisions, and gave healthcare professionals a deeper insight into patient experiences of the disease. FAU - Izquierdo, Fatima AU - Izquierdo F AD - Agencia Lain Entralgo, Madrid, Spain. fatima.izquierdo@uets.info FAU - Gracia, Javier AU - Gracia J FAU - Guerra, Mercedes AU - Guerra M FAU - Blasco, Juan Antonio AU - Blasco JA FAU - Andradas, Elena AU - Andradas E LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Int J Technol Assess Health Care JT - International journal of technology assessment in health care JID - 8508113 SB - IM MH - Adolescent MH - Adult MH - Aged MH - Breast Neoplasms/*diagnosis MH - *Decision Support Techniques MH - Female MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - Middle Aged MH - Patient Education as Topic MH - *Patient Participation MH - Socioeconomic Factors MH - Spain MH - Technology Assessment, Biomedical/*organization & administration MH - Young Adult EDAT- 2011/10/19 06:00 MHDA- 2012/08/28 06:00 CRDT- 2011/10/19 06:00 AID - S0266462311000493 [pii] AID - 10.1017/S0266462311000493 [doi] PST - ppublish SO - Int J Technol Assess Health Care. 2011 Oct;27(4):363-8. doi: 10.1017/S0266462311000493. PMID- 21988888 OWN - NLM STAT- MEDLINE DA - 20111012 DCOM- 20120126 LR - 20161125 IS - 2210-7185 (Electronic) IS - 2210-7177 (Linking) VI - 34 IP - 5 DP - 2011 TI - A novel, patient-specific mathematical pathology approach for assessment of surgical volume: application to ductal carcinoma in situ of the breast. PG - 247-63 LID - 10.3233/ACP-2011-0019 [doi] AB - We introduce a novel "mathematical pathology" approach, founded on a biophysical model, to identify robust patient-specific predictors of tumor growth useful in clinical practice to improve the accuracy of diagnosis/prognosis and intervention. In accordance with biological observations, our model simulates the diffusion-limited in situ tumors with a relatively short phase of fast initial growth, followed by a prolonged slow-growth phase where tumor size is constrained primarily by the relative weight of cell mitosis and death. The former phase may only last for a few months, so that at the time of diagnosis, we may assume that most tumors will have entered the phase where their size is changing slowly. Based on this prediction, we hypothesize that the volume of breast with ducts affected by in situ tumors at the time of diagnosis will be closely approximated by a model-derived mathematical function based on the ratio of tumor cell proliferation-to-apoptosis indices and on the extent of diffusion of cell nutrients (diffusion penetration length), which can be measured from immunohistochemical and morphometric analysis of patient histopathology specimens without the need for multiple-time measurements. We tested this idea in a retrospective study of 17 patients by staining breast tumor specimens containing ductal carcinoma in situ for mitosis with Ki-67 and for apoptosis with cleaved caspase-3 and counting cells positive for each marker. We also determined diffusion penetration by measuring the thickness of viable rims of tumor cells within ducts. Using the ensuing ratios, we applied the model to determine a predicted surgical volume or tumor size. We then corroborated our hypothesis by comparing the predicted size of each tumor based on our model with the actual size of the pathological specimen after tumor excision (R2 = 0.74-0.88). In addition, for the 17 cases studied, both histological grade and mammography were not found to correlate with tumor size (R2 = 0.08-0.47). We conclude that our mathematical pathology approach yields a high degree of accuracy in predicting the size of tumors based on the mitotic/apoptotic index and on diffusion penetration. By obtaining these ratios at the time of initial biopsy, pathologists can employ our model to predict the size of the tumor and thereby inform surgeons how much tissue to remove (surgical volume). We discuss how results from the model have implications concerning the current debate on recommendations for screening mammography, while the model itself may contribute to better planning of breast conservation surgery. FAU - Edgerton, Mary E AU - Edgerton ME AD - Department of Pathology, UT MD Anderson Cancer Center, and School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA. FAU - Chuang, Yao-Li AU - Chuang YL FAU - Macklin, Paul AU - Macklin P FAU - Yang, Wei AU - Yang W FAU - Bearer, Elaine L AU - Bearer EL FAU - Cristini, Vittorio AU - Cristini V LA - eng GR - U54 CA143907/CA/NCI NIH HHS/United States GR - R01 NS046810/NS/NINDS NIH HHS/United States GR - U54 CA143837/CA/NCI NIH HHS/United States GR - R01 NS062184/NS/NINDS NIH HHS/United States GR - U54 CA149196/CA/NCI NIH HHS/United States PT - Journal Article PL - United States TA - Anal Cell Pathol (Amst) JT - Analytical cellular pathology (Amsterdam) JID - 101541993 RN - 0 (Ki-67 Antigen) RN - EC 3.4.22.- (CASP3 protein, human) RN - EC 3.4.22.- (Caspase 3) SB - IM MH - Apoptosis MH - Breast Neoplasms/diagnostic imaging/metabolism/pathology/*surgery MH - Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging/metabolism/pathology/*surgery MH - Caspase 3/analysis MH - Cell Proliferation MH - Computer Simulation MH - *Decision Support Techniques MH - Diffusion MH - Energy Metabolism MH - Female MH - Humans MH - Immunohistochemistry MH - Ki-67 Antigen/analysis MH - Mammography MH - *Mastectomy MH - Mitotic Index MH - *Models, Biological MH - Patient Selection MH - Retrospective Studies MH - Time Factors MH - Tumor Burden PMC - PMC3613121 MID - NIHMS452618 OID - NLM: NIHMS452618 OID - NLM: PMC3613121 EDAT- 2011/10/13 06:00 MHDA- 2012/01/27 06:00 CRDT- 2011/10/13 06:00 AID - 9848673505W4121J [pii] AID - 10.3233/ACP-2011-0019 [doi] PST - ppublish SO - Anal Cell Pathol (Amst). 2011;34(5):247-63. doi: 10.3233/ACP-2011-0019. PMID- 21764374 OWN - NLM STAT- MEDLINE DA - 20120525 DCOM- 20121024 LR - 20151119 IS - 1532-2122 (Electronic) IS - 1462-3889 (Linking) VI - 16 IP - 3 DP - 2012 Jul TI - A preliminary study into women's experiences of undergoing reconstructive surgery after breast cancer. PG - 220-6 LID - 10.1016/j.ejon.2011.05.005 [doi] AB - UNLABELLED: Breast cancer is the most common type of cancer among women. In Sweden, about 40% of women diagnosed with breast cancer undergo a mastectomy; breast reconstruction (BR) may be an option for these women. However, the experience of undergoing reconstructive surgery appears to be only very scarcely researched, despite its importance in clinical nursing. AIM: The purpose of this study was to explore women's experiences of undergoing breast reconstructive surgery after mastectomy due to breast cancer. METHODS: Six women participated in narrative interviews about their experiences of reconstructive surgery, and the interview data were analysed using thematic narrative analysis. RESULTS: All six women were unprepared for the strenuous experience of undergoing a BR. They described the process as difficult and painful, entailing several operations and an unexpectedly long recovery period. They were also unprepared for how arduous it would be, both physically and emotionally. However, getting a BR had been important to all the women. The BR process was captured in four themes: (1) uninformed care; (2) arduous experiences; (3) body alterations; and (4) moving on. CONCLUSIONS: Obtaining adequate information and being involved in the decision-making process along the pathway of a BR could help the women to prepare physically and emotionally for the strenuous experiences related to reconstructive surgery. CI - Copyright (c) 2011 Elsevier Ltd. All rights reserved. FAU - Fallbjork, Ulrika AU - Fallbjork U AD - Department of Nursing, Umea University, SE-901 87 Umea, Sweden. ulrika.fallbjork@nurs.umu.se FAU - Frejeus, Elin AU - Frejeus E FAU - Rasmussen, Birgit H AU - Rasmussen BH LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20110720 PL - Scotland TA - Eur J Oncol Nurs JT - European journal of oncology nursing : the official journal of European Oncology Nursing Society JID - 100885136 SB - IM SB - N MH - Adaptation, Psychological MH - Adult MH - Body Image MH - Breast Neoplasms/nursing/*psychology/*surgery MH - Decision Making MH - Emotions MH - Female MH - Humans MH - Interviews as Topic MH - Mammaplasty/nursing/*psychology MH - Mastectomy/nursing/*psychology MH - Middle Aged MH - Patient Education as Topic MH - Qualitative Research MH - Surveys and Questionnaires MH - Sweden EDAT- 2011/07/19 06:00 MHDA- 2012/10/25 06:00 CRDT- 2011/07/19 06:00 PHST- 2011/01/18 [received] PHST- 2011/05/23 [revised] PHST- 2011/05/25 [accepted] AID - S1462-3889(11)00089-5 [pii] AID - 10.1016/j.ejon.2011.05.005 [doi] PST - ppublish SO - Eur J Oncol Nurs. 2012 Jul;16(3):220-6. doi: 10.1016/j.ejon.2011.05.005. Epub 2011 Jul 20. PMID- 21720992 OWN - NLM STAT- MEDLINE DA - 20120123 DCOM- 20120327 LR - 20161122 IS - 1097-0142 (Electronic) IS - 0008-543X (Linking) VI - 118 IP - 3 DP - 2012 Feb 01 TI - Radiation therapy for ductal carcinoma in situ: a decision analysis. PG - 603-11 LID - 10.1002/cncr.26293 [doi] AB - BACKGROUND: The benefit of adding radiation therapy after excision of ductal carcinoma in situ (DCIS) is widely debated. Randomized clinical trials are underpowered to delineate long-term outcomes after radiation. METHODS: The authors of this report constructed a Markov decision model to simulate the clinical course of DCIS in a woman aged 60 years who received treatment with either of 2 breast-conserving strategies: excision alone or excision plus radiation therapy. Sensitivity analyses were used to study the influence of risk of local recurrence, likelihood of invasive disease at recurrence, surgical choice at recurrence, and patient age at diagnosis on treatment outcomes. RESULTS: The addition of radiation therapy was associated with slight improvements in invasive disease-free and overall survival. However, radiation therapy decreased the chance of having both breasts intact over a patient's lifetime. Radiation therapy improved survival by 2.1 months for women who were diagnosed with DCIS at age 60 years but decreased the chance of having both breasts by 8.6% relative to excision alone. The differences in outcomes between the treatment strategies became smaller with increasing age at diagnosis. Sensitivity analyses revealed a greater benefit for radiation with an increased likelihood of invasive recurrence. The decrement in breast preservation with radiation therapy was mitigated by an increased likelihood of mastectomy at the time of recurrence or new breast cancer diagnosis. CONCLUSIONS: The current analysis quantified the benefits of radiation after excision of DCIS but also revealed that radiation therapy may increase the likelihood of eventual mastectomy. Therefore, the authors concluded that patient age and preferences should be considered when making the decision to add or forgo radiation for DCIS. CI - Copyright (c) 2011 American Cancer Society. FAU - Punglia, Rinaa S AU - Punglia RS AD - Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. rpunglia@lroc.harvard.edu FAU - Burstein, Harold J AU - Burstein HJ FAU - Weeks, Jane C AU - Weeks JC LA - eng GR - K05 CA166208/CA/NCI NIH HHS/United States GR - K07 CA118269/CA/NCI NIH HHS/United States GR - K07 CA118269-05/CA/NCI NIH HHS/United States GR - 1K07 CA118269/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20110630 PL - United States TA - Cancer JT - Cancer JID - 0374236 SB - AIM SB - IM MH - Aged MH - Breast Neoplasms/mortality/*radiotherapy/surgery MH - Carcinoma, Ductal, Breast/mortality/*radiotherapy/surgery MH - Carcinoma, Intraductal, Noninfiltrating/mortality/*radiotherapy/surgery MH - Combined Modality Therapy MH - *Decision Support Techniques MH - Disease-Free Survival MH - Female MH - Follow-Up Studies MH - Humans MH - Markov Chains MH - Mastectomy MH - Middle Aged MH - Neoplasm Recurrence, Local/mortality/*radiotherapy/surgery MH - Radiotherapy, Adjuvant MH - Survival Rate MH - Treatment Outcome PMC - PMC3189439 MID - NIHMS297834 OID - NLM: NIHMS297834 OID - NLM: PMC3189439 EDAT- 2011/07/02 06:00 MHDA- 2012/03/28 06:00 CRDT- 2011/07/02 06:00 PHST- 2011/02/04 [received] PHST- 2011/04/05 [revised] PHST- 2011/04/25 [accepted] AID - 10.1002/cncr.26293 [doi] PST - ppublish SO - Cancer. 2012 Feb 1;118(3):603-11. doi: 10.1002/cncr.26293. Epub 2011 Jun 30. PMID- 21665420 OWN - NLM STAT- MEDLINE DA - 20120130 DCOM- 20120423 LR - 20120130 IS - 1873-5134 (Electronic) IS - 0738-3991 (Linking) VI - 86 IP - 2 DP - 2012 Feb TI - Impact of decision aids in a sustained implementation at a breast care center. PG - 195-204 LID - 10.1016/j.pec.2011.05.011 [doi] AB - OBJECTIVE: We examined the reach and impact of five decision aids (DAs) routinely distributed to breast cancer patients as part of a shared decision making demonstration project. METHODS: From 2005 to 2008, we surveyed patients' change in knowledge and decisional conflict (DC) before and after their review of DAs. Using bivariate tests, we identified significant predictors of change in knowledge or decisional conflict and entered significant predictors into a multivariate regression model. RESULTS: We distributed 1553 DAs to 1098 patients and received 549 completed surveys. The DAs were associated with increased knowledge and decreased DC. For knowledge, significant predictors of above-average change included: lower baseline knowledge and viewing the surgery decision aid. For decisional conflict, significant predictors of above-average change included: higher decisional conflict; viewing any of the early-stage cancer DAs; and Hispanic ethnicity. CONCLUSIONS: DAs used in routine care were associated with significant knowledge gains and reductions in decisional conflict. Some subsets of patients (those reporting low baseline knowledge, high DC, or Hispanic ethnicity) may benefit more than others. PRACTICE IMPLICATIONS: Breast cancer patients benefit overall from routine distribution of DAs. Our exploratory findings may be useful in generating hypotheses to identify target populations who would most benefit from reviewing DAs. CI - Copyright (c) 2011 Elsevier Ireland Ltd. All rights reserved. FAU - Belkora, Jeffrey K AU - Belkora JK AD - Institute for Health Policy Studies, University of California, San Francisco, USA. jeff.belkora@ucsf.edu FAU - Volz, Shelley AU - Volz S FAU - Teng, Alexandra E AU - Teng AE FAU - Moore, Dan H AU - Moore DH FAU - Loth, Meredith K AU - Loth MK FAU - Sepucha, Karen R AU - Sepucha KR LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20110612 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Adult MH - Aged MH - *Breast Neoplasms/diagnosis/psychology/surgery MH - *Decision Making MH - *Decision Support Techniques MH - Female MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - Middle Aged MH - Patient Education as Topic/methods MH - Patient Participation MH - Program Development MH - Program Evaluation MH - San Francisco MH - Socioeconomic Factors EDAT- 2011/06/15 06:00 MHDA- 2012/04/24 06:00 CRDT- 2011/06/14 06:00 PHST- 2010/11/18 [received] PHST- 2011/04/30 [revised] PHST- 2011/05/05 [accepted] AID - S0738-3991(11)00237-0 [pii] AID - 10.1016/j.pec.2011.05.011 [doi] PST - ppublish SO - Patient Educ Couns. 2012 Feb;86(2):195-204. doi: 10.1016/j.pec.2011.05.011. Epub 2011 Jun 12. PMID- 21618242 OWN - NLM STAT- MEDLINE DA - 20111101 DCOM- 20111212 LR - 20111101 IS - 1096-9098 (Electronic) IS - 0022-4790 (Linking) VI - 104 IP - 7 DP - 2011 Dec TI - Standardized pretreatment breast MRI--accuracy and influence on mastectomy decisions. PG - 741-5 LID - 10.1002/jso.21960 [doi] AB - BACKGROUND AND OBJECTIVES: Routine pretreatment breast magnetic resonance imaging in newly diagnosed cancer patients remains controversial. We assess MRI accuracy and influence on mastectomy decisions after institution of standardized pretreatment MRI. METHODS: A prospectively collected database of 74 consecutive new invasive breast cancer patients with pretreatment breast MRI was reviewed for treatment choice, radiologic, and pathologic results. Thirty-eight of 72 patients with available surgical records underwent mastectomy. Mastectomy preoperative and operative electronic records were reviewed for treatment decision analysis. RESULTS: Seventeen of 72 (23.6%) invasive breast cancer patients were likely influenced to undergo mastectomy by new information from MRI. MRI reported that the multifocal/multicentric (MF/MC) rate was 20 of 72 (27.8%) versus 19 of 72 (26.4%) by surgical pathology. MRI sensitivity for MF/MC disease was 89.5% versus 11.8% for mammography. MRI specificity was 84.2%. All three false positives declined recommended preoperative biopsies. MRI MF/MC diagnosis highly correlated with pathology results, P < 0.001. CONCLUSIONS: Increased mastectomy rate from 29 to 52.8% after standardization of pre-treatment breast MRI for invasive cancer is largely due to MRI findings of increased extent of disease. These MRI findings correlate well with pathologic findings and appear to justify the performance of mastectomies in these patients. CI - Copyright (c) 2011 Wiley Periodicals, Inc. FAU - Barchie, Matthew F AU - Barchie MF AD - Department of Radiology, San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, Fort Sam Houston, TX 78234-6200, USA. mbarchie@satx.rr.com FAU - Clive, Kevin S AU - Clive KS FAU - Tyler, Joshua A AU - Tyler JA FAU - Sutcliffe, Joseph B AU - Sutcliffe JB FAU - Kirkpatrick, Aaron D AU - Kirkpatrick AD FAU - Bell, Lisa M AU - Bell LM FAU - Banks, Kevin P AU - Banks KP FAU - Belenkiy, Slava AU - Belenkiy S FAU - Saenger, Jeff S AU - Saenger JS FAU - Peoples, George E AU - Peoples GE LA - eng PT - Comparative Study PT - Journal Article DEP - 20110525 PL - United States TA - J Surg Oncol JT - Journal of surgical oncology JID - 0222643 SB - IM MH - Breast Neoplasms/*pathology/*surgery MH - Carcinoma, Ductal, Breast/*pathology/*surgery MH - Carcinoma, Lobular/*pathology/*surgery MH - Clinical Protocols MH - Female MH - Humans MH - Magnetic Resonance Imaging/*standards MH - Mammography MH - *Mastectomy/utilization MH - Middle Aged MH - *Patient Selection MH - Preoperative Care/*standards MH - Reference Standards MH - Reproducibility of Results MH - Retrospective Studies MH - Sensitivity and Specificity EDAT- 2011/05/28 06:00 MHDA- 2011/12/14 06:00 CRDT- 2011/05/28 06:00 PHST- 2010/11/30 [received] PHST- 2011/04/04 [accepted] AID - 10.1002/jso.21960 [doi] PST - ppublish SO - J Surg Oncol. 2011 Dec;104(7):741-5. doi: 10.1002/jso.21960. Epub 2011 May 25. PMID- 21587043 OWN - NLM STAT- MEDLINE DA - 20111228 DCOM- 20120914 LR - 20111228 IS - 1536-3708 (Electronic) IS - 0148-7043 (Linking) VI - 68 IP - 1 DP - 2012 Jan TI - Approaching revisional surgery in augmentation and mastopexy/augmentation patients. PG - 12-6 LID - 10.1097/SAP.0b013e3182110ff3 [doi] AB - BACKGROUND: Breast augmentation and mastopexy augmentation procedures are becoming more common. The young plastic and reconstructive surgeon is often challenged revisional surgery operations in these patients. These cases are challenging, require significant operative time, and can be associated with a high revision rate. It is important for the young surgeon to have an approach to deal with these common and difficult scenarios. METHODS: A retrospective chart review was conducted on all patients who underwent a revision augmentation or revision mastopexy augmentation procedure between 2008 and 2010 by the authors. The most commonly encountered mitigating circumstances in the revision augmentation or revision mastopexy augmentation populations were identified and an algorithm was created on how to address these difficult problems. RESULTS: Between July 1, 2008 and July 1, 2010, 264 patients underwent revision augmentation or revision mastopexy augmentation procedures. The most commonly encountered patient scenarios were recurrence of ptosis, recurrent capsular contracture, implant malposition, rippling, and desiring a reduction in implant size. We encountered many mitigating circumstances that complicated the revisions. We devised a stepwise algorithmic approach to address these problems based on the following factors: (1) blood supply to the nipple-areola complex, (2) need to change implant plane, (3) patient desire to reduce or increase in breast implant volume, (4) need for total en bloc capsulectomy or capsulorrhaphy, (5) incision approach used to perform the capsulectomy, and (6) patient-related factors that need to be medically optimized or treated before, during, and after surgery. By adhering to these steps, outcomes can be accomplished more reliably and safely. CONCLUSION: Specialized preoperative planning is necessary to consistently deliver safe and aesthetic revision augmentation and revision mastopexy augmentation results. It is important for the operative surgeon to carefully consider the potential adverse effect of implants and prior mastopexy or reduction incisions and patterns on the blood supply to the nipple-areola complex. With educated planning, successful results can be achieved in most cases, and the risk of serious complications can be minimized. FAU - Dickinson, Brian P AU - Dickinson BP AD - Brian P. Dickinson, M.D., Inc., Newport Beach, CA, USA. drbriandickinson@drbriandickinson.com FAU - Handel, Neal AU - Handel N LA - eng PT - Evaluation Studies PT - Journal Article PL - United States TA - Ann Plast Surg JT - Annals of plastic surgery JID - 7805336 SB - IM MH - Adult MH - Algorithms MH - Breast Implants/adverse effects MH - Decision Support Techniques MH - Female MH - Humans MH - Mammaplasty/instrumentation/*methods MH - Middle Aged MH - Nipples/blood supply/surgery MH - Patient Satisfaction MH - *Postoperative Complications/prevention & control MH - Reoperation MH - Retrospective Studies EDAT- 2011/05/19 06:00 MHDA- 2012/09/15 06:00 CRDT- 2011/05/19 06:00 AID - 10.1097/SAP.0b013e3182110ff3 [doi] PST - ppublish SO - Ann Plast Surg. 2012 Jan;68(1):12-6. doi: 10.1097/SAP.0b013e3182110ff3. PMID- 21585690 OWN - NLM STAT- MEDLINE DA - 20110518 DCOM- 20110909 LR - 20110518 IS - 1743-7563 (Electronic) IS - 1743-7555 (Linking) VI - 7 IP - 2 DP - 2011 Jun TI - Decision aids for breast and nodal surgery in patients with early breast cancer: development and a pilot study. PG - 114-22 LID - 10.1111/j.1743-7563.2010.01375.x [doi] AB - AIM: As survival rates for aggressive and conservative breast and lymph node surgery are similar, surgical treatment decisions for patients with early-stage breast cancer should take patient preference into account. Decision aids have been demonstrated to increase patient knowledge and satisfaction with decision making, while decreasing decisional conflict. Hundreds of decision aids exist; however, few address lymph node surgery in any detail, and none acknowledge that there is a choice comparable to that between mastectomy and breast-conserving therapy. METHODS: A systematic process was employed to develop decision aids for mastectomy versus breast-conserving therapy, axillary dissection versus sentinel node biopsy, and options following a positive sentinel node biopsy. The first two of these decision aids were evaluated in a small pilot study. Choice of operation, knowledge and decisional conflict and satisfaction were compared with outcomes in an historical control group. RESULTS: Women reported favorably on the decision aids. The numbers in the pilot group were too small to allow definitive conclusions to be drawn, but suggested a possible reduction in decisional conflict, and possibly increase in decisional satisfaction, knowledge and choice of axillary clearance (rather than sentinel node biopsy) in the intervention group. CONCLUSION: These decision aids could improve decision making for the surgical treatment of early breast cancer. A prospective randomized, control trial is needed to further evaluate the impact of these decision aids, particularly in the case of nodal surgery. CI - (c) 2011 Blackwell Publishing Asia Pty Ltd. FAU - Harwood, Rachael AU - Harwood R AD - Faculty of Medicine, The University of Newcastle, New South Wales, Australia. rachael.c.harwood@studentmail.newcastle.edu.au FAU - Douglas, Charles AU - Douglas C FAU - Clark, David AU - Clark D LA - eng PT - Clinical Trial PT - Journal Article DEP - 20110124 PL - Australia TA - Asia Pac J Clin Oncol JT - Asia-Pacific journal of clinical oncology JID - 101241430 SB - IM MH - Breast Neoplasms/pathology/*surgery MH - *Decision Support Techniques MH - Female MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Lymph Nodes/surgery MH - Lymphatic Metastasis MH - *Mastectomy MH - *Mastectomy, Segmental MH - Patient Participation/*methods MH - Patient Satisfaction MH - Pilot Projects MH - *Sentinel Lymph Node Biopsy EDAT- 2011/05/19 06:00 MHDA- 2011/09/10 06:00 CRDT- 2011/05/19 06:00 AID - 10.1111/j.1743-7563.2010.01375.x [doi] PST - ppublish SO - Asia Pac J Clin Oncol. 2011 Jun;7(2):114-22. doi: 10.1111/j.1743-7563.2010.01375.x. Epub 2011 Jan 24. PMID- 21571485 OWN - NLM STAT- MEDLINE DA - 20120130 DCOM- 20120423 LR - 20151119 IS - 1873-5134 (Electronic) IS - 0738-3991 (Linking) VI - 86 IP - 2 DP - 2012 Feb TI - Theory-based design and field-testing of an intervention to support women choosing surgery for breast cancer: BresDex. PG - 179-88 LID - 10.1016/j.pec.2011.04.014 [doi] AB - OBJECTIVE: Design and undertake usability and field-testing evaluation of a theory-guided decision aid (BresDex) in supporting women choosing surgery for early breast cancer. METHODS: An extended Theory of Planned Behavior (TPB) and the Common Sense Model of Illness Representations (CSM) guided the design of BresDex. BresDex was evaluated and refined across 3 cycles by interviewing 6 women without personal history of breast cancer, 8 women with personal history of breast cancer who had completed treatment and 11 women newly diagnosed with breast cancer. Participants were interviewed for views on content, presentation (usability) and perceived usefulness towards deciding on treatment (utility). Framework analysis was used, guided by the extended TPB and the CSM. RESULTS: BresDex was positively received in content and presentation (usability). It appeared an effective support to decision-making and useful source for further information, particularly in clarifying attitudes, social norms and perceived behavioral control, and presenting consequences of decisions (utility). CONCLUSION: This study illustrates the potential benefit of the extended TPB and CSM in designing a decision aid to support women choosing breast cancer surgery. PRACTICE IMPLICATIONS: BresDex could provide decision-making support and serve as an additional source of information, to complement the care received from the clinical team. CI - Copyright (c) 2011 Elsevier Ireland Ltd. All rights reserved. FAU - Sivell, Stephanie AU - Sivell S AD - Marie Curie Palliative Care Research Group, Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK. sivells2@cardiff.ac.uk FAU - Marsh, William AU - Marsh W FAU - Edwards, Adrian AU - Edwards A FAU - Manstead, Antony S R AU - Manstead AS FAU - Clements, Alison AU - Clements A FAU - Elwyn, Glyn AU - Elwyn G CN - BresDex group LA - eng GR - C6475/A7053/Cancer Research UK/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20110514 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Adult MH - Aged MH - Breast Neoplasms/psychology/*surgery MH - *Decision Making MH - *Decision Support Techniques MH - Female MH - Humans MH - Intention MH - Interviews as Topic MH - Mastectomy/*psychology MH - Middle Aged MH - Neoplasm Staging MH - Patient Participation MH - Psychological Theory MH - Qualitative Research MH - Reproducibility of Results IR - Caldon L FIR - Caldon, Lisa IR - Collins K FIR - Collins, Karen IR - Day TJ FIR - Day, T J IR - Evans R FIR - Evans, Rhodri IR - Patnick J FIR - Patnick, Julietta IR - Reed MW FIR - Reed, Malcolm W R IR - Rogers V FIR - Rogers, Veronica EDAT- 2011/05/17 06:00 MHDA- 2012/04/24 06:00 CRDT- 2011/05/17 06:00 PHST- 2010/09/01 [received] PHST- 2011/03/07 [revised] PHST- 2011/04/08 [accepted] AID - S0738-3991(11)00202-3 [pii] AID - 10.1016/j.pec.2011.04.014 [doi] PST - ppublish SO - Patient Educ Couns. 2012 Feb;86(2):179-88. doi: 10.1016/j.pec.2011.04.014. Epub 2011 May 14. PMID- 21543184 OWN - NLM STAT- MEDLINE DA - 20111115 DCOM- 20120509 LR - 20111115 IS - 1873-5134 (Electronic) IS - 0738-3991 (Linking) VI - 85 IP - 3 DP - 2011 Dec TI - Decision aids for surgical treatment of early stage breast cancer: a narrative review of the literature. PG - e311-21 LID - 10.1016/j.pec.2011.03.019 [doi] AB - OBJECTIVE: To review and critique the published empirical research on decision aids for women actually facing surgical treatment of early stage breast cancer, synthesize findings across studies related to outcomes of decision aids use with specific attention to the influence of system and client characteristics, and identify opportunities for further research. METHODS: A systematic and reproducible search was carried out to identify studies evaluating decision aids for women making breast cancer surgical treatment decisions. All included studies were appraised. RESULTS: Most studies evaluated the outcomes of decision aids use in terms of final treatment decisions, patients' knowledge of treatment options, anxiety, decisional conflict, satisfaction and quality of life. Included studies varied in design, measures used to assess effectiveness, format of the aids, patient populations and clinical settings. Studies yielded mixed results related to the effect of the decision aids on the outcomes measured. CONCLUSION: Despite the mixed findings of the studies, some support exists for the use of decision aids with women diagnosed with early stage breast cancer. PRACTICE IMPLICATIONS: To ensure successful implementation of decision aids in clinical practice, healthcare providers should be educated on their use. Greater allocation of time, space and access to decision aids is also needed. CI - Copyright (c) 2011 Elsevier Ireland Ltd. All rights reserved. FAU - Obeidat, Rana AU - Obeidat R AD - University at Buffalo, The State University of New York, Buffalo, NY, USA. robeidat@buffalo.edu FAU - Finnell, Deborah S AU - Finnell DS FAU - Lally, Robin M AU - Lally RM LA - eng PT - Journal Article PT - Review DEP - 20110504 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Breast Neoplasms/*surgery MH - *Decision Making MH - *Decision Support Techniques MH - Female MH - Humans MH - Narration MH - *Patient Education as Topic MH - Patient Participation MH - Quality of Life MH - Treatment Outcome EDAT- 2011/05/06 06:00 MHDA- 2012/05/10 06:00 CRDT- 2011/05/06 06:00 PHST- 2010/07/17 [received] PHST- 2011/01/31 [revised] PHST- 2011/03/26 [accepted] AID - S0738-3991(11)00185-6 [pii] AID - 10.1016/j.pec.2011.03.019 [doi] PST - ppublish SO - Patient Educ Couns. 2011 Dec;85(3):e311-21. doi: 10.1016/j.pec.2011.03.019. Epub 2011 May 4. PMID- 21444865 OWN - NLM STAT- MEDLINE DA - 20110502 DCOM- 20110628 LR - 20110502 IS - 1527-7755 (Electronic) IS - 0732-183X (Linking) VI - 29 IP - 13 DP - 2011 May 01 TI - It's now or never: fertility-related knowledge, decision-making preferences, and treatment intentions in young women with breast cancer--an Australian fertility decision aid collaborative group study. PG - 1670-7 LID - 10.1200/JCO.2010.31.2462 [doi] AB - PURPOSE: For many young women with early breast cancer, fertility is a priority. Interventions to retain fertility options generally need to be accessed before chemotherapy, but many women do not receive information regarding these options in a timely fashion. Knowledge about fertility and decisional conflict has not previously been measured in young patients with breast cancer considering future pregnancies. METHODS: One hundred eleven young women with early breast cancer who had not yet completed their families were recruited around the time of diagnosis. Knowledge regarding fertility-related information, decisional conflict, and preferences regarding fertility information and decision making was measured. RESULTS: From a potential fertility-related knowledge score of 10, the mean was 5.2 (standard deviation = 2.3; range, 0 to 10). Decreased knowledge was associated with increased decisional conflict about pursuing fertility preserving interventions (odds ratio [OR] = 0.57; 95% CI, 0.44 to 0.73; P < .001). Thirty-one percent of women reported that they would consider undertaking in vitro fertilization (IVF) as a method to conserve their fertility, whereas 38% were uncertain. Consideration of IVF was not related to whether subjects were in a committed relationship (OR = 1.20; P = .716) or a definite desire for more children (OR = 1.54; P = .513). CONCLUSION: Around diagnosis, many young patients with breast cancer have low levels of knowledge about fertility issues. Further, low knowledge is associated with increased decisional conflict, which is likely to undermine the quality of decision making. These findings suggest that targeted and timely fertility information may reduce decisional conflict and increase informed choice. Neither relationship status nor firm plans regarding future children reliably predict desire to pursue fertility preservation. FAU - Peate, Michelle AU - Peate M AD - Prince of Wales Clinical School, University of New South Wales, Randwick, NSW, Australia. m.peate@unswalumni.com FAU - Meiser, Bettina AU - Meiser B FAU - Friedlander, Michael AU - Friedlander M FAU - Zorbas, Helen AU - Zorbas H FAU - Rovelli, Susan AU - Rovelli S FAU - Sansom-Daly, Ursula AU - Sansom-Daly U FAU - Sangster, Jennifer AU - Sangster J FAU - Hadzi-Pavlovic, Dusan AU - Hadzi-Pavlovic D FAU - Hickey, Martha AU - Hickey M LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20110328 PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 SB - IM MH - Adult MH - Australia MH - Breast Neoplasms/drug therapy/*psychology MH - Conflict (Psychology) MH - *Decision Making MH - Female MH - *Fertility MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - Patient Participation EDAT- 2011/03/30 06:00 MHDA- 2011/06/29 06:00 CRDT- 2011/03/30 06:00 AID - JCO.2010.31.2462 [pii] AID - 10.1200/JCO.2010.31.2462 [doi] PST - ppublish SO - J Clin Oncol. 2011 May 1;29(13):1670-7. doi: 10.1200/JCO.2010.31.2462. Epub 2011 Mar 28. PMID- 21442198 OWN - NLM STAT- MEDLINE DA - 20110520 DCOM- 20111122 LR - 20161118 IS - 1573-7217 (Electronic) IS - 0167-6806 (Linking) VI - 127 IP - 3 DP - 2011 Jun TI - Women's interest in taking tamoxifen and raloxifene for breast cancer prevention: response to a tailored decision aid. PG - 681-8 LID - 10.1007/s10549-011-1450-1 [doi] AB - Although tamoxifen can prevent primary breast cancer, few women use it as a preventive measure. A second option, raloxifene, has recently been approved. The objective of the study was to determine women's interest in tamoxifen and raloxifene after reading a decision aid (DA) describing the risks and benefits of each medication. Women with 5-year risk of breast cancer >/= 1.66 from two large health maintenance organizations were randomized to receive a DA versus usual care. After reading an on-line DA that discussed the risks and benefits of tamoxifen and raloxifene, women completed measures of risk perception, decisional conflict, behavioral intentions, and actual behavior related to tamoxifen and raloxifene. 3 months following the intervention, 8.1% of participants had looked for additional information about breast cancer prevention drugs, and 1.8% had talked to their doctor about tamoxifen and/or raloxifene. The majority, 54.7%, had decided to not take either drug, 0.5% had started raloxifene, and none had started tamoxifen. Participants were not particularly worried about taking tamoxifen or raloxifene and did not perceive significant benefits from taking these drugs. Over 50% did not perceive a change in their risk of getting breast cancer if they took tamoxifen or raloxifene. After reading a DA about tamoxifen and raloxifene, few women were interested in taking either breast cancer prevention drug. FAU - Fagerlin, Angela AU - Fagerlin A AD - Ann Arbor VA HSR&D Center for Practice Management and Outcomes Research, Ann Arbor, MI, USA. fagerlin@umich.edu FAU - Dillard, Amanda J AU - Dillard AJ FAU - Smith, Dylan M AU - Smith DM FAU - Zikmund-Fisher, Brian J AU - Zikmund-Fisher BJ FAU - Pitsch, Rosemarie AU - Pitsch R FAU - McClure, Jennifer B AU - McClure JB FAU - Greene, Sarah AU - Greene S FAU - Alford, Sharon Hensley AU - Alford SH FAU - Nair, Vijayan AU - Nair V FAU - Hayes, Daniel F AU - Hayes DF FAU - Wiese, Cheryl AU - Wiese C FAU - Ubel, Peter A AU - Ubel PA LA - eng GR - P50 CA101451/CA/NCI NIH HHS/United States GR - P50 CA101451-08/CA/NCI NIH HHS/United States PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20110326 PL - Netherlands TA - Breast Cancer Res Treat JT - Breast cancer research and treatment JID - 8111104 RN - 0 (Anticarcinogenic Agents) RN - 0 (Selective Estrogen Receptor Modulators) RN - 094ZI81Y45 (Tamoxifen) RN - 4F86W47BR6 (Raloxifene Hydrochloride) SB - IM MH - Adult MH - Aged MH - Anticarcinogenic Agents/*therapeutic use MH - Breast Neoplasms/drug therapy/*prevention & control MH - Decision Making MH - Female MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Middle Aged MH - Patient Education as Topic MH - Raloxifene Hydrochloride/*therapeutic use MH - Selective Estrogen Receptor Modulators/therapeutic use MH - Tamoxifen/*therapeutic use PMC - PMC3742062 MID - NIHMS304862 OID - NLM: NIHMS304862 OID - NLM: PMC3742062 EDAT- 2011/03/29 06:00 MHDA- 2011/12/13 00:00 CRDT- 2011/03/29 06:00 PHST- 2011/03/08 [received] PHST- 2011/03/10 [accepted] AID - 10.1007/s10549-011-1450-1 [doi] PST - ppublish SO - Breast Cancer Res Treat. 2011 Jun;127(3):681-8. doi: 10.1007/s10549-011-1450-1. Epub 2011 Mar 26. PMID- 21401958 OWN - NLM STAT- MEDLINE DA - 20110331 DCOM- 20130405 LR - 20170220 IS - 1748-5908 (Electronic) IS - 1748-5908 (Linking) VI - 6 DP - 2011 Mar 14 TI - Study protocol: addressing evidence and context to facilitate transfer and uptake of consultation recording use in oncology: a knowledge translation implementation study. PG - 20 LID - 10.1186/1748-5908-6-20 [doi] AB - BACKGROUND: The time period from diagnosis to the end of treatment is challenging for newly diagnosed cancer patients. Patients have a substantial need for information, decision aids, and psychosocial support. Recordings of initial oncology consultations improve information recall, reduce anxiety, enhance patient satisfaction with communication, and increase patients' perceptions that the essential aspects of their disease and treatment have been addressed during the consultation. Despite the research evidence supporting the provision of consultation recordings, uptake of this intervention into oncology practice has been slow. The primary aim of this project is to conduct an implementation study to explicate the contextual factors, including use of evidence, that facilitate and impede the transfer and uptake of consultation-recording use in a sample of patients newly diagnosed with breast or prostate cancer. METHODS: Sixteen oncologists from cancer centres in three Canadian cities will participate in this three-phase study. The preimplementation phase will be used to identify and address those factors that are fundamental to facilitating the smooth adoption and delivery of the intervention during the implementation phase. During the implementation phase, breast and prostate cancer patients will receive a recording of their initial oncology consultation to take home. Patient interviews will be conducted in the days following the consultation to gather feedback on the benefits of the intervention. Patients will complete the Digital Recording Use Semi-Structured Interview (DRUSSI) and be invited to participate in focus groups in which their experiences with the consultation recording will be explored. Oncologists will receive a summary letter detailing the benefits voiced by their patients. The postimplementation phase includes a conceptual framework development meeting and a seven-point dissemination strategy. DISCUSSION: Consultation recording has been used in oncology, family medicine, and other medicine specialties, and despite affirming evidence and probable applications to a large number of diseases and a variety of clinical contexts, clinical adoption of this intervention has been slow. The proposed study findings will advance our conceptual knowledge of the ways to enhance uptake of consultation recordings in oncology. FAU - Hack, Thomas F AU - Hack TF AD - Faculty of Nursing, University of Manitoba, Winnipeg, Canada. thack@sbrc.ca FAU - Ruether, J Dean AU - Ruether JD FAU - Weir, Lorna M AU - Weir LM FAU - Grenier, Debjani AU - Grenier D FAU - Degner, Lesley F AU - Degner LF LA - eng PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't DEP - 20110314 PL - England TA - Implement Sci JT - Implementation science : IS JID - 101258411 SB - IM MH - Breast Neoplasms/*psychology MH - Canada MH - Communication MH - Evidence-Based Medicine MH - Female MH - Focus Groups MH - Humans MH - Interviews as Topic MH - Male MH - *Medical Oncology MH - Patient Education as Topic MH - *Physician-Patient Relations MH - Prostatic Neoplasms/*psychology MH - *Referral and Consultation MH - Tape Recording/*instrumentation PMC - PMC3068117 OID - NLM: PMC3068117 GN - NLM: Original DateCompleted: 20110714 EDAT- 2011/03/16 06:00 MHDA- 2011/03/16 06:01 CRDT- 2011/03/16 06:00 PHST- 2010/11/22 [received] PHST- 2011/03/14 [accepted] AID - 1748-5908-6-20 [pii] AID - 10.1186/1748-5908-6-20 [doi] PST - epublish SO - Implement Sci. 2011 Mar 14;6:20. doi: 10.1186/1748-5908-6-20. PMID- 21369831 OWN - NLM STAT- MEDLINE DA - 20110510 DCOM- 20110823 LR - 20161019 IS - 1573-3599 (Electronic) IS - 1059-7700 (Linking) VI - 20 IP - 3 DP - 2011 Jun TI - Development and evaluation of a decision aid for BRCA carriers with breast cancer. PG - 294-307 LID - 10.1007/s10897-011-9350-4 [doi] AB - BRCA+ breast cancer patients face high risk for a second breast cancer and ovarian cancer. Helping these women decide among risk-reducing options requires effectively conveying complex, emotionally-laden, information. To support their decision-making needs, we developed a web-based decision aid (DA) as an adjunct to genetic counseling. Phase 1 used focus groups to determine decision-making needs. These findings and the Ottawa Decision Support Framework guided the DA development. Phase 2 involved nine focus groups of four stakeholder types (BRCA+ breast cancer patients, breast cancer advocates, and genetics and oncology professionals) to evaluate the DA's decision-making utility, information content, visual display, and implementation. Overall, feedback was very favorable about the DA, especially a values and preferences ranking-exercise and an output page displaying personalized responses. Stakeholders were divided as to whether the DA should be offered at-home versus only in a clinical setting. This well-received DA will be further tested to determine accessibility and effectiveness. FAU - Culver, Julie O AU - Culver JO AD - Division of Clinical Cancer Genetics, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA 91010-3000, USA. jculver@coh.org FAU - MacDonald, Deborah J AU - MacDonald DJ FAU - Thornton, Andrea A AU - Thornton AA FAU - Sand, Sharon R AU - Sand SR FAU - Grant, Marcia AU - Grant M FAU - Bowen, Deborah J AU - Bowen DJ FAU - Burke, Harry AU - Burke H FAU - Garcia, Nellie AU - Garcia N FAU - Metcalfe, Kelly A AU - Metcalfe KA FAU - Weitzel, Jeffrey N AU - Weitzel JN LA - eng GR - P30CA033572/CA/NCI NIH HHS/United States GR - P30 CA033572-26/CA/NCI NIH HHS/United States GR - M01 RR00043/RR/NCRR NIH HHS/United States GR - M01 RR000043/RR/NCRR NIH HHS/United States GR - P30 CA033572/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20110303 PL - United States TA - J Genet Couns JT - Journal of genetic counseling JID - 9206865 SB - IM EIN - J Genet Couns. 2013 Jun;22(3):406 MH - Breast Neoplasms/genetics/*psychology/surgery MH - *Decision Support Techniques MH - Female MH - Focus Groups MH - *Genes, BRCA1 MH - *Genes, BRCA2 MH - Genetic Counseling MH - *Heterozygote Detection MH - Humans MH - Mastectomy MH - Ovariectomy MH - Risk Reduction Behavior PMC - PMC3531556 MID - NIHMS366519 OID - NLM: NIHMS366519 OID - NLM: PMC3531556 EDAT- 2011/03/04 06:00 MHDA- 2011/08/24 06:00 CRDT- 2011/03/04 06:00 PHST- 2010/09/09 [received] PHST- 2011/01/06 [accepted] AID - 10.1007/s10897-011-9350-4 [doi] PST - ppublish SO - J Genet Couns. 2011 Jun;20(3):294-307. doi: 10.1007/s10897-011-9350-4. Epub 2011 Mar 3. PMID- 21299290 OWN - NLM STAT- MEDLINE DA - 20110208 DCOM- 20110621 LR - 20151119 IS - 1930-7810 (Electronic) IS - 0278-6133 (Linking) VI - 30 IP - 1 DP - 2011 Jan TI - How and for whom are decision aids effective? Long-term psychological outcome of a randomized controlled trial in women with newly diagnosed breast cancer. PG - 12-9 LID - 10.1037/a0021648 [doi] AB - OBJECTIVE: The current study evaluates the long-term psychological impact of a decision aid intervention for surgical and systemic treatment in women with newly diagnosed breast cancer from a previous reported randomized, controlled trial (Vodermaier et al., 2009). METHODS: Patients (n = 111) were randomized into usual care, or a 20-min decision aid intervention plus an information brochure prior to consultation planning with the senior physician. The retention rate at 1 year was 88%. RESULTS: Linear mixed model analyses demonstrated that the intervention group experienced less decisional conflict (p = .047; d = .19), which was driven by perceptions of a more effective choice (p = .029; d = .20) over time. Subgroup analyses revealed that patients in the intervention group who participated in chemotherapy decision making showed better long-term body image outcomes (p = .009; d = .44), which were mediated by reduced depressive coping (p = .049). No effects emerged for anxiety and depressive symptoms, or for quality of life. Internal health locus of control moderated group effects on 'uncertainty with the decision' (p = .003). CONCLUSIONS: The study results provide novel evidence on the role of individual differences and the mechanisms behind decision aid effectiveness, and demonstrate the long-term impact of decision aid interventions on some indices of well-being. CI - (PsycINFO Database Record (c) 2010 APA, all rights reserved). FAU - Vodermaier, Andrea AU - Vodermaier A AD - Department of Obstetrics and Gynaecology-Campus Grosshadern, University of Munich. avoderma@psych.ubc.ca FAU - Caspari, Cornelia AU - Caspari C FAU - Wang, Lisa AU - Wang L FAU - Koehm, Janna AU - Koehm J FAU - Ditsch, Nina AU - Ditsch N FAU - Untch, Michael AU - Untch M LA - eng PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PL - United States TA - Health Psychol JT - Health psychology : official journal of the Division of Health Psychology, American Psychological Association JID - 8211523 SB - IM MH - *Adaptation, Psychological MH - Aged MH - Breast Neoplasms/*diagnosis/*psychology MH - Conflict (Psychology) MH - *Decision Making MH - Female MH - Humans MH - Internal-External Control MH - Linear Models MH - Middle Aged MH - *Patient Education as Topic MH - Surveys and Questionnaires EDAT- 2011/02/09 06:00 MHDA- 2011/06/22 06:00 CRDT- 2011/02/09 06:00 AID - 2011-02060-002 [pii] AID - 10.1037/a0021648 [doi] PST - ppublish SO - Health Psychol. 2011 Jan;30(1):12-9. doi: 10.1037/a0021648. PMID- 21223468 OWN - NLM STAT- MEDLINE DA - 20111117 DCOM- 20120404 LR - 20170220 IS - 1369-7625 (Electronic) IS - 1369-6513 (Linking) VI - 14 IP - 4 DP - 2011 Dec TI - Development and pilot-testing of a Decision Aid for use among Chinese women facing breast cancer surgery. PG - 405-16 LID - 10.1111/j.1369-7625.2010.00655.x [doi] AB - BACKGROUND: Women choosing breast cancer surgery encounter treatment decision-making (TDM) difficulties, which can cause psychological distress. Decision Aids (DAs) may facilitate TDM, but there are no DAs designed for Chinese populations. We developed a DA for Chinese women newly diagnosed with breast cancer, for use during the initial surgical consultation. AIMS: Conduct a pilot study to assess the DA acceptability and utility among Chinese women diagnosed with breast cancer. METHODS: Women preferred the DA in booklet format. A booklet was developed and revised and evaluated in two consecutive pilot studies (P1 and P2). On concluding their initial diagnostic consultation, 95 and 38 Chinese women newly diagnosed with breast cancer received the draft and revised draft DA booklet, respectively. Four-day post-consultation, women had questionnaires read out to them and to which they responded assessing attitudes towards the DA and their understanding of treatment options. RESULTS: The original DA was read/partially read by 66/22% (n = 84) of women, whilst the revised version was read/partially read by 74/16% (n = 35), including subliterate women (chi(2) = 0.76, P = 0.679). Knowledge scores varied with the extent the booklet was read (P1: F = 12.68, d.f. 2, P < 0.001; P2: F = 3.744, d.f. 2, P = 0.034). The revised, shorter version was graphically rich and resulted in improved perceived utility, [except for the 'treatment options' (chi(2) = 5.50, P = 0.019) and 'TDM guidance' (chi(2) = 8.19, P = 0.004) sections] without increasing anxiety (F = 0.689, P = 0.408; F = 3.45, P = 0.073). CONCLUSION: The DA was perceived as acceptable and useful for most women. The DA effectiveness is currently being evaluated using a randomized controlled trial. CI - (c) 2011 Blackwell Publishing Ltd. FAU - Au, Angel H Y AU - Au AH AD - Centre for Psycho-Oncological Research & Training, School of Public Health, The University of Hong Kong, Hong Kong, China. FAU - Lam, Wendy W T AU - Lam WW FAU - Chan, Miranda C M AU - Chan MC FAU - Or, Amy Y M AU - Or AY FAU - Kwong, Ava AU - Kwong A FAU - Suen, Dacita AU - Suen D FAU - Wong, Annie L AU - Wong AL FAU - Juraskova, Ilona AU - Juraskova I FAU - Wong, Teresa W T AU - Wong TW FAU - Fielding, Richard AU - Fielding R LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20110111 PL - England TA - Health Expect JT - Health expectations : an international journal of public participation in health care and health policy JID - 9815926 SB - IM MH - Asian Continental Ancestry Group/psychology MH - Breast Neoplasms/ethnology/psychology/*surgery MH - *Decision Making MH - Female MH - *Health Knowledge, Attitudes, Practice MH - Hong Kong MH - Humans MH - Interviews as Topic MH - *Pamphlets MH - *Patient Participation MH - Pilot Projects MH - Stress, Psychological MH - Surveys and Questionnaires PMC - PMC5060593 EDAT- 2011/01/13 06:00 MHDA- 2012/04/05 06:00 CRDT- 2011/01/13 06:00 AID - 10.1111/j.1369-7625.2010.00655.x [doi] PST - ppublish SO - Health Expect. 2011 Dec;14(4):405-16. doi: 10.1111/j.1369-7625.2010.00655.x. Epub 2011 Jan 11. PMID- 21181326 OWN - NLM STAT- MEDLINE DA - 20110520 DCOM- 20110927 LR - 20110520 IS - 1543-0154 (Electronic) IS - 0885-8195 (Linking) VI - 26 IP - 2 DP - 2011 Jun TI - Preoperative patient education for breast reconstruction: a systematic review of the literature. PG - 270-6 LID - 10.1007/s13187-010-0182-y [doi] AB - This study aims to assess the current state of patient educational tools available for the purposes of educating women about postmastectomy breast reconstruction. A systematic review of the English language literature was conducted between the years 1966 and 2009 of all studies pertaining to the use of educational materials for breast reconstruction. MEDLINE, CINAHAL, PsycINFO, EMBASE, SCOPUS, and the Science Citation Index were searched. Only studies that both employed and evaluated a patient educational tool in the setting of postmastectomy reconstruction were selected for review. Qualifying studies were then evaluated with respect to their study design, sample size, and outcome measure evaluated. Each educational tool identified was similarly evaluated with respect to its development process, content, and educational medium. A total of 497 articles were retrieved. Of these, only seven met our inclusion criteria. These publications evaluated a total of seven educational tools. Among them were employed various mediums including written, visual, and audio materials. Detailed review revealed that the development of only one educational program included an educational needs assessment. Only two of the seven studies identified evaluated the efficacy of their educational tool using a randomized controlled trial study design. Outcome measures evaluated varied among the studies identified and included: knowledge gains (n = 4), the 'yes' or 'no' decision to undergo reconstruction (n = 3), satisfaction with decision regarding reconstruction (n = 1), decisional conflict (n = 3), and type of reconstruction (n = 3). This review highlights the need for well-designed, methodologically sound research into patient education regarding breast reconstruction. Such information is invaluable in developing patient education programs and decision aids that aim at patient empowerment. FAU - Preminger, Beth Aviva AU - Preminger BA AD - Plastic and Reconstructive Surgery, Department of Surgery, Columbia University, The Affiliation at Harlem Hospital, 506 Lenox Ave, New York, NY 10037, USA. FAU - Lemaine, Valerie AU - Lemaine V FAU - Sulimanoff, Isabel AU - Sulimanoff I FAU - Pusic, Andrea L AU - Pusic AL FAU - McCarthy, Colleen M AU - McCarthy CM LA - eng PT - Journal Article PT - Review PL - England TA - J Cancer Educ JT - Journal of cancer education : the official journal of the American Association for Cancer Education JID - 8610343 SB - IM MH - Decision Making MH - Female MH - Humans MH - *Mammaplasty MH - *Patient Education as Topic MH - Preoperative Care MH - Research Design EDAT- 2010/12/25 06:00 MHDA- 2011/09/29 06:00 CRDT- 2010/12/25 06:00 AID - 10.1007/s13187-010-0182-y [doi] PST - ppublish SO - J Cancer Educ. 2011 Jun;26(2):270-6. doi: 10.1007/s13187-010-0182-y. PMID- 21134649 OWN - NLM STAT- MEDLINE DA - 20101207 DCOM- 20110419 LR - 20101207 IS - 1532-9461 (Electronic) IS - 1053-4296 (Linking) VI - 21 IP - 1 DP - 2011 Jan TI - Surgical considerations in early-stage breast cancer: lessons learned and future directions. PG - 10-9 LID - 10.1016/j.semradonc.2010.08.002 [doi] AB - Emerging evidence regarding the relationship between local failure and outcome in breast cancer has placed increased emphasis on the surgeon's role in reducing local recurrence after breast-conserving surgery. This includes both improving patient selection and optimizing the procedure. Proper patient selection, selective use of magnetic resonance imaging, and better patient-physician communication including the use of decision aids can optimize both local control and patient satisfaction without unnecessarily increasing the mastectomy rate. Neoadjuvant systemic therapy can increase both the number of patients eligible for breast-conservation surgery as well as the likelihood of success. Adequate surgical margins are crucial and can be achieved without excessive re-excision rates with detailed preoperative planning, consideration of oncoplastic resections. and intraoperative margin analysis. This article reviews several areas in which the surgeon can help ensure the success of breast-conservation therapy. CI - Copyright (c) 2011 Elsevier Inc. All rights reserved. FAU - Sabel, Michael S AU - Sabel MS AD - University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA. msabel@umich.edu LA - eng PT - Journal Article PT - Review PL - United States TA - Semin Radiat Oncol JT - Seminars in radiation oncology JID - 9202882 SB - IM MH - Breast Neoplasms/pathology/*surgery MH - Decision Support Techniques MH - Female MH - Humans MH - Magnetic Resonance Imaging MH - Mastectomy/*methods MH - Neoadjuvant Therapy MH - Patient Satisfaction MH - Patient Selection MH - Physician-Patient Relations MH - Reoperation MH - Specimen Handling EDAT- 2010/12/08 06:00 MHDA- 2011/04/20 06:00 CRDT- 2010/12/08 06:00 AID - S1053-4296(10)00061-5 [pii] AID - 10.1016/j.semradonc.2010.08.002 [doi] PST - ppublish SO - Semin Radiat Oncol. 2011 Jan;21(1):10-9. doi: 10.1016/j.semradonc.2010.08.002. PMID- 21029281 OWN - NLM STAT- MEDLINE DA - 20110519 DCOM- 20110907 LR - 20170220 IS - 1369-7625 (Electronic) IS - 1369-6513 (Linking) VI - 14 IP - 2 DP - 2011 Jun TI - Clinicians' concerns about decision support interventions for patients facing breast cancer surgery options: understanding the challenge of implementing shared decision-making. PG - 133-46 LID - 10.1111/j.1369-7625.2010.00633.x [doi] AB - BACKGROUND: There is interest in interventions that provide support for patients facing challenging decisions, such as the choice between mastectomy and breast conservation surgery for breast cancer. However, it is difficult to implement these interventions. One potential source of resistance is the attitudes of clinicians. OBJECTIVE: To examine specialist breast clinicians' opinions about the provision of decision support interventions (DesIs) for patients. METHODS: As part of the development of a web-based DesI (BresDex), semi-structured interviews were conducted with specialist clinicians [breast surgeons, breast care nurses (BCNs) and oncologists] from four breast units in a UK region, and speciality national opinion leaders. Interviews were recorded, transcribed and analysed using the Framework approach. RESULTS: A majority of the 24 clinicians interviewed did not have a working knowledge of DesIs and were ambivalent or sceptical. Many expressed conflicting opinions: they noted the potential benefits, but at the same time expressed reservations about information overlap, overload and about content that they considered inappropriate. Many wanted access to DesIs to be always under clinical supervision. In particular, they were uncertain as regards how DeSIs could be tailored to individual patients' needs and also accommodate clinical practice variation. BCNs were particularly concerned that DesIs might induce patient anxiety and replace their role. CONCLUSIONS: The concept of providing interventions to support patients in decision-making tasks generated concern, defensiveness and scepticism. These attitudes will be a significant barrier. Implementation efforts will need to recognize and address these issues if these interventions are to become embedded in clinical practice. CI - (c) 2010 Blackwell Publishing Ltd. FAU - Caldon, Lisa J M AU - Caldon LJ AD - Department of Oncology, University of Sheffield, Sheffield, UK. l.caldon@sheffield.ac.uk FAU - Collins, Karen A AU - Collins KA FAU - Reed, Malcolm W AU - Reed MW FAU - Sivell, Stephanie AU - Sivell S FAU - Austoker, Joan AU - Austoker J FAU - Clements, Alison M AU - Clements AM FAU - Patnick, Julietta AU - Patnick J FAU - Elwyn, Glyn AU - Elwyn G CN - BresDex Group LA - eng GR - Cancer Research UK/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20101028 PL - England TA - Health Expect JT - Health expectations : an international journal of public participation in health care and health policy JID - 9815926 SB - IM MH - *Attitude of Health Personnel MH - Breast Neoplasms/psychology/*surgery MH - *Decision Support Systems, Clinical MH - Female MH - Humans MH - Internet MH - Interviews as Topic MH - Male MH - Mastectomy/methods/*psychology MH - Patient Education as Topic/*methods MH - Physician-Patient Relations MH - Physicians/*psychology MH - United Kingdom PMC - PMC5060572 IR - Edwards A FIR - Edwards, Adrian IR - Evans R FIR - Evans, Rhodri IR - Rogers V FIR - Rogers, Veronica IR - Day TJ FIR - Day, T J IR - Donald A FIR - Donald, Anne EDAT- 2010/10/30 06:00 MHDA- 2011/09/08 06:00 CRDT- 2010/10/30 06:00 AID - 10.1111/j.1369-7625.2010.00633.x [doi] PST - ppublish SO - Health Expect. 2011 Jun;14(2):133-46. doi: 10.1111/j.1369-7625.2010.00633.x. Epub 2010 Oct 28. PMID- 20937486 OWN - NLM STAT- MEDLINE DA - 20101012 DCOM- 20110223 LR - 20101012 IS - 1532-0480 (Electronic) IS - 1532-0464 (Linking) VI - 43 IP - 5 Suppl DP - 2010 Oct TI - The Communication and Care Plan: a novel approach to patient-centered clinical information systems. PG - S6-8 LID - 10.1016/j.jbi.2010.07.004 [doi] AB - The US health care system and its information access models are organized around institutions and providers. Patient-centered functionality is rarely present in prevailing information systems and, if present, it typically does not ideally support shared decision making about important treatment events. We sought to better understand the functional needs of providers and patients around the process of care plan decision making, and used this information to develop a prototype decision support tool, using women with newly diagnosed breast cancer as our clinical scenario. This paper describes the user-centered design process we undertook and the resulting prototype system, the Communication and Care Plan (CCP). CI - Copyright (c) 2010 Elsevier Inc. All rights reserved. FAU - Hogarth, Michael AU - Hogarth M AD - Department of Pathology and Laboratory Medicine, University of California, Davis, USA. FAU - Hajopoulos, Kathy AU - Hajopoulos K FAU - Young, Meg AU - Young M FAU - Cowles, Neil AU - Cowles N FAU - Churin, John AU - Churin J FAU - Hornthal, Bethany AU - Hornthal B FAU - Esserman, Laura AU - Esserman L LA - eng PT - Journal Article PL - United States TA - J Biomed Inform JT - Journal of biomedical informatics JID - 100970413 SB - IM MH - Appointments and Schedules MH - Breast Neoplasms/therapy MH - Decision Support Systems, Clinical MH - *Electronic Health Records MH - Female MH - Humans MH - Internet MH - Patient Care Management MH - Patient-Centered Care/*methods MH - Telemedicine/*methods MH - User-Computer Interface EDAT- 2010/10/22 06:00 MHDA- 2011/02/24 06:00 CRDT- 2010/10/13 06:00 PHST- 2010/06/01 [received] PHST- 2010/07/01 [revised] PHST- 2010/07/03 [accepted] AID - S1532-0464(10)00103-6 [pii] AID - 10.1016/j.jbi.2010.07.004 [doi] PST - ppublish SO - J Biomed Inform. 2010 Oct;43(5 Suppl):S6-8. doi: 10.1016/j.jbi.2010.07.004. PMID- 20956831 OWN - NLM STAT- MEDLINE DA - 20101019 DCOM- 20110211 LR - 20161122 IS - 1745-6614 (Electronic) IS - 1052-6773 (Linking) VI - 2010 IP - 41 DP - 2010 TI - Communication between patients and providers and informed decision making. PG - 204-9 LID - 10.1093/jncimonographs/lgq038 [doi] AB - Women with ductal carcinoma in situ (DCIS) need to comprehend the meaning of the diagnosis and the potential benefits and harms of treatment options. Full and understandable information is a requirement, not an option. However, with DCIS, as with many areas of medicine, a high level of uncertainty about the disease remains. In this article, we define informed medical decision making, review challenges to its implementation, and provide suggestions on how to improve communication with women about the diagnosis and treatment of DCIS. FAU - Elmore, Joann G AU - Elmore JG AD - Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98104-2499, USA. jelmore@uw.edu FAU - Ganschow, Pamela S AU - Ganschow PS FAU - Geller, Berta M AU - Geller BM LA - eng GR - K05 CA104699/CA/NCI NIH HHS/United States GR - K05 CA104699-05/CA/NCI NIH HHS/United States GR - KO5 CA 104699/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Review PL - United States TA - J Natl Cancer Inst Monogr JT - Journal of the National Cancer Institute. Monographs JID - 9011255 SB - IM MH - Attitude to Health MH - Breast Neoplasms/diagnosis/*psychology/therapy MH - Carcinoma, Intraductal, Noninfiltrating/diagnosis/*psychology/therapy MH - *Communication MH - *Decision Making MH - Decision Support Techniques MH - Female MH - Humans MH - *Informed Consent MH - Mass Media MH - Mastectomy/psychology/utilization MH - Patient Participation MH - Patient Preference MH - Patients/*psychology MH - *Professional-Patient Relations MH - Prognosis MH - Risk Assessment MH - Truth Disclosure MH - Uncertainty MH - Video Recording PMC - PMC3140849 MID - NIHMS311344 OID - NLM: NIHMS311344 OID - NLM: PMC3140849 EDAT- 2010/10/20 06:00 MHDA- 2011/02/12 06:00 CRDT- 2010/10/20 06:00 AID - lgq038 [pii] AID - 10.1093/jncimonographs/lgq038 [doi] PST - ppublish SO - J Natl Cancer Inst Monogr. 2010;2010(41):204-9. doi: 10.1093/jncimonographs/lgq038. PMID- 20880821 OWN - NLM STAT- MEDLINE DA - 20100930 DCOM- 20110204 LR - 20110916 IS - 1538-067X (Electronic) IS - 1092-1095 (Linking) VI - 14 IP - 5 DP - 2010 Oct TI - The Breast Surgery Gallery: an educational and counseling tool for people with breast cancer or having prophylactic breast surgery. PG - 643-8 LID - 10.1188/10.CJON.643-648 [doi] AB - The Breast Surgery Gallery is a unique and innovative computer program of digital photographs depicting sequential images of oncoplastic and prophylactic breast surgery. Specialist breast nurse counselors developed the tool to provide education and assist in decision making for people facing oncoplastic and prophylactic breast surgery. This article presents a historical perspective of the development of the gallery and how it can be used during education and counseling. The authors discuss background validation, structure, and testing of the gallery, with case studies that illustrate its flexibility. Data from regular audits of the breast surgery gallery demonstrate the tool's value. The Breast Surgery Gallery is a user-friendly tool that enables patients to make informed decisions while providing realistic photographs of the postoperative recovery phase. FAU - Kydd, Lesley A AU - Kydd LA AD - Royal Perth Hospital, Perth, Western Australia. lesley.kydd@health.wa.gov.au FAU - Reid, Sheryl A AU - Reid SA FAU - Adams, Jillian AU - Adams J LA - eng PT - Journal Article PL - United States TA - Clin J Oncol Nurs JT - Clinical journal of oncology nursing JID - 9705336 SB - N MH - Australia MH - Breast Neoplasms/*surgery MH - Counseling MH - Female MH - Humans MH - Mastectomy MH - Mastectomy, Segmental MH - *Patient Education as Topic MH - *Photography MH - *Software MH - User-Computer Interface EDAT- 2010/10/01 06:00 MHDA- 2011/02/05 06:00 CRDT- 2010/10/01 06:00 AID - RM1225JX82820700 [pii] AID - 10.1188/10.CJON.643-648 [doi] PST - ppublish SO - Clin J Oncol Nurs. 2010 Oct;14(5):643-8. doi: 10.1188/10.CJON.643-648. PMID- 20876346 OWN - NLM STAT- MEDLINE DA - 20110525 DCOM- 20110927 LR - 20170220 IS - 1552-681X (Electronic) IS - 0272-989X (Linking) VI - 31 IP - 3 DP - 2011 May-Jun TI - Longitudinal changes in patient distress following interactive decision aid use among BRCA1/2 carriers: a randomized trial. PG - 412-21 LID - 10.1177/0272989X10381283 [doi] AB - BACKGROUND: Increasingly, women with a strong family history of breast cancer are seeking genetic testing as a starting point to making significant decisions regarding management of their cancer risks. Individuals who are found to be carriers of a BRCA1 or BRCA2 mutation have a substantially elevated risk for breast cancer and are frequently faced with the decision of whether to undergo risk-reducing mastectomy. OBJECTIVE: In order to provide BRCA1/2 carriers with ongoing decision support for breast cancer risk management, a computer-based interactive decision aid was developed and tested against usual care in a randomized controlled trial. DESIGN: . Following genetic counseling, 214 female (aged 21-75 years) BRCA1/2 mutation carriers were randomized to usual care (UC; n = 114) or usual care plus decision aid (DA; n = 100) arms. UC participants received no further intervention; DA participants were sent the CD-ROM-based decision aid to view at home. MAIN OUTCOME MEASURES: The authors measured general distress, cancer-specific distress, and genetic testing-specific distress at 1-, 6-, and 12-month follow-up time points postrandomization. RESULTS: Longitudinal analyses revealed a significant longitudinal impact of the DA on cancer-specific distress (B = 5.67, z = 2.81, P = 0.005), which varied over time (DA group by time; B = -2.19, z = -2.47, P = 0.01), and on genetic testing-specific distress (B = 5.55, z = 2.46, P = 0.01), which also varied over time (DA group by time; B = -2.46, z = -2.51, P = 0.01). Individuals randomized to UC reported significantly decreased distress in the month following randomization, whereas individuals randomized to the DA maintained their postdisclosure distress over the short term. By 12 months, the overall decrease in distress between the 2 groups was similar. CONCLUSION: This report provides new insight into the long-term longitudinal effects of DAs. FAU - Hooker, Gillian W AU - Hooker GW AD - Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA. FAU - Leventhal, Kara-Grace AU - Leventhal KG FAU - DeMarco, Tiffani AU - DeMarco T FAU - Peshkin, Beth N AU - Peshkin BN FAU - Finch, Clinton AU - Finch C FAU - Wahl, Erica AU - Wahl E FAU - Joines, Jessica Rispoli AU - Joines JR FAU - Brown, Karen AU - Brown K FAU - Valdimarsdottir, Heiddis AU - Valdimarsdottir H FAU - Schwartz, Marc D AU - Schwartz MD LA - eng GR - R01 CA082346/CA/NCI NIH HHS/United States GR - R01 CA1846/CA/NCI NIH HHS/United States PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20100927 PL - United States TA - Med Decis Making JT - Medical decision making : an international journal of the Society for Medical Decision Making JID - 8109073 SB - IM MH - Adaptation, Psychological MH - Adult MH - Aged MH - Breast Neoplasms/*genetics/*psychology/surgery MH - Decision Making, Computer-Assisted MH - *Decision Support Techniques MH - Female MH - Genes, BRCA1 MH - Genes, BRCA2 MH - Genetic Counseling/*psychology MH - Humans MH - Longitudinal Studies MH - Mammography MH - Mastectomy MH - Middle Aged MH - Multivariate Analysis MH - New York/epidemiology MH - Patient Education as Topic MH - Psychometrics MH - Risk Assessment MH - *Stress, Psychological MH - Surveys and Questionnaires MH - Time Factors MH - Young Adult PMC - PMC3935602 MID - NIHMS556265 OID - NLM: NIHMS556265 OID - NLM: PMC3935602 EDAT- 2010/09/30 06:00 MHDA- 2011/09/29 06:00 CRDT- 2010/09/30 06:00 AID - 0272989X10381283 [pii] AID - 10.1177/0272989X10381283 [doi] PST - ppublish SO - Med Decis Making. 2011 May-Jun;31(3):412-21. doi: 10.1177/0272989X10381283. Epub 2010 Sep 27. PMID- 20848183 OWN - NLM STAT- MEDLINE DA - 20101018 DCOM- 20110209 LR - 20101018 IS - 1573-7217 (Electronic) IS - 0167-6806 (Linking) VI - 124 IP - 2 DP - 2010 Nov TI - Incorporating margin status information in treatment decisions for women with ductal carcinoma in situ: a decision analysis. PG - 393-402 LID - 10.1007/s10549-010-1166-7 [doi] AB - To integrate margin status information into the decision to undergo radiation therapy (RT) following breast-conserving surgery (BCS) for women with ductal carcinoma in situ (DCIS). We developed a decision-analytic Markov model to project quality-adjusted life years (QALYs) for a hypothetical cohort of 55-year-old women with DCIS over a lifetime horizon treated with or without RT following BCS. We estimated the transition probabilities of local DCIS and invasive recurrences based on the margin status (free, close, or positive) from a systematic literature review. Other probability estimates and utilities were collected from the published literature. Using the conditions defined in this model, expected QALYs after BCS alone were better than those after BCS with RT under the free-margin scenario (15.72 vs. 15.58) and worse in the close-margin (15.44 vs. 15.50) and positive-margin scenarios (15.20 vs. 15.33). The probability of receiving a salvage mastectomy varied from 10 to 28%, depending on margin status and treatment. One-way sensitivity analyses showed that the optimal treatment was sensitive to patients' preferences and RT side effects. Probabilistic sensitivity analyses revealed that BCS alone would be the best strategy in 54% of the cases under the free-margin scenario, 48% under the close-margin scenario, and 44% under the positive-margin scenario. This study illustrates that margin status is able to provide supplementary information on the decision of DCIS treatment. Our analyses also highlight the importance of patients' preferences in decision making. Our findings suggest that RT is not necessary for all patients with DCIS undergoing BCS. FAU - Wang, Shi-Yi AU - Wang SY AD - Department of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware Street S.E. MMC 729, Minneapolis, MN 55455, USA. wang1018@umn.edu FAU - Kuntz, Karen AU - Kuntz K FAU - Tuttle, Todd AU - Tuttle T FAU - Kane, Robert AU - Kane R LA - eng PT - Journal Article DEP - 20100917 PL - Netherlands TA - Breast Cancer Res Treat JT - Breast cancer research and treatment JID - 8111104 SB - IM MH - Breast Neoplasms/mortality/pathology/radiotherapy/surgery/*therapy MH - Carcinoma, Intraductal, Noninfiltrating/mortality/radiotherapy/secondary/surgery/*therapy MH - *Decision Support Techniques MH - Female MH - Humans MH - Markov Chains MH - *Mastectomy, Segmental MH - Middle Aged MH - Neoplasm Recurrence, Local MH - Patient Preference MH - *Patient Selection MH - Quality-Adjusted Life Years MH - Radiotherapy, Adjuvant/adverse effects MH - Risk Assessment MH - Risk Factors MH - Time Factors MH - Treatment Outcome EDAT- 2010/09/18 06:00 MHDA- 2011/02/10 06:00 CRDT- 2010/09/18 06:00 PHST- 2010/06/17 [received] PHST- 2010/09/03 [accepted] AID - 10.1007/s10549-010-1166-7 [doi] PST - ppublish SO - Breast Cancer Res Treat. 2010 Nov;124(2):393-402. doi: 10.1007/s10549-010-1166-7. Epub 2010 Sep 17. PMID- 20829330 OWN - NLM STAT- MEDLINE DA - 20101102 DCOM- 20110224 LR - 20170220 IS - 1078-0432 (Print) IS - 1078-0432 (Linking) VI - 16 IP - 21 DP - 2010 Nov 01 TI - New strategies in ovarian cancer: uptake and experience of women at high risk of ovarian cancer who are considering risk-reducing salpingo-oophorectomy. PG - 5094-106 LID - 10.1158/1078-0432.CCR-09-2953 [doi] AB - Here, we review factors associated with uptake of risk-reducing salpingo-oophorectomy by women at increased hereditary risk for ovarian cancer, as well as quality of life issues following surgery. Forty-one research studies identified through PubMed and PsychInfo met inclusion criteria. Older age, having had children, a family history of ovarian cancer, a personal history of breast cancer, prophylactic mastectomy, and BRCA1/2 mutation carrier status increase the likelihood of undergoing surgery. Psychosocial variables predictive of surgery uptake include greater perceived risk of ovarian cancer and cancer-related anxiety. Most women report satisfaction with their decision to undergo surgery and both lower perceived ovarian cancer risk and less cancer-related anxiety as benefits. Hormonal deprivation is the main disadvantage reported, particularly by premenopausal women who are not on hormonal replacement therapy (HRT). The evidence is mixed about satisfaction with the level of information provided prior to surgery, although generally, women report receiving insufficient information about the pros and cons of HRT. These findings indicate that when designing decision aids, demographic, medical history, and psychosocial variables need to be addressed in order to facilitate quality decision making. CI - (c)2010 AACR. FAU - Miller, Suzanne M AU - Miller SM AD - Psychosocial and Biobehavioral Medicine Program, Fox Chase Cancer Center, Cheltenham, Pennsylvania 19012, USA. suzanne.miller@fccc.edu FAU - Roussi, Pagona AU - Roussi P FAU - Daly, Mary B AU - Daly MB FAU - Scarpato, John AU - Scarpato J LA - eng GR - RC1 CA 145063-01/CA/NCI NIH HHS/United States GR - R01 CA104979/CA/NCI NIH HHS/United States GR - P01 CA057586/CA/NCI NIH HHS/United States GR - RC1 CA145063/CA/NCI NIH HHS/United States GR - R01 HG011766/HG/NHGRI NIH HHS/United States GR - P30 CA006927/CA/NCI NIH HHS/United States GR - P01CA57586/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. PT - Review DEP - 20100909 PL - United States TA - Clin Cancer Res JT - Clinical cancer research : an official journal of the American Association for Cancer Research JID - 9502500 SB - IM MH - Carcinoma/etiology/prevention & control/*therapy MH - Choice Behavior MH - Decision Making/physiology MH - Female MH - Hormone Replacement Therapy/adverse effects/statistics & numerical data/utilization MH - Humans MH - Medical Oncology/education/methods/*trends MH - Ovarian Neoplasms/etiology/prevention & control/*therapy MH - Ovariectomy/education/methods/*utilization MH - Patient Education as Topic MH - Risk Factors MH - *Risk Reduction Behavior MH - Salpingostomy/education/methods/*utilization PMC - PMC3107031 MID - NIHMS226892 OID - NLM: NIHMS226892 OID - NLM: PMC3107031 EDAT- 2010/09/11 06:00 MHDA- 2011/02/25 06:00 CRDT- 2010/09/11 06:00 AID - 1078-0432.CCR-09-2953 [pii] AID - 10.1158/1078-0432.CCR-09-2953 [doi] PST - ppublish SO - Clin Cancer Res. 2010 Nov 1;16(21):5094-106. doi: 10.1158/1078-0432.CCR-09-2953. Epub 2010 Sep 9. PMID- 20688457 OWN - NLM STAT- MEDLINE DA - 20110613 DCOM- 20111013 LR - 20110613 IS - 1873-5134 (Electronic) IS - 0738-3991 (Linking) VI - 84 IP - 1 DP - 2011 Jul TI - An exploration of patient decision-making for autologous breast reconstructive surgery following a mastectomy. PG - 105-10 LID - 10.1016/j.pec.2010.07.004 [doi] AB - OBJECTIVE: The aim of this study was to examine patients' experiences of the decision to undergo breast reconstructive surgery following mastectomy. METHOD: 21 Women, who had undergone reconstruction, took part in a semi-structured qualitative interview, which examined the participants' experience of the decision-making process. The recorded interviews were transcribed verbatim and analyzed using "framework analysis". RESULTS: Women who underwent immediate reconstruction spoke of the convenience of undergoing only one operation with regards to juggling work and childcare arrangements. For women who underwent delayed reconstructive surgery the reasons centre on dissatisfaction with wearing prosthesis. Others spoke of no choice, as immediate reconstruction was not offered as an option. However both groups did report similar influential factors and received and used similar informational content and informational sources in order to make their decision. CONCLUSION: The study outlines the different motivations for undergoing immediate or delayed breast reconstruction and highlights that there is not always a choice offered to patients. PRACTICE IMPLICATIONS: Future patients who are considering breast reconstruction should be provided with the relevant information to make a well informed decision and may benefit from different methods of information delivery that could include decision aids such as informational booklets, photographs, and videos. CI - Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved. FAU - Begum, Shelima AU - Begum S AD - King's College London, Department of Psychology, Institute of Psychiatry, Guy's Hospital, London, UK. FAU - Grunfeld, Elizabeth A AU - Grunfeld EA FAU - Ho-Asjoe, Mark AU - Ho-Asjoe M FAU - Farhadi, Jian AU - Farhadi J LA - eng PT - Journal Article DEP - 20100804 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Adult MH - Breast Neoplasms/*psychology/*surgery MH - *Decision Making MH - Female MH - Humans MH - Mammaplasty/*psychology MH - Mastectomy/*psychology MH - Middle Aged MH - Patient Satisfaction MH - Physician-Patient Relations MH - Time Factors EDAT- 2010/08/07 06:00 MHDA- 2011/10/14 06:00 CRDT- 2010/08/07 06:00 PHST- 2009/12/10 [received] PHST- 2010/06/22 [revised] PHST- 2010/07/03 [accepted] AID - S0738-3991(10)00405-2 [pii] AID - 10.1016/j.pec.2010.07.004 [doi] PST - ppublish SO - Patient Educ Couns. 2011 Jul;84(1):105-10. doi: 10.1016/j.pec.2010.07.004. Epub 2010 Aug 4. PMID- 20687957 OWN - NLM STAT- MEDLINE DA - 20100825 DCOM- 20101025 LR - 20170220 IS - 1472-6874 (Electronic) IS - 1472-6874 (Linking) VI - 10 DP - 2010 Aug 05 TI - Women's constructions of the 'right time' to consider decisions about risk-reducing mastectomy and risk-reducing oophorectomy. PG - 24 LID - 10.1186/1472-6874-10-24 [doi] AB - BACKGROUND: Women who are notified they carry a BRCA1/2 mutation are presented with surgical options to reduce their risk of breast and ovarian cancer, including risk-reducing mastectomy (RRM) and risk-reducing oophorectomy (RRO). Growing evidence suggests that a sub-group of women do not make decisions about RRM and RRO immediately following genetic testing, but rather, consider these decisions years later. Women's perspectives on the timing of these decisions are not well understood. Accordingly, the purpose of this research was to describe how women construct the 'right time' to consider decisions about RRM and RRO. METHODS: In-depth interviews were conducted with 22 BRCA1/2 carrier women and analyzed using qualitative, constant comparative methods. RESULTS: The time that lapsed between receipt of genetic test results and receipt of RRM or RRO ranged from three months to nine years. The findings highlighted the importance of considering decisions about RRM and RRO one at a time. The women constructed the 'right time' to consider these decisions to be when: (1) decisions fit into their lives, (2) they had enough time to think about decisions, (3) they were ready emotionally to deal with the decisions and the consequences, (4) all the issues and conflicts were sorted out, (5) there were better options available, and (6) the health care system was ready for them. CONCLUSIONS: These findings offer novel insights relevant to health care professionals who provide decision support to women considering RRM and RRO. FAU - Howard, A Fuchsia AU - Howard AF AD - School of Population and Public Health, University of British Columbia, Canada. fuchsia.howard@ubc.ca FAU - Bottorff, Joan L AU - Bottorff JL FAU - Balneaves, Lynda G AU - Balneaves LG FAU - Kim-Sing, Charmaine AU - Kim-Sing C LA - eng GR - Canadian Institutes of Health Research/Canada PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20100805 PL - England TA - BMC Womens Health JT - BMC women's health JID - 101088690 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Body Image MH - Breast Neoplasms/genetics/*prevention & control/surgery MH - *Decision Making MH - Female MH - Genes, BRCA1 MH - Genes, BRCA2 MH - Genetic Predisposition to Disease/psychology MH - Genetic Testing/psychology MH - Humans MH - Mastectomy/*psychology MH - Middle Aged MH - Ovarian Neoplasms/genetics/*prevention & control/surgery MH - Ovariectomy/*psychology MH - Risk Reduction Behavior MH - Time Factors PMC - PMC2927493 OID - NLM: PMC2927493 EDAT- 2010/08/07 06:00 MHDA- 2010/10/26 06:00 CRDT- 2010/08/07 06:00 PHST- 2010/01/14 [received] PHST- 2010/08/05 [accepted] AID - 1472-6874-10-24 [pii] AID - 10.1186/1472-6874-10-24 [doi] PST - epublish SO - BMC Womens Health. 2010 Aug 5;10:24. doi: 10.1186/1472-6874-10-24. PMID- 20637714 OWN - NLM STAT- MEDLINE DA - 20110314 DCOM- 20110531 LR - 20151119 IS - 1878-0539 (Electronic) IS - 1748-6815 (Linking) VI - 64 IP - 4 DP - 2011 Apr TI - Patient satisfaction in relation to nipple reconstruction: the importance of information provision. PG - 494-9 LID - 10.1016/j.bjps.2010.06.008 [doi] AB - 127 women who had previously undergone surgical nipple reconstruction completed self-report questionnaires to assess body image, anxiety, depression, information preference, and satisfaction with surgical outcome, information provision, and the decision to undergo the procedure. Whilst most women were satisfied with the outcome of surgery and of their decision to have nipple reconstruction, this study highlights the importance of information provision that meets patients' needs at the time of decision-making, in particular information about likely nipple sensation after surgery. CI - Copyright (c) 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. FAU - Harcourt, D AU - Harcourt D AD - Dept of Breast Surgery, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, E Grinstead, W Sussex RH19 3DZ, UK. Diana2.Harcourt@uwe.ac.uk FAU - Russell, C AU - Russell C FAU - Hughes, J AU - Hughes J FAU - White, P AU - White P FAU - Nduka, C AU - Nduka C FAU - Smith, R AU - Smith R LA - eng PT - Journal Article DEP - 20100716 PL - Netherlands TA - J Plast Reconstr Aesthet Surg JT - Journal of plastic, reconstructive & aesthetic surgery : JPRAS JID - 101264239 SB - IM MH - Adult MH - Aged MH - Anxiety/diagnosis MH - Body Image MH - Breast Neoplasms/surgery MH - Decision Making MH - Depression/diagnosis MH - Esthetics MH - Female MH - Humans MH - *Mammaplasty MH - Middle Aged MH - Nipples/*surgery MH - Patient Education as Topic MH - *Patient Satisfaction MH - Regression Analysis MH - Surveys and Questionnaires EDAT- 2010/07/20 06:00 MHDA- 2011/06/01 06:00 CRDT- 2010/07/20 06:00 PHST- 2010/02/16 [received] PHST- 2010/05/28 [revised] PHST- 2010/06/09 [accepted] AID - S1748-6815(10)00348-7 [pii] AID - 10.1016/j.bjps.2010.06.008 [doi] PST - ppublish SO - J Plast Reconstr Aesthet Surg. 2011 Apr;64(4):494-9. doi: 10.1016/j.bjps.2010.06.008. Epub 2010 Jul 16. PMID- 20629766 OWN - NLM STAT- MEDLINE DA - 20110221 DCOM- 20110609 LR - 20170220 IS - 1369-7625 (Electronic) IS - 1369-6513 (Linking) VI - 14 IP - 1 DP - 2011 Mar TI - Sharing decisions in breast cancer care: Development of the Decision Analysis System for Oncology (DAS-O) to identify shared decision making during treatment consultations. PG - 29-37 LID - 10.1111/j.1369-7625.2010.00613.x [doi] AB - BACKGROUND: Shared Decision Making (SDM) is widely accepted as the preferred method for reaching treatment decisions in the oncology setting including those about clinical trial participation: however, there is some disagreement between researchers over the components of SDM. Specific standardized coding systems are needed to help overcome this difficulty. OBJECTIVE: The first objective was to describe the development of an oncology specific SDM coding system, the DAS-O. The second objective was to provide reliability and validity data supporting the DAS-O. SETTING AND PARTICIPANTS: Consultation data were available from tertiary cancer center out patient oncology clinics in: Australia, New Zealand (ANZ), Switzerland, Germany and Austria (SGA). Patients were women with a confirmed diagnosis of early stage breast cancer. Reliability data were from 18 randomly selected coded transcripts drawn from ANZ and SGA. Concurrent validity data are from 55 (ANZ) consultations. MEASUREMENT: Inter and Intra rater reliability data was evaluated using Kappa correlation statistics and correlation coefficients. Correlation coefficients were used to assess concurrent validity between the DAS-O and two other SDM coding systems, OPTION and DSAT. RESULTS: Inter and Intra rater reliability for the system were high with average Kappas of 0.58 and 0.65 respectively. Correlation coefficients between DAS-O and OPTION was 0.73 and >0.5 for DSAT. CONCLUSIONS: We have developed a reliable and valid coding system for identifying and rating the quality of SDM in breast cancer consultations. CI - (c) 2010 The Authors. Health Expectations (c) 2010 Blackwell Publishing Ltd. FAU - Brown, Richard F AU - Brown RF AD - Department of Social and Behavioral Health, Virginia Commonwealth University School of Medicine, Richmond, VA, USA. FAU - Butow, Phyllis N AU - Butow PN FAU - Juraskova, Ilona AU - Juraskova I FAU - Ribi, Karin AU - Ribi K FAU - Gerber, Daniela AU - Gerber D FAU - Bernhard, Jurg AU - Bernhard J FAU - Tattersall, Martin H N AU - Tattersall MH LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Health Expect JT - Health expectations : an international journal of public participation in health care and health policy JID - 9815926 SB - IM MH - Breast Neoplasms/*therapy MH - Communication MH - *Decision Making MH - Female MH - Humans MH - Observer Variation MH - Patient Participation/*methods MH - Physician-Patient Relations MH - Reproducibility of Results PMC - PMC5060562 EDAT- 2010/07/16 06:00 MHDA- 2011/06/10 06:00 CRDT- 2010/07/16 06:00 AID - HEX613 [pii] AID - 10.1111/j.1369-7625.2010.00613.x [doi] PST - ppublish SO - Health Expect. 2011 Mar;14(1):29-37. doi: 10.1111/j.1369-7625.2010.00613.x. PMID- 20609546 OWN - NLM STAT- MEDLINE DA - 20110613 DCOM- 20111013 LR - 20110613 IS - 1873-5134 (Electronic) IS - 0738-3991 (Linking) VI - 84 IP - 1 DP - 2011 Jul TI - Entertainment education for breast cancer surgery decisions: a randomized trial among patients with low health literacy. PG - 41-8 LID - 10.1016/j.pec.2010.06.009 [doi] AB - OBJECTIVE: To evaluate an entertainment-based patient decision aid for early stage breast cancer surgery in low health literacy patients. METHODS: Newly diagnosed female patients with early stage breast cancer from two public hospitals were randomized to receive an entertainment-based decision aid for breast cancer treatment along with usual care (intervention arm) or to receive usual care only (control arm). Pre-decision (baseline), pre-surgery, and 1-year follow-up assessments were conducted. RESULTS: Patients assigned to the intervention arm of the study were more likely than the controls to choose mastectomy rather than breast-conserving surgery; however, they appeared better informed and clearer about their surgical options than women assigned to the control group. No differences in satisfaction with the surgical decision or the decision-making process were observed between the patients who viewed the intervention and those assigned to the control group. CONCLUSIONS: Entertainment education may be a desirable strategy for informing lower health literate women about breast cancer surgery options. PRACTICE IMPLICATIONS: Incorporating patient decision aids, particularly computer-based decision aids, into standard clinical practice remains a challenge; however, patients may be directed to view programs at home or at public locations (e.g., libraries, community centers). CI - Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved. FAU - Jibaja-Weiss, Maria L AU - Jibaja-Weiss ML AD - Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX 77098, USA. mariaj@bcm.edu FAU - Volk, Robert J AU - Volk RJ FAU - Granchi, Thomas S AU - Granchi TS FAU - Neff, Nancy E AU - Neff NE FAU - Robinson, Emily K AU - Robinson EK FAU - Spann, Stephen J AU - Spann SJ FAU - Aoki, Noriaki AU - Aoki N FAU - Friedman, Lois C AU - Friedman LC FAU - Beck, J Robert AU - Beck JR LA - eng PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20100707 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Adult MH - Aged MH - Breast Neoplasms/diagnosis/psychology/*surgery MH - Computer-Assisted Instruction/*methods MH - *Decision Support Techniques MH - Educational Status MH - Female MH - Follow-Up Studies MH - Health Knowledge, Attitudes, Practice MH - *Health Literacy MH - Hospitals, Public MH - Humans MH - Mastectomy MH - Middle Aged MH - Multimedia MH - Patient Education as Topic/*methods MH - *Patient Participation/methods/psychology EDAT- 2010/07/09 06:00 MHDA- 2011/10/14 06:00 CRDT- 2010/07/09 06:00 PHST- 2009/09/25 [received] PHST- 2010/05/04 [revised] PHST- 2010/06/04 [accepted] AID - S0738-3991(10)00368-X [pii] AID - 10.1016/j.pec.2010.06.009 [doi] PST - ppublish SO - Patient Educ Couns. 2011 Jul;84(1):41-8. doi: 10.1016/j.pec.2010.06.009. Epub 2010 Jul 7. PMID- 20579123 OWN - NLM STAT- MEDLINE DA - 20110217 DCOM- 20110520 LR - 20170220 IS - 1369-7625 (Electronic) IS - 1369-6513 (Linking) VI - 14 Suppl 1 DP - 2011 Mar TI - Understanding surgery choices for breast cancer: how might the Theory of Planned Behaviour and the Common Sense Model contribute to decision support interventions? PG - 6-19 LID - 10.1111/j.1369-7625.2009.00558.x [doi] AB - OBJECTIVE: To describe the evidence about factors influencing breast cancer patients' surgery choices and the implications for designing decision support in reference to an extended Theory of Planned Behaviour (TPB) and the Common Sense Model of Illness Representations (CSM). BACKGROUND: A wide range of factors are known to influence the surgery choices of women diagnosed with early breast cancer facing the choice of mastectomy or breast conservation surgery with radiotherapy. However, research does not always reflect the complexities of decision making and is often atheoretical. A theoretical approach, as provided by the CSM and the TPB, could help to identify and tailor support by focusing on patients' representations of their breast cancer and predicting surgery choices. DESIGN: Literature search and narrative synthesis of data. SYNTHESIS: Twenty-six studies reported women's surgery choices to be influenced by perceived clinical outcomes of surgery, appearance and body image, treatment concerns, involvement in decision making and preferences of clinicians. These factors can be mapped onto the key constructs of both the TPB and CSM and used to inform the design and development of decision support interventions to ensure accurate information is provided in areas most important to patients. CONCLUSIONS: The TPB and CSM have the potential to inform the design of decision support for breast cancer patients, with accurate and clear information that avoids leading patients to make decisions they may come to regret. Further research is needed examining how the components of the extended TPB and CSM account for patients' surgery choices. CI - (c) 2010 Blackwell Publishing Ltd. FAU - Sivell, Stephanie AU - Sivell S AD - Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, Wales, UK. sivells2@cardiff.ac.uk FAU - Edwards, Adrian AU - Edwards A FAU - Elwyn, Glyn AU - Elwyn G FAU - Manstead, Antony S R AU - Manstead AS LA - eng GR - Cancer Research UK/United Kingdom PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Health Expect JT - Health expectations : an international journal of public participation in health care and health policy JID - 9815926 SB - IM MH - Body Image MH - Breast Neoplasms/*surgery MH - *Decision Support Techniques MH - Female MH - Humans MH - Patient Education as Topic/methods MH - Patient Participation/*methods/*psychology MH - Patient Preference MH - Risk Assessment MH - Treatment Outcome PMC - PMC5057170 EDAT- 2010/06/29 06:00 MHDA- 2011/05/21 06:00 CRDT- 2010/06/29 06:00 AID - HEX558 [pii] AID - 10.1111/j.1369-7625.2009.00558.x [doi] PST - ppublish SO - Health Expect. 2011 Mar;14 Suppl 1:6-19. doi: 10.1111/j.1369-7625.2009.00558.x. PMID- 20175937 OWN - NLM STAT- MEDLINE DA - 20100315 DCOM- 20120430 LR - 20170220 IS - 1472-6963 (Electronic) IS - 1472-6963 (Linking) VI - 10 DP - 2010 Feb 23 TI - Association of shared decision-making with type of breast cancer surgery: a cross-sectional study. PG - 48 LID - 10.1186/1472-6963-10-48 [doi] AB - BACKGROUND: Although some studies examined the association between shared decision-making (SDM) and type of breast cancer surgery received, it is little known how treatment decisions might be shaped by the information provided by physicians. The purpose of this study was to identify the associations between shared decision making (SDM) and surgical treatment received. METHODS: Questionnaires on SDM were administered to 1,893 women undergoing primary curative surgery for newly diagnosed stage 0-II localized breast cancer at five hospitals in Korea. Questions included being informed on treatment options and the patient's own opinion in decision-making. RESULTS: Patients more likely to undergo mastectomy were those whose opinions were respected in treatment decisions (adjusted odds ratio, aOR), 1.40; 95% confidence interval (CI), 1.14-1.72) and who were informed on chemotherapy (aOR, 2.57; CI, 2.20-3.01) or hormone therapy (aOR, 2.03; CI, 1.77-2.32). In contrast, patients less likely to undergo mastectomy were those who were more informed on breast surgery options (aOR, 0.34; CI, 0.27-0.42). In patients diagnosed with stage 0-IIa cancer, clinical factors and the provision of information on treatment by the doctor were associated with treatment decisions. In patients diagnosed with stage IIb cancer, the patient's opinion was more respected in treatment decisions. CONCLUSION: Our population-based study suggested that women's treatment decisions might be shaped by the information provided by physicians, and that women might request different information from their physicians based on their preferred treatment options. These results might need to be confirmed in other studies of treatment decisions. FAU - Lee, Myung Kyung AU - Lee MK AD - Division of Cancer Control, Research Institute for National Cancer Control and Evaluation, National Cancer Center, Goyang, Gyeonggi, Korea. FAU - Noh, Dong Young AU - Noh DY FAU - Nam, Seok Jin AU - Nam SJ FAU - Ahn, Se Hyun AU - Ahn SH FAU - Park, Byeong Woo AU - Park BW FAU - Lee, Eun Sook AU - Lee ES FAU - Yun, Young Ho AU - Yun YH LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20100223 PL - England TA - BMC Health Serv Res JT - BMC health services research JID - 101088677 SB - IM MH - Aged MH - Breast Neoplasms/*surgery MH - Communication MH - Cross-Sectional Studies MH - *Decision Making MH - Female MH - Humans MH - Informed Consent/psychology MH - Mastectomy/methods MH - Mastectomy, Segmental/methods MH - Middle Aged MH - *Patient Education as Topic MH - *Patient Participation MH - Republic of Korea MH - Surveys and Questionnaires PMC - PMC2837652 OID - NLM: PMC2837652 EDAT- 2010/02/24 06:00 MHDA- 2012/05/01 06:00 CRDT- 2010/02/24 06:00 PHST- 2009/02/13 [received] PHST- 2010/02/23 [accepted] AID - 1472-6963-10-48 [pii] AID - 10.1186/1472-6963-10-48 [doi] PST - epublish SO - BMC Health Serv Res. 2010 Feb 23;10:48. doi: 10.1186/1472-6963-10-48. PMID- 20162470 OWN - NLM STAT- MEDLINE DA - 20100907 DCOM- 20110203 LR - 20161019 IS - 1543-0154 (Electronic) IS - 0885-8195 (Linking) VI - 25 IP - 3 DP - 2010 Sep TI - Interactive decision support for risk management: a qualitative evaluation in cancer genetic counselling sessions. PG - 312-6 LID - 10.1007/s13187-009-0035-8 [doi] AB - Genetic counselling for inherited susceptibility to cancer involves communication of a significant amount of information about possible consequences of different interventions. This study explores counsellors' attitudes to computer software designed to aid this process. Eight genetic counsellors used the software with actors playing patients. Clinicians' rating of expected patient satisfaction, content, accuracy, timeliness, format, overall value, ease of use, effect on the patient-provider relationship and effect on clinician's performance were evaluated via qualitative and quantitative analysis of interviews, training tasks and questionnaires. Most counsellors found the software effective. Concerns related to possible impact on consultation dynamics and content. Participants suggested countering these through appropriate new counselling skills and selective use of the computer. The REACT software could provide effective support for genetic risk management counselling. FAU - Glasspool, David W AU - Glasspool DW AD - School of Informatics, University of Edinburgh, Informatics Forum, 10 Crichton Street, Edinburgh EH8 9AB, Scotland. dglasspo@inf.ed.ac.uk FAU - Oettinger, Ayelet AU - Oettinger A FAU - Braithwaite, Dejana AU - Braithwaite D FAU - Fox, John AU - Fox J LA - eng GR - Cancer Research UK/United Kingdom PT - Evaluation Studies PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - J Cancer Educ JT - Journal of cancer education : the official journal of the American Association for Cancer Education JID - 8610343 SB - IM MH - Breast Neoplasms/*genetics MH - *Decision Making, Computer-Assisted MH - Feasibility Studies MH - Female MH - Genetic Counseling/*methods MH - *Genetic Predisposition to Disease MH - Genetic Testing/*methods MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Patient Education as Topic MH - Patient Satisfaction MH - *Risk Management MH - Software PMC - PMC2933800 OID - NLM: PMC2933800 EDAT- 2010/02/18 06:00 MHDA- 2011/02/04 06:00 CRDT- 2010/02/18 06:00 AID - 10.1007/s13187-009-0035-8 [doi] PST - ppublish SO - J Cancer Educ. 2010 Sep;25(3):312-6. doi: 10.1007/s13187-009-0035-8. PMID- 20159458 OWN - NLM STAT- MEDLINE DA - 20100217 DCOM- 20100507 LR - 20101004 IS - 1532-3080 (Electronic) IS - 0960-9776 (Linking) VI - 19 IP - 1 DP - 2010 Feb TI - Pre-operative MRI for women with newly diagnosed breast cancer: perspectives on clinician and patient decision-making when evidence is uncertain. PG - 10-2 LID - 10.1016/j.breast.2009.11.005 [doi] AB - The routine use of pre-operative MRI in women with newly diagnosed breast cancer highlights the complexities of the use of new technology when evidence of benefit is uncertain. There are both potential harms and benefits. In the short term patients may desire and feel reassured by further testing and the use of new diagnostic techniques. However, they may also experience greater anxiety and distress from further tests and related follow-up procedures such as biopsy. In the long term MRI may result in more radical treatment decisions which are associated with poorer quality of life for women. Both patients and clinicians often (wrongly) assume that more information via testing leads to better outcomes (information bias). So how should pre-operative MRI be integrated into breast cancer care? First women need to be made aware of the uncertain evidence surrounding MRI. However whether it is appropriate to burden women with complex information and yet another decision at a time of high vulnerability and emotional distress should be considered. One potential solution is to use a Community Informed Consent approach in which a representative sample of patients and healthy women are educated about the benefits and harms and give their informed opinion about whether pre-operative MRI should be offered. Another approach is to provide patients with an evidence based decision aid to support individual informed choice. Either or a combination of both approaches would be acceptable and should be investigated. At present women are poorly informed about pre operative MRI and it is likely that they assume outcomes are be improved as a result. Clear communication about the limits of MRI to patients is needed alongside randomised trials to provide the evidence that benefit indeed outweighs the harms so that all parties involved may be comprehensively informed. CI - Copyright (c) 2009 Elsevier Ltd. All rights reserved. FAU - McCaffery, Kirsten J AU - McCaffery KJ AD - Screening and Test Evaluation Program, School of Public Health, University of Sydney, NSW 2006, Australia. FAU - Jansen, Jesse AU - Jansen J LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review PL - Netherlands TA - Breast JT - Breast (Edinburgh, Scotland) JID - 9213011 SB - IM CIN - Breast. 2010 Oct;19(5):435-6. PMID: 20493698 MH - Breast Neoplasms/*diagnosis/pathology/psychology MH - *Decision Making MH - Female MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Magnetic Resonance Imaging/contraindications/*methods MH - Mammography/methods MH - Neoplasm Staging MH - Patient Participation/*psychology MH - Preoperative Care/*methods/psychology MH - Professional-Patient Relations MH - Women's Health RF - 35 EDAT- 2010/02/18 06:00 MHDA- 2010/05/08 06:00 CRDT- 2010/02/18 06:00 AID - S0960-9776(09)00165-9 [pii] AID - 10.1016/j.breast.2009.11.005 [doi] PST - ppublish SO - Breast. 2010 Feb;19(1):10-2. doi: 10.1016/j.breast.2009.11.005. PMID- 20048188 OWN - NLM STAT- MEDLINE DA - 20100209 DCOM- 20100304 LR - 20161019 IS - 1527-7755 (Electronic) IS - 0732-183X (Linking) VI - 28 IP - 5 DP - 2010 Feb 10 TI - Validation of a web-based predictive nomogram for ipsilateral breast tumor recurrence after breast conserving therapy. PG - 718-22 LID - 10.1200/JCO.2009.22.6662 [doi] AB - PURPOSE IBTR! version 1.0 is a web-based tool that uses literature-derived relative risk ratios for seven clinicopathologic variables to predict ipsilateral breast tumor recurrence (IBTR) after breast-conserving therapy (BCT). Preliminary testing demonstrated over-estimation in high-risk subgroups. This study uses two independent population-based datasets to create and validate a modified nomogram, IBTR! version 2.0. METHODS Cox regression modeling was performed on 7,811 patients treated with BCT at the British Columbia Cancer Agency (median follow-up, 9.4 years). Population-based hazard ratios were generated for the seven variables in the original nomogram. A modified nomogram was then tested against 664 patients from Massachusetts General Hospital (median follow-up, 9.3 years). The mean predicted and observed 10-year estimates were compared for the entire cohort and for four groups predefined by nomogram-predicted risks: group 1: less than 3%; group 2: 3% to 5%; group 3: 5% to 10%; and group 4: more than 10%. Results IBTR! version 2.0 predicted an overall 10-year IBTR estimate of 4.0% (95% CI, 3.8 to 4.2), while the observed estimate was 2.8% (95% CI, 1.6 to 4.7; P = .10). The predicted and observed IBTR estimates were: group 1 (n = 283): 2.2% versus 1.3%, P = .40; group 2 (n = 237): 3.8% versus 3.5%, P = .80; group 3 (n = 111): 6.7% versus 3.2%, P = .05; and group 4 (n = 33): 12.5% versus 8.7%, P = .50. CONCLUSION IBTR! version 2.0 is accurate in the majority of patients with a low to moderate risk of in-breast recurrence. The nomogram still overestimates risk in a minority of patients with higher risk features. Validation in a larger prospective data set is warranted. FAU - Sanghani, Mona AU - Sanghani M AD - Department of Radiation Oncology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA. FAU - Truong, Pauline T AU - Truong PT FAU - Raad, Rita Abi AU - Raad RA FAU - Niemierko, Andrzej AU - Niemierko A FAU - Lesperance, Mary AU - Lesperance M FAU - Olivotto, Ivo A AU - Olivotto IA FAU - Wazer, David E AU - Wazer DE FAU - Taghian, Alphonse G AU - Taghian AG LA - eng GR - P01 CA021239/CA/NCI NIH HHS/United States GR - R01 CA050628/CA/NCI NIH HHS/United States GR - CA21239/CA/NCI NIH HHS/United States GR - CA50628/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Validation Studies DEP - 20100104 PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 SB - IM CIN - J Clin Oncol. 2010 Feb 10;28(5):709-11. PMID: 20048173 MH - Adult MH - Aged MH - Breast Neoplasms/pathology/radiotherapy/*surgery MH - British Columbia MH - Databases as Topic MH - *Decision Support Techniques MH - Female MH - Humans MH - *Internet MH - Kaplan-Meier Estimate MH - *Mastectomy, Segmental MH - Middle Aged MH - *Models, Biological MH - *Neoplasm Recurrence, Local MH - *Nomograms MH - Predictive Value of Tests MH - Proportional Hazards Models MH - Radiotherapy, Adjuvant MH - Reproducibility of Results MH - Risk Assessment MH - Risk Factors MH - Time Factors MH - Treatment Outcome MH - United States PMC - PMC2834390 OID - NLM: PMC2834390 EDAT- 2010/01/06 06:00 MHDA- 2010/03/05 06:00 CRDT- 2010/01/06 06:00 AID - JCO.2009.22.6662 [pii] AID - 10.1200/JCO.2009.22.6662 [doi] PST - ppublish SO - J Clin Oncol. 2010 Feb 10;28(5):718-22. doi: 10.1200/JCO.2009.22.6662. Epub 2010 Jan 4. PMID- 20048173 OWN - NLM STAT- MEDLINE DA - 20100209 DCOM- 20100304 LR - 20100209 IS - 1527-7755 (Electronic) IS - 0732-183X (Linking) VI - 28 IP - 5 DP - 2010 Feb 10 TI - Breast conservation treatment with radiation: an ongoing success story. PG - 709-11 LID - 10.1200/JCO.2009.26.1164 [doi] FAU - Solin, Lawrence J AU - Solin LJ LA - eng PT - Comment PT - Editorial DEP - 20100104 PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 SB - IM CON - J Clin Oncol. 2010 Feb 10;28(5):718-22. PMID: 20048188 MH - Breast Neoplasms/pathology/*radiotherapy/*surgery MH - Decision Support Techniques MH - Female MH - Humans MH - Internet MH - *Mastectomy, Segmental MH - Models, Biological MH - *Neoplasm Recurrence, Local MH - Nomograms MH - Radiotherapy, Adjuvant MH - Risk Assessment MH - Risk Factors MH - Time Factors MH - Treatment Outcome EDAT- 2010/01/06 06:00 MHDA- 2010/03/05 06:00 CRDT- 2010/01/06 06:00 AID - JCO.2009.26.1164 [pii] AID - 10.1200/JCO.2009.26.1164 [doi] PST - ppublish SO - J Clin Oncol. 2010 Feb 10;28(5):709-11. doi: 10.1200/JCO.2009.26.1164. Epub 2010 Jan 4. PMID- 20039216 OWN - NLM STAT- MEDLINE DA - 20100212 DCOM- 20100520 LR - 20100212 IS - 1534-4681 (Electronic) IS - 1068-9265 (Linking) VI - 17 IP - 3 DP - 2010 Mar TI - Computer-based learning module increases shared decision making in breast reconstruction. PG - 738-43 LID - 10.1245/s10434-009-0869-7 [doi] AB - BACKGROUND: Shared decision making (SDM) combines evidence-based medicine with individual patient preferences. Patients who are actively engaged in their own health care management with their physicians have been shown to experience not only increased compliance, but also higher satisfaction and better outcomes. We hypothesize that a computer-based learning module for breast reconstruction increases patient involvement in the decision-making process. MATERIALS AND METHODS: Women who underwent either immediate or delayed breast reconstruction at an academic teaching hospital from 2004 to 2007 were identified. Patients meeting inclusion criteria were mailed questionnaires on demographics, informational resources, and decision-making processes. Questionnaire results were divided into 2 groups for analysis: patients who received a standard surgeon consultation and patients who were shown a computer-based decision aid in addition to the standard consultation. RESULTS: There were 358 women eligible for our study. A total of 255 patients (75.9%) responded to the survey; 168 patients were shown the computer-based decision aid and 87 patients were not. Patients who used the computer-based learning module reported a greater role in choosing the type of reconstruction (P < .001). Additionally, these patients reported a greater number of reconstructive options offered to them (P < .001) and were more satisfied with the amount of information provided by their reconstructive surgeon (P = .049). CONCLUSIONS: A computer-based learning module allows patients to assimilate information and actively participate in choosing type of breast reconstruction. Use of this educational modality represents a simple and effective way to improve the shared decision-making process. FAU - Lee, Bernard T AU - Lee BT AD - Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. blee3@bidmc.harvard.edu FAU - Chen, Chen AU - Chen C FAU - Yueh, Janet H AU - Yueh JH FAU - Nguyen, Minh-Doan AU - Nguyen MD FAU - Lin, Samuel J AU - Lin SJ FAU - Tobias, Adam M AU - Tobias AM LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20091229 PL - United States TA - Ann Surg Oncol JT - Annals of surgical oncology JID - 9420840 SB - IM CIN - Ann Surg Oncol. 2010 Mar;17(3):674-5. PMID: 20039213 MH - Breast Neoplasms/pathology/*surgery MH - *Computer-Assisted Instruction MH - Cross-Sectional Studies MH - *Decision Making MH - Female MH - Humans MH - Logistic Models MH - *Mammaplasty MH - Mastectomy MH - Middle Aged MH - Outcome Assessment (Health Care) EDAT- 2009/12/30 06:00 MHDA- 2010/05/21 06:00 CRDT- 2009/12/30 06:00 PHST- 2009/05/18 [received] AID - 10.1245/s10434-009-0869-7 [doi] PST - ppublish SO - Ann Surg Oncol. 2010 Mar;17(3):738-43. doi: 10.1245/s10434-009-0869-7. Epub 2009 Dec 29. PMID- 20004545 OWN - NLM STAT- MEDLINE DA - 20100706 DCOM- 20101101 LR - 20170220 IS - 1873-5134 (Electronic) IS - 0738-3991 (Linking) VI - 80 IP - 2 DP - 2010 Aug TI - Testing whether decision aids introduce cognitive biases: results of a randomized trial. PG - 158-63 LID - 10.1016/j.pec.2009.10.021 [doi] AB - OBJECTIVE: Women at high risk of breast cancer face a difficult decision whether to take medications like tamoxifen to prevent a first breast cancer diagnosis. Decision aids (DAs) offer a promising method of helping them make this decision. But concern lingers that DAs might introduce cognitive biases. METHODS: We recruited 663 women at high risk of breast cancer and presented them with a DA designed to experimentally test potential methods of identifying and reducing cognitive biases that could influence this decision, by varying specific aspects of the DA across participants in a factorial design. RESULTS: Participants were susceptible to a cognitive bias - an order effect - such that those who learned first about the risks of tamoxifen thought more favorably of the drug than women who learned first about the benefits. This order effect was eliminated among women who received additional information about competing health risks. CONCLUSION: We discovered that the order of risk/benefit information influenced women's perceptions of tamoxifen. This bias was eliminated by providing contextual information about competing health risks. PRACTICE IMPLICATIONS: We have demonstrated the feasibility of using factorial experimental designs to test whether DAs introduce cognitive biases, and whether specific elements of DAs can reduce such biases. CI - Published by Elsevier Ireland Ltd. FAU - Ubel, Peter A AU - Ubel PA AD - VA Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. paubel@med.umich.edu FAU - Smith, Dylan M AU - Smith DM FAU - Zikmund-Fisher, Brian J AU - Zikmund-Fisher BJ FAU - Derry, Holly A AU - Derry HA FAU - McClure, Jennifer AU - McClure J FAU - Stark, Azadeh AU - Stark A FAU - Wiese, Cheryl AU - Wiese C FAU - Greene, Sarah AU - Greene S FAU - Jankovic, Aleksandra AU - Jankovic A FAU - Fagerlin, Angela AU - Fagerlin A LA - eng GR - P50 CA101451/CA/NCI NIH HHS/United States GR - P50 CA101451-060006/CA/NCI NIH HHS/United States GR - R01 CA087595/CA/NCI NIH HHS/United States GR - R01 CA087595-06A1/CA/NCI NIH HHS/United States PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural DEP - 20091209 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 RN - 0 (Selective Estrogen Receptor Modulators) RN - 094ZI81Y45 (Tamoxifen) SB - N MH - Adult MH - Aged MH - Breast Neoplasms/*prevention & control MH - Cognition MH - *Comprehension MH - Decision Making MH - *Decision Support Techniques MH - Female MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Middle Aged MH - Patient Education as Topic/methods MH - Risk Assessment MH - Selective Estrogen Receptor Modulators/*therapeutic use MH - Tamoxifen/*therapeutic use PMC - PMC2889196 MID - NIHMS158927 OID - NLM: NIHMS158927 OID - NLM: PMC2889196 EDAT- 2009/12/17 06:00 MHDA- 2010/11/03 06:00 CRDT- 2009/12/17 06:00 PHST- 2009/02/12 [received] PHST- 2009/09/30 [revised] PHST- 2009/10/03 [accepted] AID - S0738-3991(09)00511-4 [pii] AID - 10.1016/j.pec.2009.10.021 [doi] PST - ppublish SO - Patient Educ Couns. 2010 Aug;80(2):158-63. doi: 10.1016/j.pec.2009.10.021. Epub 2009 Dec 9. PMID- 19996031 OWN - NLM STAT- MEDLINE DA - 20100108 DCOM- 20100121 LR - 20161019 IS - 1527-7755 (Electronic) IS - 0732-183X (Linking) VI - 28 IP - 2 DP - 2010 Jan 10 TI - Survival analysis of cancer risk reduction strategies for BRCA1/2 mutation carriers. PG - 222-31 LID - 10.1200/JCO.2009.22.7991 [doi] AB - PURPOSE: Women with BRCA1/2 mutations inherit high risks of breast and ovarian cancer; options to reduce cancer mortality include prophylactic surgery or breast screening, but their efficacy has never been empirically compared. We used decision analysis to simulate risk-reducing strategies in BRCA1/2 mutation carriers and to compare resulting survival probability and causes of death. METHODS: We developed a Monte Carlo model of breast screening with annual mammography plus magnetic resonance imaging (MRI) from ages 25 to 69 years, prophylactic mastectomy (PM) at various ages, and/or prophylactic oophorectomy (PO) at ages 40 or 50 years in 25-year-old BRCA1/2 mutation carriers. RESULTS: With no intervention, survival probability by age 70 is 53% for BRCA1 and 71% for BRCA2 mutation carriers. The most effective single intervention for BRCA1 mutation carriers is PO at age 40, yielding a 15% absolute survival gain; for BRCA2 mutation carriers, the most effective single intervention is PM, yielding a 7% survival gain if performed at age 40 years. The combination of PM and PO at age 40 improves survival more than any single intervention, yielding 24% survival gain for BRCA1 and 11% for BRCA2 mutation carriers. PM at age 25 instead of age 40 offers minimal incremental benefit (1% to 2%); substituting screening for PM yields a similarly minimal decrement in survival (2% to 3%). CONCLUSION: Although PM at age 25 plus PO at age 40 years maximizes survival probability, substituting mammography plus MRI screening for PM seems to offer comparable survival. These results may guide women with BRCA1/2 mutations in their choices between prophylactic surgery and breast screening. FAU - Kurian, Allison W AU - Kurian AW AD - Departments of Medicine, Health Research and Policy, and Radiology, Stanford University School of Medicine, Stanford, CA, USA. FAU - Sigal, Bronislava M AU - Sigal BM FAU - Plevritis, Sylvia K AU - Plevritis SK LA - eng GR - R01 CA066785/CA/NCI NIH HHS/United States GR - U01 CA088248/CA/NCI NIH HHS/United States GR - R01 CA66785/CA/NCI NIH HHS/United States GR - R01 CA829040/CA/NCI NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20091207 PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 SB - IM CIN - J Clin Oncol. 2010 Jan 10;28(2):189-91. PMID: 19996025 CIN - J Am Coll Surg. 2011 Sep;213(3):447-50. PMID: 21871383 MH - Adult MH - Aged MH - Breast Neoplasms/genetics/*mortality MH - Cause of Death MH - Decision Support Techniques MH - Female MH - *Genes, BRCA1 MH - *Genes, BRCA2 MH - Heterozygote MH - Humans MH - Magnetic Resonance Imaging MH - Mammography MH - Mastectomy MH - Middle Aged MH - Monte Carlo Method MH - Mutation MH - Ovarian Neoplasms/genetics/*mortality MH - Ovariectomy MH - *Risk Reduction Behavior PMC - PMC2815712 OID - NLM: PMC2815712 EDAT- 2009/12/10 06:00 MHDA- 2010/01/22 06:00 CRDT- 2009/12/10 06:00 AID - JCO.2009.22.7991 [pii] AID - 10.1200/JCO.2009.22.7991 [doi] PST - ppublish SO - J Clin Oncol. 2010 Jan 10;28(2):222-31. doi: 10.1200/JCO.2009.22.7991. Epub 2009 Dec 7. PMID- 19996025 OWN - NLM STAT- MEDLINE DA - 20100108 DCOM- 20100121 LR - 20100108 IS - 1527-7755 (Electronic) IS - 0732-183X (Linking) VI - 28 IP - 2 DP - 2010 Jan 10 TI - Weighing options for cancer risk reduction in carriers of BRCA1 and BRCA2 mutations. PG - 189-91 LID - 10.1200/JCO.2009.25.6875 [doi] FAU - Stadler, Zsofia K AU - Stadler ZK FAU - Kauff, Noah D AU - Kauff ND LA - eng PT - Comment PT - Editorial DEP - 20091207 PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 SB - IM CON - J Clin Oncol. 2010 Jan 10;28(2):222-31. PMID: 19996031 MH - Adult MH - Aged MH - *Decision Support Techniques MH - Fallopian Tubes MH - Female MH - Genes, BRCA1 MH - *Genes, BRCA2 MH - Genital Neoplasms, Female/prevention & control MH - Heterozygote MH - Humans MH - Mastectomy MH - Middle Aged MH - Mutation MH - Neoplasms/genetics/*mortality MH - Ovariectomy MH - *Risk Reduction Behavior EDAT- 2009/12/10 06:00 MHDA- 2010/01/22 06:00 CRDT- 2009/12/10 06:00 AID - JCO.2009.25.6875 [pii] AID - 10.1200/JCO.2009.25.6875 [doi] PST - ppublish SO - J Clin Oncol. 2010 Jan 10;28(2):189-91. doi: 10.1200/JCO.2009.25.6875. Epub 2009 Dec 7. PMID- 19967885 OWN - NLM STAT- MEDLINE DA - 20091208 DCOM- 20100115 LR - 20131121 IS - 0003-469X (Print) IS - 0003-469X (Linking) VI - 80 IP - 4 DP - 2009 Jul-Aug TI - [Antibiotic prophylaxis in breast surgery. Preliminary resuls of a multicenter randomized study on 1400 cases]. PG - 275-9 AB - UNLABELLED: Breast surgery is classified among the procedures performed in clean surgery and is associated with a low incidence of wound infection (3-15%). The objective of this study was to evaluate the advantages antibiotic prophylaxis in patients undergoing breast surgery. A multicenter randomized controlled study was performed between January 2008 and November 2008. One thousand four hundred patients were enrolled in prospective randomized study; surgical wound infection was found in 41 patients (2.93%). In our RCT we have shown that in breast surgery antibiotic prophylaxis does not present significant advantages in patients with potential risk of infection (17 patients, 2.42%, subjected to antibiotic prophylaxis vs 24 patients, 3.43%, without antibiotic prophylaxis) (P = 0.27). In patients with drainage there is a significant minor incidence of wound infections in patients receiving antibiotic prophylaxis (5 patients, 0.92%, subjected to antibiotic prophylaxis vs 14 patients, 3.09%, without antibiotic prophylaxis) (P = 0.02). CONCLUSION: This study is only a preliminary RCT to be followed by a study which should be enrolled more patients in order to get the results as statistically significant. FAU - Sanguinetti, Alessandro AU - Sanguinetti A AD - SC Chirurgia Endocrina, Universita degli Studi di Perugia. cirrocchiroberto@yahoo.it FAU - Rosato, Lodovico AU - Rosato L FAU - Cirocchi, Roberto AU - Cirocchi R FAU - Barberini, Francesco AU - Barberini F FAU - Pezzolla, Angela AU - Pezzolla A FAU - Cavallaro, Giuseppe AU - Cavallaro G FAU - Parmeggiani, Domenico AU - Parmeggiani D FAU - Ruggiero, Roberto AU - Ruggiero R FAU - Docimo, Giovanni AU - Docimo G FAU - Procaccini, Eugenio AU - Procaccini E FAU - Santoriello, Antonio AU - Santoriello A FAU - Rulli, Antonio AU - Rulli A FAU - Gubitosi, Adelmo AU - Gubitosi A FAU - Canonico, Silvestro AU - Canonico S FAU - Taffurelli, Mario AU - Taffurelli M FAU - Sciannameo, Francesco AU - Sciannameo F FAU - Barbarisi, Alfonso AU - Barbarisi A FAU - Docimo, Ludovico AU - Docimo L FAU - Agresti, Massimo AU - Agresti M FAU - De Toma, Giorgio AU - De Toma G FAU - Noya, Giuseppe AU - Noya G FAU - Parmeggiani, Umberto AU - Parmeggiani U FAU - Avenia, Nicola AU - Avenia N LA - ita PT - Comparative Study PT - English Abstract PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial TT - Antibiotico profilassi in Chirurgia Senologica. Risultati preliminari di uno studio multicentrico randomizzato su 1400 casi trattati. PL - Italy TA - Ann Ital Chir JT - Annali italiani di chirurgia JID - 0372343 RN - 0 (Anti-Bacterial Agents) RN - 23521W1S24 (Clavulanic Acid) RN - 804826J2HU (Amoxicillin) RN - IHS69L0Y4T (Cefazolin) SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Amoxicillin/administration & dosage/therapeutic use MH - Anti-Bacterial Agents/administration & dosage/*therapeutic use MH - *Antibiotic Prophylaxis MH - Breast Diseases/*surgery MH - Breast Neoplasms/*surgery MH - Cefazolin/administration & dosage/*therapeutic use MH - Clavulanic Acid/administration & dosage/therapeutic use MH - Data Interpretation, Statistical MH - Female MH - Humans MH - *Mastectomy, Radical MH - *Mastectomy, Segmental MH - Middle Aged MH - Odds Ratio MH - Patient Selection MH - Surgical Wound Infection/drug therapy/*prevention & control MH - Treatment Outcome EDAT- 2009/12/09 06:00 MHDA- 2010/01/16 06:00 CRDT- 2009/12/09 06:00 PST - ppublish SO - Ann Ital Chir. 2009 Jul-Aug;80(4):275-9. PMID- 19908143 OWN - NLM STAT- MEDLINE DA - 20100119 DCOM- 20100323 LR - 20161025 IS - 1573-7217 (Electronic) IS - 0167-6806 (Linking) VI - 119 IP - 3 DP - 2010 Feb TI - Women's decisions regarding tamoxifen for breast cancer prevention: responses to a tailored decision aid. PG - 613-20 LID - 10.1007/s10549-009-0618-4 [doi] AB - Tamoxifen reduces primary breast cancer incidence, yet causes serious side effects. To date, few women with increased breast cancer risk have elected to use tamoxifen for chemoprevention. The objective of the study was to determine women's knowledge of and attitudes toward tamoxifen following exposure to a tailored decision aid (DA). A total of 632 women with a 5-year risk of breast cancer > or = 1.66% (Mean = 2.56, range = 1.7-17.3) were recruited from two healthcare organizations. Participants viewed an online DA that informed them about their 5-year risk of breast cancer and presented individually tailored content depicting the risks/benefits of tamoxifen prophylaxis. Outcome measures included behavioral intentions (to seek additional information about tamoxifen, to talk to a physician about tamoxifen, and to take tamoxifen); knowledge; and perceived risks and benefits of tamoxifen. After viewing the DA, 29% of participants said they intended to seek more information or talk to their doctor about tamoxifen, and only 6% believed they would take tamoxifen. Knowledge was considerable, with 63% of women answering at least 5 of 6 knowledge questions correctly. Participants were concerned about the risks of tamoxifen, and many believed that the benefits of tamoxifen did not outweigh the risks. This study is the largest to date to test women's preferences for taking tamoxifen and one of the largest to have tested the impact of a tailored DA. After viewing the DA, women demonstrated good understanding of tamoxifen's risks and benefits, but most were not interested in taking tamoxifen for breast cancer chemoprevention. FAU - Fagerlin, Angela AU - Fagerlin A AD - Ann Arbor VA HSR&D, Center for Clinical Management Research, Ann Arbor, MI, USA. FAU - Zikmund-Fisher, Brian J AU - Zikmund-Fisher BJ FAU - Nair, Vijayan AU - Nair V FAU - Derry, Holly A AU - Derry HA FAU - McClure, Jennifer B AU - McClure JB FAU - Greene, Sarah AU - Greene S FAU - Stark, Azadeh AU - Stark A FAU - Hensley Alford, Sharon AU - Hensley Alford S FAU - Lantz, Paula AU - Lantz P FAU - Hayes, Daniel F AU - Hayes DF FAU - Wiese, Cheryl AU - Wiese C FAU - Claud Zweig, Sarah AU - Claud Zweig S FAU - Pitsch, Rosemarie AU - Pitsch R FAU - Jankovic, Aleksandra AU - Jankovic A FAU - Ubel, Peter A AU - Ubel PA LA - eng GR - P50 CA101451/CA/NCI NIH HHS/United States PT - Clinical Trial PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. PL - Netherlands TA - Breast Cancer Res Treat JT - Breast cancer research and treatment JID - 8111104 RN - 0 (Selective Estrogen Receptor Modulators) RN - 094ZI81Y45 (Tamoxifen) SB - IM MH - Adult MH - Aged MH - Breast Neoplasms/*prevention & control MH - Decision Making MH - *Decision Support Techniques MH - Female MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - Middle Aged MH - Patient Education as Topic/*methods MH - Selective Estrogen Receptor Modulators/*therapeutic use MH - Tamoxifen/*therapeutic use PMC - PMC3736824 MID - NIHMS487993 OID - NLM: NIHMS487993 OID - NLM: PMC3736824 EDAT- 2009/11/13 06:00 MHDA- 2010/03/24 06:00 CRDT- 2009/11/13 06:00 PHST- 2009/10/21 [received] PHST- 2009/10/22 [accepted] AID - 10.1007/s10549-009-0618-4 [doi] PST - ppublish SO - Breast Cancer Res Treat. 2010 Feb;119(3):613-20. doi: 10.1007/s10549-009-0618-4. PMID- 19883996 OWN - NLM STAT- MEDLINE DA - 20100215 DCOM- 20100511 LR - 20151119 IS - 1433-2981 (Electronic) IS - 0936-6555 (Linking) VI - 22 IP - 2 DP - 2010 Mar TI - Attitudes of Canadian radiation oncologists towards post-lumpectomy radiotherapy for elderly women with stage I hormone-responsive breast cancer. PG - 97-106 LID - 10.1016/j.clon.2009.10.001 [doi] AB - AIMS: Post-lumpectomy breast radiation is the standard of care for all patient subgroups. However, elderly women with stage I breast cancer on adjuvant tamoxifen therapy have a 4% risk of local recurrence after lumpectomy without adjuvant breast radiation. The purpose of this study was to explore the attitudes of Canadian radiation oncologists who treat breast cancer with respect to their use of adjuvant post-lumpectomy radiotherapy, and their willingness to implement a decision aid for this patient population. MATERIALS AND METHODS: The questionnaire was mailed to 141 Canadian radiation oncologists who treat breast cancer. The respondents were asked to complete an online survey consisting of four parts: (1) demographic information; (2) factors determining post-lumpectomy radiation treatment decisions; (3) hypothetical case scenarios; (4) interest in using a decision aid in their practice. RESULTS: Among the 61 (43%) physicians who completed the survey, there was substantial response variation. After contraindications to radiotherapy, patient overall health and patient preference had the greatest influence on their decision to offer radiotherapy to this patient subgroup. Margin status and use of hormonal therapy were given less importance. For each of the case scenarios, 60-83% of physicians (depending on the case scenario) would offer the patient a choice; far fewer (12-57%) would be comfortable not irradiating. Sixty-four per cent of respondents welcomed the concept of a decision aid for this population. CONCLUSIONS: Although there is significant variation in practice patterns and attitudes among radiation oncologists regarding post-lumpectomy radiotherapy for elderly, low-risk breast cancer patients, the vast majority value patient choice and would be willing to use a decision aid designed for this population in their practice. CI - 2009 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. FAU - Warner, E AU - Warner E AD - Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada. FAU - Chow, E AU - Chow E FAU - Fairchild, A AU - Fairchild A FAU - Franssen, E AU - Franssen E FAU - Paszat, L AU - Paszat L FAU - Szumacher, E AU - Szumacher E LA - eng PT - Case Reports PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20091101 PL - England TA - Clin Oncol (R Coll Radiol) JT - Clinical oncology (Royal College of Radiologists (Great Britain)) JID - 9002902 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - *Attitude of Health Personnel MH - Breast Neoplasms/pathology/*radiotherapy/surgery MH - Canada MH - Carcinoma, Ductal, Breast/pathology/*radiotherapy/surgery MH - Female MH - Humans MH - Male MH - *Mastectomy, Segmental MH - Middle Aged MH - Neoplasm Staging MH - Neoplasms, Hormone-Dependent/pathology/*radiotherapy/surgery MH - Postoperative Period MH - Practice Patterns, Physicians' MH - *Radiation Oncology MH - Radiotherapy Planning, Computer-Assisted MH - Survival Rate MH - Treatment Outcome EDAT- 2009/11/04 06:00 MHDA- 2010/05/12 06:00 CRDT- 2009/11/04 06:00 PHST- 2009/03/13 [received] PHST- 2009/09/09 [revised] PHST- 2009/10/01 [accepted] AID - S0936-6555(09)00328-8 [pii] AID - 10.1016/j.clon.2009.10.001 [doi] PST - ppublish SO - Clin Oncol (R Coll Radiol). 2010 Mar;22(2):97-106. doi: 10.1016/j.clon.2009.10.001. Epub 2009 Nov 1. PMID- 19850438 OWN - NLM STAT- MEDLINE DA - 20091201 DCOM- 20110113 LR - 20091201 IS - 1873-5134 (Electronic) IS - 0738-3991 (Linking) VI - 77 IP - 3 DP - 2009 Dec TI - Implementing decision and communication aids to facilitate patient-centered care in breast cancer: a case study. PG - 360-8 LID - 10.1016/j.pec.2009.09.012 [doi] AB - OBJECTIVE: Decision Services (DS) provide support for breast cancer patients at the University of California, San Francisco to help ensure patient-centered care. METHODS: We examined a case study to explore whether our program practices matched our program theory, and what the patient in the case thought was effective and ineffective about our decision support interventions. RESULTS: The patient relied on a decision aid to educate her husband about her condition; felt that her question list contributed to a productive and efficient consultation with her oncologist; credited an audio-recording with helping her remember to follow-up with a genetic counselor; and reviewed the consultation summary 30 days into treatment in order to reflect on her decision. The patient rated the interventions highly on surveys, and experienced desirable reductions in decisional conflict, and improvements in knowledge. However, the question-prompting intervention was associated with a small decrease in self-efficacy, and the patient criticized the decision aid for omitting mention of a prognostic test. CONCLUSION: This case illustrates how decision support interventions can be deployed to promote patient-centered care. PRACTICE IMPLICATIONS: Breast care centers should consider distributing decision aids and assisting patients in listing questions, recording consultations, and obtaining written consultation summaries. FAU - Belkora, Jeffrey K AU - Belkora JK AD - University of California, San Francisco, CA, United States. jeff.belkora@ucsfmedctr.org FAU - Loth, Meredith K AU - Loth MK FAU - Volz, Shelley AU - Volz S FAU - Rugo, Hope S AU - Rugo HS LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20091021 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - *Breast Neoplasms MH - *Communication MH - *Decision Making MH - Female MH - Genetic Counseling MH - Health Knowledge, Attitudes, Practice MH - Humans MH - *Patient-Centered Care MH - *Physician-Patient Relations MH - Tape Recording EDAT- 2009/10/24 06:00 MHDA- 2011/01/14 06:00 CRDT- 2009/10/24 06:00 PHST- 2008/09/30 [received] PHST- 2009/09/09 [revised] PHST- 2009/09/15 [accepted] AID - S0738-3991(09)00428-5 [pii] AID - 10.1016/j.pec.2009.09.012 [doi] PST - ppublish SO - Patient Educ Couns. 2009 Dec;77(3):360-8. doi: 10.1016/j.pec.2009.09.012. Epub 2009 Oct 21. PMID- 19809867 OWN - NLM STAT- MEDLINE DA - 20100223 DCOM- 20100608 LR - 20100223 IS - 1573-3599 (Electronic) IS - 1059-7700 (Linking) VI - 19 IP - 1 DP - 2010 Feb TI - Perceptions of high-risk care and barriers to care among women at risk for hereditary breast and ovarian cancer following genetic counseling in the community setting. PG - 44-54 LID - 10.1007/s10897-009-9261-9 [doi] AB - Data are limited regarding barriers to care among women, with or at risk for hereditary breast and ovarian cancer (HBOC), following genetic counseling in the community setting. Using a telephone survey, we retrospectively addressed perceptions of post-genetic counseling medical care and barriers to care among 69 at-risk women from the non-academic setting. Of these, all agreed that following cancer screening recommendations was better than not following them; none felt recommendations were too difficult to follow; all believed screening would help keep them healthy; 57% believed screening would prevent cancer. Twenty-five percent noted discomfort with breast imaging; 29% found ovarian cancer screening uncomfortable. Close to a quarter of participants reported difficulty deciding whether or not to undergo risk-reducing mastectomy while 10% noted difficulty deciding for or against bilateral salpingo-oophorectomy. There were no perceived major barriers to care, although 38% felt that screening reminders would be helpful, and 10% needed more help in following through with care. Overall, participants believed that they were benefiting from their post-genetic counseling medical care. This work identified HBOC-related support needs to include: informational resources that promote improved understanding of cancer risk and high-risk management; screening reminder systems; and decision support tools. FAU - Morgan, Debra AU - Morgan D AD - Maine Medical Center Research Institute, Scarborough, ME, USA. FAU - Sylvester, Heather AU - Sylvester H FAU - Lucas, F Lee AU - Lucas FL FAU - Miesfeldt, Susan AU - Miesfeldt S LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20091007 PL - United States TA - J Genet Couns JT - Journal of genetic counseling JID - 9206865 SB - IM MH - Adult MH - Aged MH - Breast Neoplasms/*genetics MH - *Community Health Services MH - Female MH - Genes, BRCA1 MH - Genes, BRCA2 MH - *Genetic Counseling MH - Humans MH - Middle Aged MH - Ovarian Neoplasms/*genetics MH - Point Mutation/genetics MH - Risk Factors MH - Women's Health Services/*utilization MH - Young Adult EDAT- 2009/10/08 06:00 MHDA- 2010/06/09 06:00 CRDT- 2009/10/08 06:00 PHST- 2009/04/17 [received] PHST- 2009/09/10 [accepted] AID - 10.1007/s10897-009-9261-9 [doi] PST - ppublish SO - J Genet Couns. 2010 Feb;19(1):44-54. doi: 10.1007/s10897-009-9261-9. Epub 2009 Oct 7. PMID- 19768651 OWN - NLM STAT- MEDLINE DA - 20100521 DCOM- 20100820 LR - 20170220 IS - 1573-7217 (Electronic) IS - 0167-6806 (Linking) VI - 121 IP - 2 DP - 2010 Jun TI - Health states of women after conservative surgery and radiation for breast cancer. PG - 519-26 LID - 10.1007/s10549-009-0552-5 [doi] AB - The aim of the study is to use the EQ-5D instrument to evaluate the long-term health states of women with early stage breast cancer treated by breast-conserving surgery and radiation. A total of 1,050 women treated with conservative surgery and radiation with or without systemic therapy completed 2,480 questionnaires during follow-up visits. The EQ-5D is a standardized and validated instrument for measuring quality of life outcomes. The descriptive system uses 5 dimensions of health with three possible levels of response that combine into 243 (3(5)) possible unique health states that are each assigned a values-based index score from 0 to 1. The visual analog scale (VAS) rates health on a simple vertical line from 0 to 100. Higher scores correspond to better health status. The mean index scores were 0.89 (95% CI: 0.87-0.91) at 5 years, 0.9 (95% CI: 0.86-0.94) at 10 years, and 0.9 (95% CI: 0.83-1.0) at 15 years. There were no significant differences in health states between patients by age when compared with U.S. controls. There was a statistically significant positive correlation between the results of the VAS and descriptive system. Significant trends in health dimensions over 15 years were increased problems with self-care and decreased problems with anxiety/depression, pain/discomfort, and performing usual activities. This study of EQ-5D is unique and demonstrates very high quality of life in patients long-term after breast-conserving surgery and radiation. These health states are comparable to the adult female U.S. population. These data will provide valuable patient utility information for informing decision analyses investigating new treatments in women with breast cancer. FAU - Freedman, Gary M AU - Freedman GM AD - Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA. Gary.Freedman@FCCC.edu FAU - Li, Tianyu AU - Li T FAU - Anderson, Penny R AU - Anderson PR FAU - Nicolaou, Nicos AU - Nicolaou N FAU - Konski, Andre AU - Konski A LA - eng GR - P30 CA006927/CA/NCI NIH HHS/United States GR - P30 CA006927-46/CA/NCI NIH HHS/United States PT - Journal Article DEP - 20090920 PL - Netherlands TA - Breast Cancer Res Treat JT - Breast cancer research and treatment JID - 8111104 SB - IM MH - Activities of Daily Living MH - Adolescent MH - Adult MH - Aged MH - *Breast Neoplasms/psychology/therapy MH - Female MH - *Health Status MH - Health Status Indicators MH - Humans MH - Mastectomy MH - Middle Aged MH - *Outcome Assessment (Health Care) MH - *Quality of Life MH - Radiotherapy MH - Young Adult PMC - PMC2874617 MID - NIHMS145599 OID - NLM: NIHMS145599 OID - NLM: PMC2874617 EDAT- 2009/09/22 06:00 MHDA- 2010/08/21 06:00 CRDT- 2009/09/22 06:00 PHST- 2009/04/17 [received] PHST- 2009/09/10 [accepted] AID - 10.1007/s10549-009-0552-5 [doi] PST - ppublish SO - Breast Cancer Res Treat. 2010 Jun;121(2):519-26. doi: 10.1007/s10549-009-0552-5. Epub 2009 Sep 20. PMID- 19730290 OWN - NLM STAT- MEDLINE DA - 20090904 DCOM- 20090923 LR - 20150624 IS - 1529-4242 (Electronic) IS - 0032-1052 (Linking) VI - 124 IP - 3 DP - 2009 Sep TI - Discussion. A detailed analysis of the reduction mammaplasty learning curve: a statistical process model for approaching surgical performance improvement. PG - 715-6 LID - 10.1097/PRS.0b013e3181b17989 [doi] FAU - Hidalgo, David A AU - Hidalgo DA AD - dh@drdavidhidalgo.com LA - eng PT - Comment PT - Journal Article PL - United States TA - Plast Reconstr Surg JT - Plastic and reconstructive surgery JID - 1306050 SB - AIM SB - IM CON - Plast Reconstr Surg. 2009 Sep;124(3):706-14. PMID: 19730289 MH - *Clinical Competence MH - Data Interpretation, Statistical MH - Female MH - Humans MH - Learning MH - Mammaplasty/*education/standards MH - *Models, Statistical EDAT- 2009/09/05 06:00 MHDA- 2009/09/24 06:00 CRDT- 2009/09/05 06:00 AID - 10.1097/PRS.0b013e3181b17989 [doi] AID - 00006534-200909000-00004 [pii] PST - ppublish SO - Plast Reconstr Surg. 2009 Sep;124(3):715-6. doi: 10.1097/PRS.0b013e3181b17989. PMID- 19730289 OWN - NLM STAT- MEDLINE DA - 20090904 DCOM- 20090923 LR - 20150624 IS - 1529-4242 (Electronic) IS - 0032-1052 (Linking) VI - 124 IP - 3 DP - 2009 Sep TI - A detailed analysis of the reduction mammaplasty learning curve: a statistical process model for approaching surgical performance improvement. PG - 706-14 LID - 10.1097/PRS.0b013e3181b17a13 [doi] AB - BACKGROUND: The increased focus on quality and efficiency improvement within academic surgery has met with variable success among plastic surgeons. Traditional surgical performance metrics, such as morbidity and mortality, are insufficient to improve the majority of today's plastic surgical procedures. In-process analyses that allow rapid feedback to the surgeon based on surrogate markers may provide a powerful method for quality improvement. METHODS: The authors reviewed performance data from all bilateral reduction mammaplasties performed at their institution by eight surgeons between 1995 and 2007. Multiple linear regression analyses were conducted to determine the relative impact of key factors on operative time. Explanatory learning curve models were generated, and complication data were analyzed to elucidate clinical outcomes and trends. RESULTS: A total of 1068 procedures were analyzed. The mean operative time for bilateral reduction mammaplasty was 134 +/- 34 minutes, with a mean operative experience of 11 +/- 4.7 years and total resection volume of 1680 +/- 930 g. Multiple linear regression analyses showed that operative time (R = 0.57) was most closely related to surgeon experience and resection volume. The complication rate diminished in a logarithmic fashion with increasing surgeon experience and in a linear fashion with declining operative time. CONCLUSIONS: The results of this study suggest a three-phase learning curve in which complication rates, variance in operative time, and operative time all decrease with surgeon experience. In-process statistical analyses may represent the beginning of a new paradigm in academic surgical quality and efficiency improvement in low-risk surgical procedures. FAU - Carty, Matthew J AU - Carty MJ AD - Harvard Combined Plastic Surgery Residency Program, Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, USA. FAU - Chan, Rodney AU - Chan R FAU - Huckman, Robert AU - Huckman R FAU - Snow, Daniel AU - Snow D FAU - Orgill, Dennis P AU - Orgill DP LA - eng PT - Journal Article PL - United States TA - Plast Reconstr Surg JT - Plastic and reconstructive surgery JID - 1306050 SB - AIM SB - IM CIN - Plast Reconstr Surg. 2009 Sep;124(3):715-6. PMID: 19730290 MH - Adult MH - *Clinical Competence MH - Data Collection MH - Data Interpretation, Statistical MH - Female MH - Humans MH - Learning MH - Mammaplasty/*education/standards MH - *Models, Statistical MH - Quality Assurance, Health Care MH - Surgery, Plastic/education EDAT- 2009/09/05 06:00 MHDA- 2009/09/24 06:00 CRDT- 2009/09/05 06:00 AID - 10.1097/PRS.0b013e3181b17a13 [doi] AID - 00006534-200909000-00003 [pii] PST - ppublish SO - Plast Reconstr Surg. 2009 Sep;124(3):706-14. doi: 10.1097/PRS.0b013e3181b17a13. PMID- 19726385 OWN - NLM STAT- MEDLINE DA - 20090903 DCOM- 20100312 LR - 20131121 IS - 1538-0688 (Electronic) IS - 0190-535X (Linking) VI - 36 IP - 5 DP - 2009 Sep TI - In the moment: women speak about surgical treatment decision making days after a breast cancer diagnosis. PG - E257-65 LID - 10.1188/09.ONF.E257-E265 [doi] AB - PURPOSE/OBJECTIVES: To explore the pretreatment thoughts and behaviors of women newly diagnosed with breast cancer regarding their surgical treatment decision-making experience. RESEARCH APPROACH: Qualitative, descriptive. SETTING: A multispecialty breast center in the midwestern region of the United States. PARTICIPANTS: 18 English-speaking women, aged 37-87 years, mean of 12 days postdiagnosis of clinical stage 0-11 breast cancer. METHODOLOGIC APPROACH: Open to semistructured interviews were conducted during the period following surgical consultation but prior to surgical treatment. Transcribed interviews, originally analyzed to identify the psychological processes of women in response to breast cancer diagnosis, were additionally analyzed using directed content analysis focusing on women's thoughts and behaviors related to their surgical treatment decision-making process. MAIN RESEARCH VARIABLES: Breast cancer surgery and decision making pretreatment. FINDINGS: Women's pretreatment thoughts and behaviors related to surgical treatment decision making were characterized by information processing, contemplating options, and interacting with others. Breast cancer information was used by women before the surgical consultation and after treatment decisions had been made. Treatment options were contemplated and preferences formed often before the initial surgical consultation. Women associated having options with a better prognosis. Age was a factor primarily in the type of information women desired. CONCLUSIONS: Most women made their own surgical treatment decisions with ease, supported by the confidence instilled by their surgeons and oncology nurses. INTERPRETATION: The findings provide oncology nurses with insight regarding women's desire for and use of information and their contemplation of surgical options, therefore suggesting areas on which to focus clinical assessment and to test tailored interventions. FAU - Lally, Robin M AU - Lally RM AD - School of Nursing, University of Buffalo, New York, USA. rmlally@buffalo.edu LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Oncol Nurs Forum JT - Oncology nursing forum JID - 7809033 SB - IM SB - N MH - Adult MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/diagnosis/nursing/*psychology/*surgery MH - Decision Making MH - Emotions MH - Female MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - Interpersonal Relations MH - Mastectomy/nursing/psychology MH - Middle Aged MH - Motivation MH - Oncology Nursing/methods MH - Patient Education as Topic/methods MH - Patient Participation/*psychology MH - Qualitative Research EDAT- 2009/09/04 06:00 MHDA- 2010/03/13 06:00 CRDT- 2009/09/04 06:00 AID - 60479J6810742700 [pii] AID - 10.1188/09.ONF.E257-E265 [doi] PST - ppublish SO - Oncol Nurs Forum. 2009 Sep;36(5):E257-65. doi: 10.1188/09.ONF.E257-E265. PMID- 19609726 OWN - NLM STAT- MEDLINE DA - 20100217 DCOM- 20100603 LR - 20170220 IS - 1573-7292 (Electronic) IS - 1389-9600 (Linking) VI - 9 IP - 1 DP - 2010 Mar TI - On the development of a decision support intervention for mothers undergoing BRCA1/2 cancer genetic testing regarding communicating test results to their children. PG - 89-97 LID - 10.1007/s10689-009-9267-3 [doi] AB - Parent communication of BRCA1/2 test results to minor-age children is an important, yet understudied, clinical issue that is commonly raised in the management of familial cancer risk. Genetic counseling professionals and others who work with parents undergoing this form of testing often confront questions about the risks/benefits and timing of such disclosures, as well as the psychosocial impact of disclosure and nondisclosure on children's health and development. This paper briefly reviews literature on the prevalence and outcome of parent-child communication surrounding maternal BRCA1/2 test results. It also describes a formative research process that was used to develop a decision support intervention for mothers participating in genetic counseling and testing for BRCA1/2 mutations to address this issue, and highlights the conceptual underpinnings that guided and informed the intervention's development. The intervention consists of a print-based decision aid to facilitate parent education and counseling regarding if, when, and potentially how to disclose hereditary cancer risk information to children. We conclude with a summary of the role of social, behavioral, and decision science research to support the efforts of providers of familial cancer care regarding this important decision, and to improve the outcomes of cancer genetic testing for tested parents and their nontested children. FAU - Peshkin, Beth N AU - Peshkin BN AD - Jess & Mildred Fisher Center for Familial Cancer Research, Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007-2401, USA. peshkinb@georgetown.edu FAU - Demarco, Tiffani A AU - Demarco TA FAU - Tercyak, Kenneth P AU - Tercyak KP LA - eng GR - R01 HG002686/HG/NHGRI NIH HHS/United States GR - R03 HG003686/HG/NHGRI NIH HHS/United States GR - R01HG02686/HG/NHGRI NIH HHS/United States GR - R03HG003686/HG/NHGRI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20090717 PL - Netherlands TA - Fam Cancer JT - Familial cancer JID - 100898211 RN - 0 (BRCA1 Protein) SB - IM MH - Adaptation, Psychological MH - BRCA1 Protein/*genetics MH - Breast Neoplasms/diagnosis/*genetics MH - Child MH - Decision Making MH - Disclosure/legislation & jurisprudence MH - Female MH - Genetic Counseling/*legislation & jurisprudence MH - Genetic Predisposition to Disease/*genetics MH - Genetic Testing/*methods MH - Humans MH - Informed Consent/ethics MH - Mothers MH - Mutation MH - Patient Education as Topic MH - Physician's Role/psychology MH - Risk Assessment/methods PMC - PMC3556511 MID - NIHMS433351 OID - NLM: NIHMS433351 OID - NLM: PMC3556511 EDAT- 2009/07/18 09:00 MHDA- 2010/06/04 06:00 CRDT- 2009/07/18 09:00 PHST- 2009/01/28 [received] PHST- 2009/07/03 [accepted] AID - 10.1007/s10689-009-9267-3 [doi] PST - ppublish SO - Fam Cancer. 2010 Mar;9(1):89-97. doi: 10.1007/s10689-009-9267-3. Epub 2009 Jul 17. PMID- 19548125 OWN - NLM STAT- MEDLINE DA - 20100820 DCOM- 20101230 LR - 20141120 IS - 1559-131X (Electronic) IS - 1357-0560 (Linking) VI - 27 IP - 3 DP - 2010 Sep TI - Verification of a prolonged untreated natural history of breast cancer by the multigene assay. PG - 624-7 LID - 10.1007/s12032-009-9258-0 [doi] AB - Individualization of therapy for breast cancer patients has progressed significantly over the last 5 years. A 54-year-old female went over 2 years after her diagnosis of breast cancer with no treatment. The pathologic size, however, indicated that the tumor may not have progressed from diagnosis to operation. Due to the apparent lack of progression over 2 years without treatment, a multigene assay was ordered. The recurrence score was 15, indicating a less than 10% risk of distant recurrence at 10 years. The recurrence score also falls into the "low risk" category. The prolonged natural history of this breast cancer patient suggested an indolent cancer. The "low risk" recurrence score confirmed this history and indicated that adjuvant chemotherapy is probably not beneficial to this patient. FAU - Urbas, Tadeja AU - Urbas T AD - Breast Center, Maricopa Medical Center, Hogan Building, 2nd Floor, 2601 E Roosevelt Street, Phoenix, AZ 85008, USA. FAU - Agee, Neal AU - Agee N FAU - Bouton, Marcia E AU - Bouton ME FAU - Komenaka, Ian K AU - Komenaka IK LA - eng PT - Case Reports PT - Journal Article DEP - 20090623 PL - United States TA - Med Oncol JT - Medical oncology (Northwood, London, England) JID - 9435512 RN - 0 (Neoplasm Proteins) RN - 0 (RNA, Messenger) RN - 0 (RNA, Neoplasm) RN - 0 (Receptors, Estrogen) RN - 0 (Receptors, Progesterone) RN - EC 2.7.10.1 (ERBB2 protein, human) RN - EC 2.7.10.1 (Receptor, ErbB-2) SB - IM MH - Breast Neoplasms/*chemistry/genetics/pathology/surgery MH - Carcinoma, Lobular/*chemistry/genetics/pathology/surgery MH - Chemotherapy, Adjuvant MH - *Decision Support Techniques MH - Disease Progression MH - Female MH - Humans MH - Mastectomy MH - Middle Aged MH - Neoplasm Proteins/*genetics MH - Paraffin Embedding MH - RNA, Messenger/*analysis MH - RNA, Neoplasm/*analysis MH - Receptor, ErbB-2/analysis MH - Receptors, Estrogen/analysis MH - Receptors, Progesterone/analysis MH - Recurrence MH - Risk MH - Sentinel Lymph Node Biopsy MH - Tumor Burden EDAT- 2009/06/24 09:00 MHDA- 2010/12/31 06:00 CRDT- 2009/06/24 09:00 PHST- 2009/04/02 [received] PHST- 2009/06/08 [accepted] AID - 10.1007/s12032-009-9258-0 [doi] PST - ppublish SO - Med Oncol. 2010 Sep;27(3):624-7. doi: 10.1007/s12032-009-9258-0. Epub 2009 Jun 23. PMID- 19523124 OWN - NLM STAT- MEDLINE DA - 20090615 DCOM- 20090707 LR - 20161122 IS - 1468-0009 (Electronic) IS - 0887-378X (Linking) VI - 87 IP - 2 DP - 2009 Jun TI - The converged experience of risk and disease. PG - 417-42 LID - 10.1111/j.1468-0009.2009.00563.x [doi] AB - CONTEXT: One underappreciated consequence of modern clinical and public health practices is that the experience of being at risk for disease has been converging with the experience of disease itself. This is especially true for certain chronic diseases, in which early diagnosis and aggressive treatment have led to symptom-less and sign-less disease and in which treatments have largely been aimed at altering the disease's future course. METHODS: This article reviews the historical scholarship and medical literature pertinent to transformations in the chronic disease and risk experiences. FINDINGS: The experience of chronic disease increasingly resembles or has become indistinguishable from risk because of (1) new clinical interventions that have directly changed the natural history of disease; (2) increased biological, clinical, and epidemiological knowledge about the risk of chronic disease; (3) the recruitment of larger numbers into chronic disease diagnoses via new screening and diagnostic technology and disease definitions; (4) new ways of conceptualizing efficacy; and (5) intense diagnostic testing and medical interventions. CONCLUSIONS: The converged experience of risk and disease has led to some unsettling and generally underappreciated consequences that might be subjected to more clinical and policy reflection and response: (1) some puzzling trends in medical decision making, such as the steep and uniform increase in the numbers of women across a broad spectrum of risk/disease in breast cancer who have opted for prophylactic mastectomies; (2) a larger and highly mobilized disease/risk population, resulting in an expanded market for interventions and greater clout for disease advocates; (3) shifts in the perceived severity of the disease, with ripple effects on how people experience and understand their illness and risk of disease; and (4) interventions that promise both to reduce the risk of disease and to treat its symptoms. FAU - Aronowitz, Robert A AU - Aronowitz RA AD - University of Pennsylvania, Logan Hall, Rm. 303, 249 S. 36th Street, Philadelphia, PA 19104, USA. aronowit@wharton.upenn.edu LA - eng GR - G13 LM009587/LM/NLM NIH HHS/United States GR - G13 LM009587-01A1/LM/NLM NIH HHS/United States GR - 1G13 LM009587-01A1/LM/NLM NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PT - Review PL - United States TA - Milbank Q JT - The Milbank quarterly JID - 8607003 SB - IM MH - Attitude of Health Personnel MH - Chronic Disease/classification/*epidemiology/*prevention & control MH - Early Diagnosis MH - Evidence-Based Medicine/*organization & administration MH - Health Status MH - Humans MH - Mass Screening/trends MH - Medical History Taking/methods MH - Patient Care Planning/*trends MH - Patient Education as Topic/organization & administration MH - Primary Prevention/*trends MH - Risk Assessment/trends MH - Risk Factors MH - United States RF - 42 PMC - PMC2728027 MID - NIHMS109126 OID - NLM: NIHMS109126 OID - NLM: PMC2728027 EDAT- 2009/06/16 09:00 MHDA- 2009/07/08 09:00 CRDT- 2009/06/16 09:00 AID - MILQ563 [pii] AID - 10.1111/j.1468-0009.2009.00563.x [doi] PST - ppublish SO - Milbank Q. 2009 Jun;87(2):417-42. doi: 10.1111/j.1468-0009.2009.00563.x. PMID- 19473959 OWN - NLM STAT- MEDLINE DA - 20090703 DCOM- 20090724 LR - 20091111 IS - 1769-6917 (Electronic) IS - 0007-4551 (Linking) VI - 96 IP - 6 DP - 2009 Jun TI - [Influence of social and cultural patterns on decision-making in oncology]. PG - 733-9 LID - 10.1684/bdc.2009.0882 [doi] AB - Shared decision-making is based on the idea of an enlightened participation of the patient to the therapeutic decision process, especially when the ratio between risks and benefits of treatment options is uncertain. The physician owes to ponder the advantages and the inconveniences of chemotherapy, which can be enlightened by a discussion with the patient. Thus, neither shared decision-making nor decision tools are currently used in France. Our aim is to evaluate the variables that step in the therapeutic choice of French physicians concerning the adjuvant chemotherapy prescription in breast cancer. We focus on the impact of different medical cultures on decision processes and shared decision-making conceptions. A socio-anthropological study is carried out with the participation of six French medical centre. First results show the influence of local specificities, professional groups and individual sociocultural background of physicians. FAU - Soum-Pouyalet, F AU - Soum-Pouyalet F AD - Institut Bergonie, CLCC, 229, cours de l'Argonne, 33076 Bordeaux, France. soum-pouyalet@bergonie.org FAU - Regnier, V AU - Regnier V FAU - Querre, M AU - Querre M FAU - Jacquin, J-P AU - Jacquin JP FAU - Hubert, A AU - Hubert A FAU - Debled, M AU - Debled M LA - fre PT - English Abstract PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't TT - Influence des facteurs socioculturels dans la prise de decision medicale en cancerologie. PL - France TA - Bull Cancer JT - Bulletin du cancer JID - 0072416 SB - IM MH - Breast Neoplasms/*drug therapy/ethnology MH - Chemotherapy, Adjuvant MH - Consensus MH - *Culture MH - *Decision Making MH - Decision Support Techniques MH - Female MH - France MH - Humans MH - *Medical Oncology MH - *Patient Participation MH - Professional Practice MH - Risk Assessment EDAT- 2009/05/29 09:00 MHDA- 2009/07/25 09:00 CRDT- 2009/05/29 09:00 AID - bdc.2009.0882 [pii] AID - 10.1684/bdc.2009.0882 [doi] PST - ppublish SO - Bull Cancer. 2009 Jun;96(6):733-9. doi: 10.1684/bdc.2009.0882. PMID- 19407644 OWN - NLM STAT- MEDLINE DA - 20090501 DCOM- 20090609 LR - 20150624 IS - 1529-4242 (Electronic) IS - 0032-1052 (Linking) VI - 123 IP - 5 DP - 2009 May TI - A prospective, randomized, double-blind, controlled trial of continuous local anesthetic infusion in cosmetic breast augmentation: what lies beyond data? PG - 1636-7 LID - 10.1097/PRS.0b013e3181a07766 [doi] FAU - La Colla, Luca AU - La Colla L FAU - Mangano, Alberto AU - Mangano A FAU - Albertin, Andrea AU - Albertin A LA - eng PT - Comment PT - Letter PL - United States TA - Plast Reconstr Surg JT - Plastic and reconstructive surgery JID - 1306050 RN - 0 (Anesthetics, Local) SB - AIM SB - IM CON - Plast Reconstr Surg. 2008 Mar;121(3):711-5. PMID: 18317120 MH - Anesthetics, Local/*administration & dosage MH - Data Interpretation, Statistical MH - Double-Blind Method MH - Female MH - Humans MH - *Mammaplasty MH - Prospective Studies MH - Randomized Controlled Trials as Topic MH - Research Design EDAT- 2009/05/02 09:00 MHDA- 2009/06/10 09:00 CRDT- 2009/05/02 09:00 AID - 10.1097/PRS.0b013e3181a07766 [doi] AID - 00006534-200905000-00038 [pii] PST - ppublish SO - Plast Reconstr Surg. 2009 May;123(5):1636-7. doi: 10.1097/PRS.0b013e3181a07766. PMID- 19377163 OWN - NLM STAT- MEDLINE DA - 20090420 DCOM- 20090623 LR - 20090420 IS - 0926-9630 (Print) IS - 0926-9630 (Linking) VI - 142 DP - 2009 TI - Visualizing treatment options for breast reconstructive surgery. PG - 262-4 AB - We propose that high-fidelity animations enhanced with real-time 3d interactivity, that demonstrate various breast reconstruction procedures will assist in a patient's decision-making process. These computer based modules will in no way replace a consultation with the physician; instead they will be added to the armamentarium of patient education. FAU - Qualter, John AU - Qualter J AD - NYU School of Medicine, Division of Educational Informatics, New York, NY10016, USA. FAU - Fana, Melissa AU - Fana M FAU - Deluccia, Nicolette AU - Deluccia N FAU - Colen, Kari AU - Colen K FAU - Scharf, Carrie AU - Scharf C FAU - Hazen, Alexes AU - Hazen A LA - eng PT - Journal Article PL - Netherlands TA - Stud Health Technol Inform JT - Studies in health technology and informatics JID - 9214582 SB - T MH - Breast Neoplasms/*surgery MH - Computer Simulation MH - Female MH - Humans MH - Imaging, Three-Dimensional MH - *Patient Education as Topic MH - *Reconstructive Surgical Procedures EDAT- 2009/04/21 09:00 MHDA- 2009/06/24 09:00 CRDT- 2009/04/21 09:00 PST - ppublish SO - Stud Health Technol Inform. 2009;142:262-4. PMID- 19332586 OWN - NLM STAT- MEDLINE DA - 20090331 DCOM- 20091014 LR - 20161125 IS - 1473-4257 (Electronic) IS - 0306-6800 (Linking) VI - 35 IP - 4 DP - 2009 Apr TI - Informed choice requires information about both benefits and harms. PG - 268-9 LID - 10.1136/jme.2008.027961 [doi] AB - A study found that women participating in mammography screening were content with the programme and the paternalistic invitations that directly encourage participation and include a pre-specified time of appointment. We argue that this merely reflects that the information presented to the invited women is seriously biased in favour of participation. Women are not informed about the major harms of screening, and the decision to attend has already been made for them by a public authority. This short-circuits informed decision-making and the legislation on informed consent, and violates the autonomy of the women. Screening invitations must present both benefits and harms in a balanced fashion, and should offer, not encourage, participation. It should be stated clearly that the choice not to participate is as sensible as the choice to do so. To allow this to happen, the responsibility for the screening programmes must be separated from the responsibility for the information material. FAU - Jorgensen, K J AU - Jorgensen KJ AD - The Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark. kj@cochrane.dk FAU - Brodersen, J AU - Brodersen J FAU - Hartling, O J AU - Hartling OJ FAU - Nielsen, M AU - Nielsen M FAU - Gotzsche, P C AU - Gotzsche PC LA - eng PT - Journal Article PL - England TA - J Med Ethics JT - Journal of medical ethics JID - 7513619 SB - E SB - IM MH - Bias (Epidemiology) MH - Breast Neoplasms/diagnostic imaging MH - Decision Making/*ethics MH - Decision Support Techniques MH - *Early Detection of Cancer MH - Female MH - Humans MH - Informed Consent/*ethics/psychology MH - Mammography/*ethics MH - Patient Education as Topic MH - Risk Factors EDAT- 2009/04/01 09:00 MHDA- 2009/10/15 06:00 CRDT- 2009/04/01 09:00 AID - 35/4/268 [pii] AID - 10.1136/jme.2008.027961 [doi] PST - ppublish SO - J Med Ethics. 2009 Apr;35(4):268-9. doi: 10.1136/jme.2008.027961. PMID- 19329775 OWN - NLM STAT- MEDLINE DA - 20090727 DCOM- 20100923 LR - 20090727 IS - 0272-989X (Print) IS - 0272-989X (Linking) VI - 29 IP - 4 DP - 2009 Jul-Aug TI - Is there a role for decision aids in advanced breast cancer? PG - 475-82 LID - 10.1177/0272989X09333124 [doi] AB - BACKGROUND: A diagnosis of metastatic breast cancer (BC) forces patients and providers to make difficult treatment decisions. OBJECTIVE: To pilot test a decision aid (DA) for advanced BC. DESIGN: Pretest, posttest study. SETTING: Two academic cancer centers in Boston, Massachusetts. PATIENTS: Fifty patients diagnosed with advanced BC. INTERVENTION: A patient DA that consisted of a 30-minute DVD and booklet. MEASUREMENTS: Patients were surveyed at baseline, after the intervention, and at 3 months. MEASURES: included use and acceptability of DA, distress, treatment goals, and preference for and actual participation in decisions. Physicians were surveyed at baseline and 3 months. Measures included treatment goals, assessment of patients' experience with treatments, and patients' preference for and actual participation in decisions. RESULTS: Thirty-two patients (64%) enrolled and completed the baseline survey, 30 completed the postvideo survey, and 25 completed the 3-month survey. The DA was acceptable and did not increase distress. The majority desired to share decision making with their doctor. Only 38% achieved their desired level of participation. At baseline, agreement between patients and providers on the main goal of treatment (lengthen life v. relieve symptoms) was 50% (kappa = -0.045, P = 0.71), and at 3 months it was 74% (kappa = 0.125, P = 0.48). CONCLUSIONS: . It is feasible to perform a clinical trial of a DA with advanced BC patients. Most participants wanted to participate in decisions about their care and found the DA acceptable. This study highlights several issues in developing and implementing DAs in this vulnerable population facing complex decisions. FAU - Sepucha, Karen R AU - Sepucha KR AD - Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. ksepucha@partners.org FAU - Ozanne, Elissa M AU - Ozanne EM FAU - Partridge, Ann H AU - Partridge AH FAU - Moy, Beverly AU - Moy B LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20090327 PL - United States TA - Med Decis Making JT - Medical decision making : an international journal of the Society for Medical Decision Making JID - 8109073 SB - IM MH - Adult MH - Aged MH - Breast Neoplasms/*psychology/therapy MH - Choice Behavior MH - Confidence Intervals MH - Data Collection MH - Decision Making MH - *Decision Support Techniques MH - Female MH - Humans MH - Middle Aged MH - Neoplasm Metastasis MH - *Patient Education as Topic MH - Patient Participation MH - Patients/*psychology MH - Pilot Projects EDAT- 2009/03/31 09:00 MHDA- 2010/09/24 06:00 CRDT- 2009/03/31 09:00 AID - 0272989X09333124 [pii] AID - 10.1177/0272989X09333124 [doi] PST - ppublish SO - Med Decis Making. 2009 Jul-Aug;29(4):475-82. doi: 10.1177/0272989X09333124. Epub 2009 Mar 27. PMID- 19291763 OWN - NLM STAT- MEDLINE DA - 20090331 DCOM- 20090617 LR - 20161122 IS - 1552-4833 (Electronic) IS - 1552-4825 (Linking) VI - 149A IP - 4 DP - 2009 Feb 15 TI - Interventions to improve patient education regarding multifactorial genetic conditions: a systematic review. PG - 819-30 LID - 10.1002/ajmg.a.32723 [doi] AB - The careful education of patients with complex genetic disease is essential. However, healthcare providers often have limited time to spend providing thorough genetic education. Furthermore, the number of healthcare professionals possessing strong genetics training may be inadequate to meet increasing patient demands. Due to such constraints, several interventions have been investigated over the past decade to identify potential resources for the facilitation of this specific type of patient education. This systematic literature review of these interventions for patient education attempts to elucidate the answer to the question: is there sufficient evidence for best practice for delivering genetic information to patients with multifactorial conditions? The various interventions (CD-ROM, group counseling, video/decision aid, and miscellaneous) were analyzed in terms of quality criteria and achievement of specific outcomes and were rated according to the Stetler model for evidence-based practice. Seven main outcomes were evaluated: (1) objective and subjective knowledge assessment, (2) psychological measures (general anxiety, depression, stress, cancer worry), (3) satisfaction/effectiveness of intervention, (4) time spent in counseling (time spent on basic genetic information vs. specific concerns), (5) decision-making/intent to undergo genetic testing, (6) treatment choice and value of that choice, and, finally (7) risk perception. Overall, the computer interventions resulted in more significant findings that were beneficial than any other category followed by the video category, although the group and miscellaneous categories did not measure all of the outcomes reported by the other two categories. Nevertheless, while these groups had neutral or negative findings in some of the outcomes, the computer intervention group showed significant improvement in genetics knowledge, psychological measures, satisfaction/effectiveness, time spent with counselor, and decision/intent to undergo testing. FAU - Meilleur, Katherine G AU - Meilleur KG AD - Johns Hopkins University, School of Nursing, Bethesda, Maryland, USA. meilleurk@mail.nih.gov FAU - Littleton-Kearney, Marguerite T AU - Littleton-Kearney MT LA - eng GR - R01 NR005339/NR/NINR NIH HHS/United States GR - R01 NR005339-09/NR/NINR NIH HHS/United States GR - Z99 NS999999/Intramural NIH HHS/United States PT - Journal Article PT - Review PL - United States TA - Am J Med Genet A JT - American journal of medical genetics. Part A JID - 101235741 SB - IM MH - Breast Neoplasms/genetics/psychology MH - Computer-Assisted Instruction MH - Decision Making MH - Evidence-Based Practice MH - Female MH - Genetic Counseling/methods/psychology MH - *Genetic Diseases, Inborn/psychology MH - Humans MH - Knowledge MH - Male MH - Patient Education as Topic/*methods MH - Patient Satisfaction MH - Perception MH - Risk Factors RF - 24 PMC - PMC2776676 MID - NIHMS156000 OID - NLM: NIHMS156000 OID - NLM: PMC2776676 EDAT- 2009/03/18 09:00 MHDA- 2009/06/18 09:00 CRDT- 2009/03/18 09:00 AID - 10.1002/ajmg.a.32723 [doi] PST - ppublish SO - Am J Med Genet A. 2009 Feb 15;149A(4):819-30. doi: 10.1002/ajmg.a.32723. PMID- 19267384 OWN - NLM STAT- MEDLINE DA - 20091229 DCOM- 20100322 LR - 20161122 IS - 1099-1611 (Electronic) IS - 1057-9249 (Linking) VI - 19 IP - 1 DP - 2010 Jan TI - Development of decision-support intervention for Black women with breast cancer. PG - 62-70 LID - 10.1002/pon.1530 [doi] AB - BACKGROUND: Adjuvant therapy improves breast cancer survival but is underutilized by Black women. Few interventions have addressed this problem. This preliminary report describes the process we used to develop a decision-support intervention for Black women eligible for adjuvant therapy. Aims were to use qualitative methods to describe factors that influence Black women's adjuvant therapy decisions, use these formative data to develop messages for a treatment decision-support intervention, and pilot test the acceptability and utility of the intervention with community members and newly diagnosed women. METHODS: Thirty-four in-depth interviews were conducted with breast cancer patients in active treatment, survivors and cancer providers to gather qualitative data. Participant ages ranged from 38 to 69 years. A cultural framework was used to analyze the data and to inform intervention messages. Most women relied on their providers for treatment recommendations. Several women reported problems communicating with providers and felt unprepared to ask questions and discuss adjuvant treatment options. Other factors related to treatment experiences were: spiritual coping, collectivism and sharing breast cancer experiences with other Black survivors. RESULTS: Using these formative data, we developed an intervention that is survivor-based and includes an in-person session which incorporates sharing personal stories, communication skills training and decision support. Intervention materials were reviewed by community members, researchers/clinicians and patients newly diagnosed with breast cancer. CONCLUSION: Patients reported satisfaction with the intervention and felt better prepared to talk with providers. The intervention will be tested in a randomized trial to enhance decision support and increase use of indicated adjuvant treatment. CI - (c) 2009 John Wiley & Sons Ltd. FAU - Sheppard, Vanessa B AU - Sheppard VB AD - Cancer Control Program, Georgetown University, Washington, DC 20007, USA. vls3@georgetown.edu FAU - Williams, Karen Patricia AU - Williams KP FAU - Harrison, Toni Michelle AU - Harrison TM FAU - Jennings, Yvonne AU - Jennings Y FAU - Lucas, Wanda AU - Lucas W FAU - Stephen, Juleen AU - Stephen J FAU - Robinson, Dana AU - Robinson D FAU - Mandelblatt, Jeanne S AU - Mandelblatt JS FAU - Taylor, Kathryn L AU - Taylor KL LA - eng GR - R01 CA127617/CA/NCI NIH HHS/United States GR - K05 CA096940-07/CA/NCI NIH HHS/United States GR - U10 CA084131-05S1/CA/NCI NIH HHS/United States GR - U10 CA084131/CA/NCI NIH HHS/United States GR - KO5 CA96940/CA/NCI NIH HHS/United States GR - K05 CA096940/CA/NCI NIH HHS/United States PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - England TA - Psychooncology JT - Psycho-oncology JID - 9214524 SB - IM MH - Adult MH - African Continental Ancestry Group/*psychology MH - Aged MH - Attitude to Health MH - Breast Neoplasms/*ethnology/pathology/psychology/*therapy MH - Chemotherapy, Adjuvant/*psychology MH - Communication MH - *Decision Making MH - Female MH - Humans MH - Mastectomy/*psychology MH - Mastectomy, Segmental/*psychology MH - Middle Aged MH - Motivation MH - Neoplasm Staging MH - Patient Acceptance of Health Care/psychology MH - Patient Education as Topic MH - Patient Satisfaction MH - Physician-Patient Relations MH - Pilot Projects MH - Radiotherapy, Adjuvant/*psychology MH - Social Support MH - Spirituality MH - Survivors/*psychology PMC - PMC3136087 MID - NIHMS127369 OID - NLM: NIHMS127369 OID - NLM: PMC3136087 EDAT- 2009/03/10 09:00 MHDA- 2010/03/23 06:00 CRDT- 2009/03/10 09:00 AID - 10.1002/pon.1530 [doi] PST - ppublish SO - Psychooncology. 2010 Jan;19(1):62-70. doi: 10.1002/pon.1530. PMID- 19210013 OWN - NLM STAT- MEDLINE DA - 20090212 DCOM- 20090326 LR - 20170220 IS - 0278-6133 (Print) IS - 0278-6133 (Linking) VI - 28 IP - 1 DP - 2009 Jan TI - Randomized trial of a decision aid for BRCA1/BRCA2 mutation carriers: impact on measures of decision making and satisfaction. PG - 11-9 LID - 10.1037/a0013147 [doi] AB - OBJECTIVE: Genetic testing is increasingly part of routine clinical care for women with a family history of breast cancer. Given their substantially elevated risk for breast cancer, BRCA1/BRCA2 mutation carriers must make the difficult decision whether or not to opt for risk reducing mastectomy. To help BRCA1/2 carriers make this decision, the authors developed a computer-based interactive decision aid that was tested against usual care in a randomized controlled trial. DESIGN: After the completion of genetic counseling, 214 female (aged 21-75) BRCA1/BRCA2 mutation carriers were randomized to Usual Care (UC; N = 114) or Usual Care plus Decision Aid (DA; N = 100) arms. UC participants received no additional intervention. DA participants were sent the CD-ROM DA to view at home. MAIN OUTCOME MEASURES: The authors measured final management decision, decisional conflict, decisional satisfaction, and receipt of risk reducing mastectomy at 1-, 6-, and 12-months postrandomization. RESULTS: Longitudinal analyses revealed that the DA was effective among carriers who were initially undecided about how to manage their breast cancer risk. Within this group, the DA led to an increased likelihood of reaching a management decision (OR = 3.09, 95% CI = 1.62, 5.90; p < .001), decreased decisional conflict (B = -.46, z = -3.1, p <002), and increased satisfaction (B = .27, z = 3.1, p = .002) compared to UC. Among carriers who had already made a management decision by the time of randomization, the DA had no benefit relative to UC. CONCLUSION: These results demonstrate that BRCA1/BRCA2 mutation carriers who are having difficulty making a breast cancer risk management decision can benefit from adjunct decision support. CI - (c) 2009 APA, all rights reserved. FAU - Schwartz, Marc D AU - Schwartz MD AD - Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA. schwartm@georgetown.edu FAU - Valdimarsdottir, Heiddis B AU - Valdimarsdottir HB FAU - DeMarco, Tiffani A AU - DeMarco TA FAU - Peshkin, Beth N AU - Peshkin BN FAU - Lawrence, William AU - Lawrence W FAU - Rispoli, Jessica AU - Rispoli J FAU - Brown, Karen AU - Brown K FAU - Isaacs, Claudine AU - Isaacs C FAU - O'Neill, Suzanne AU - O'Neill S FAU - Shelby, Rebecca AU - Shelby R FAU - Grumet, Sherry C AU - Grumet SC FAU - McGovern, Margaret M AU - McGovern MM FAU - Garnett, Sarah AU - Garnett S FAU - Bremer, Heather AU - Bremer H FAU - Leaman, Suzanne AU - Leaman S FAU - O'Mara, Kathryn AU - O'Mara K FAU - Kelleher, Sarah AU - Kelleher S FAU - Komaridis, Kathryn AU - Komaridis K LA - eng GR - R01 CA082346/CA/NCI NIH HHS/United States GR - R01 CA01846/CA/NCI NIH HHS/United States PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural PL - United States TA - Health Psychol JT - Health psychology : official journal of the Division of Health Psychology, American Psychological Association JID - 8211523 SB - IM MH - Adult MH - Aged MH - Breast Neoplasms/*genetics MH - *Decision Making MH - Female MH - *Genes, BRCA1 MH - *Genes, BRCA2 MH - Genetic Counseling MH - Genetic Testing/*psychology MH - Humans MH - Mastectomy MH - Middle Aged MH - *Patient Satisfaction MH - Risk Assessment PMC - PMC3580845 MID - NIHMS442299 OID - NLM: NIHMS442299 OID - NLM: PMC3580845 EDAT- 2009/02/13 09:00 MHDA- 2009/03/27 09:00 CRDT- 2009/02/13 09:00 AID - 2009-00026-004 [pii] AID - 10.1037/a0013147 [doi] PST - ppublish SO - Health Psychol. 2009 Jan;28(1):11-9. doi: 10.1037/a0013147. PMID- 19209172 OWN - NLM STAT- MEDLINE DA - 20090219 DCOM- 20090323 LR - 20170220 IS - 1532-1827 (Electronic) IS - 0007-0920 (Linking) VI - 100 IP - 4 DP - 2009 Feb 24 TI - Contextual factors in shared decision making: a randomised controlled trial in women with a strong suspicion of breast cancer. PG - 590-7 LID - 10.1038/sj.bjc.6604916 [doi] AB - Decision aids in North American breast cancer outpatients have been shown to assist with treatment decision making and reduce decisional conflict. To date, appropriate delivery formats to effectively increase patient participation in newly diagnosed breast cancer inpatients have not been investigated in the context of German health care provision. The impact of a decision aid intervention was studied in patients (n=111) with a strong suspicion of breast cancer in a randomised controlled trial. The primary outcome variable was decisional conflict. Participants were followed up 1 week post-intervention with a retention rate of 92%. Analyses revealed that the intervention group felt better informed (eta(p)(2)=0.06) but did not experience an overall reduction in decisional conflict as compared with the control group. The intervention had no effect on uptake rates of treatment options, length of consultation with the surgeon, time point of treatment decision making, perceived involvement in decision making, neither decision related nor general patient satisfaction. Patients who received the decision aid intervention experienced a small benefit with regards to how informed they felt about advantages and disadvantages of relevant treatment options. Results are discussed in terms of contextual factors and individual differences as moderators of treatment decision aid effectiveness. FAU - Vodermaier, A AU - Vodermaier A AD - Department of Obstetrics and Gynaecology-Grosshadern, University of Munich, Marchioninistr. 15, Munich 81377, Germany. avoderma@psych.ubc.ca FAU - Caspari, C AU - Caspari C FAU - Koehm, J AU - Koehm J FAU - Kahlert, S AU - Kahlert S FAU - Ditsch, N AU - Ditsch N FAU - Untch, M AU - Untch M LA - eng PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20090210 PL - England TA - Br J Cancer JT - British journal of cancer JID - 0370635 SB - IM MH - Adult MH - Aged MH - Breast Neoplasms/diagnosis/*psychology/therapy MH - *Decision Making MH - Female MH - Germany MH - Humans MH - Middle Aged MH - Patient Participation MH - Patient Satisfaction MH - Referral and Consultation MH - Young Adult PMC - PMC2653746 OID - NLM: PMC2653746 EDAT- 2009/02/12 09:00 MHDA- 2009/03/24 09:00 CRDT- 2009/02/12 09:00 AID - 6604916 [pii] AID - 10.1038/sj.bjc.6604916 [doi] PST - ppublish SO - Br J Cancer. 2009 Feb 24;100(4):590-7. doi: 10.1038/sj.bjc.6604916. Epub 2009 Feb 10. PMID- 19114703 OWN - NLM STAT- MEDLINE DA - 20090202 DCOM- 20090219 LR - 20151119 IS - 1527-7755 (Electronic) IS - 0732-183X (Linking) VI - 27 IP - 4 DP - 2009 Feb 01 TI - Can women with early-stage breast cancer make an informed decision for mastectomy? PG - 519-25 LID - 10.1200/JCO.2008.16.6215 [doi] AB - PURPOSE: The purpose of this study was to measure the degree to which informed women chose mastectomy, and to reveal their reasons for this choice. PATIENTS AND METHODS: This was a prospective cohort study of patients radiographically and pathologically eligible for either mastectomy or breast-conserving surgery (BCS; n = 125). Participants completed questionnaires at three time points: baseline, after viewing a decision aid, and after a surgical consultation. Questionnaires assessed clinical history, preference for participation in decision making, information comprehension, values, decisional conflict, and preferred treatment. RESULTS: Of 125 participants, 44 (35%) chose mastectomy. Most understood that BCS and mastectomy offer an equivalent survival benefit (98%) and that BCS has a slightly higher local recurrence risk (63%); most accurately identified the magnitude of ipsilateral local recurrence risk (91%). Values assigned to three treatment attributes/outcomes ("remove breast for peace of mind," "avoid radiation," and "keep breast") clearly discriminated between patients choosing mastectomy or BCS. High decisional conflict scores improved after both the decision aid and surgical consultation. CONCLUSION: Although conventional wisdom may view BCS as the preferred treatment, a notable proportion of well informed women choose mastectomy. Whereas prior studies have linked objective factors to treatment choice, this study reveals subjective preferences that underlie decision making. The systematic use of a decision aid before the surgical consultation may help women make informed, values-based decisions, while clearly reducing decisional conflict. FAU - Collins, E Dale AU - Collins ED AD - Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA. e.dale.collins@hitchcock.org FAU - Moore, Caroline P AU - Moore CP FAU - Clay, Kate F AU - Clay KF FAU - Kearing, Stephen A AU - Kearing SA FAU - O'Connor, Annette M AU - O'Connor AM FAU - Llewellyn-Thomas, Hilary A AU - Llewellyn-Thomas HA FAU - Barth, Richard J Jr AU - Barth RJ Jr FAU - Sepucha, Karen R AU - Sepucha KR LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20081229 PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 SB - IM CIN - J Clin Oncol. 2009 Oct 20;27(30):e158-9; author reply e160-3. PMID: 19687330 CIN - J Clin Oncol. 2009 Feb 1;27(4):484-6. PMID: 19114690 MH - Breast Neoplasms/*surgery MH - Choice Behavior MH - Cohort Studies MH - *Decision Making MH - Education MH - Female MH - Health Knowledge, Attitudes, Practice MH - Humans MH - *Mastectomy MH - *Mastectomy, Segmental MH - Middle Aged MH - Patient Education as Topic MH - *Patient Participation MH - Patient Satisfaction MH - Prospective Studies MH - Surveys and Questionnaires EDAT- 2008/12/31 09:00 MHDA- 2009/02/20 09:00 CRDT- 2008/12/31 09:00 AID - JCO.2008.16.6215 [pii] AID - 10.1200/JCO.2008.16.6215 [doi] PST - ppublish SO - J Clin Oncol. 2009 Feb 1;27(4):519-25. doi: 10.1200/JCO.2008.16.6215. Epub 2008 Dec 29. PMID- 19114690 OWN - NLM STAT- MEDLINE DA - 20090202 DCOM- 20090219 LR - 20091021 IS - 1527-7755 (Electronic) IS - 0732-183X (Linking) VI - 27 IP - 4 DP - 2009 Feb 01 TI - When informed, all women do not prefer breast conservation. PG - 484-6 LID - 10.1200/JCO.2008.19.5057 [doi] FAU - Throckmorton, Alyssa D AU - Throckmorton AD FAU - Esserman, Laura J AU - Esserman LJ LA - eng PT - Comment PT - Editorial DEP - 20081229 PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 SB - IM CON - J Clin Oncol. 2009 Feb 1;27(4):519-25. PMID: 19114703 CIN - J Clin Oncol. 2009 Oct 20;27(30):e158-9; author reply e160-3. PMID: 19687330 MH - Breast Neoplasms/*surgery MH - Decision Making MH - Female MH - Humans MH - *Mastectomy, Segmental MH - Patient Education as Topic MH - Patients/*psychology EDAT- 2008/12/31 09:00 MHDA- 2009/02/20 09:00 CRDT- 2008/12/31 09:00 AID - JCO.2008.19.5057 [pii] AID - 10.1200/JCO.2008.19.5057 [doi] PST - ppublish SO - J Clin Oncol. 2009 Feb 1;27(4):484-6. doi: 10.1200/JCO.2008.19.5057. Epub 2008 Dec 29. PMID- 19072459 OWN - NLM STAT- MEDLINE DA - 20081216 DCOM- 20090330 LR - 20160701 IS - 1745-5065 (Electronic) IS - 1745-5057 (Linking) VI - 4 IP - 6 DP - 2008 Nov TI - Ductal carcinoma in situ of the breast: 11 reasons to consider treatment with excision alone. PG - 565-77 LID - 10.2217/17455057.4.6.565 [doi] AB - For the last 15 years, there has been a vigorous ongoing debate as to whether or not all conservatively treated patients with ductal carcinoma in situ (DCIS) require radiation therapy following excision or whether selected patients with DCIS can be treated by excision alone. At just about all breast cancer symposia where DCIS is discussed, experts are assigned to debate the pros and cons of radiation therapy after excision. The debate is often heated. This article outlines numerous reasons to consider excision alone in the treatment of selected DCIS patients. FAU - Silverstein, Melvin J AU - Silverstein MJ AD - Hoag Hospital Breast Program, Hoag Memorial Hospital Presbyterian, One Hoag Drive, Newport Beach, CA 92658, USA. melsilver9@aol.com LA - eng PT - Journal Article PL - United States TA - Womens Health (Lond) JT - Women's health (London, England) JID - 101271249 SB - IM CIN - Womens Health (Lond). 2008 Nov;4(6):579-81. PMID: 19072460 MH - Breast Neoplasms/epidemiology/psychology/radiotherapy/*surgery MH - Carcinoma, Ductal, Breast/epidemiology/psychology/radiotherapy/*surgery MH - Decision Making MH - Decision Support Techniques MH - Female MH - Humans MH - *Mastectomy, Segmental MH - Neoplasm Recurrence, Local/prevention & control/radiotherapy/surgery MH - Prognosis MH - Randomized Controlled Trials as Topic MH - Survival Analysis EDAT- 2008/12/17 09:00 MHDA- 2009/03/31 09:00 CRDT- 2008/12/17 09:00 AID - 10.2217/17455057.4.6.565 [doi] PST - ppublish SO - Womens Health (Lond). 2008 Nov;4(6):565-77. doi: 10.2217/17455057.4.6.565. PMID- 18999286 OWN - NLM STAT- MEDLINE DA - 20081112 DCOM- 20100108 LR - 20161122 IS - 1942-597X (Electronic) IS - 1559-4076 (Linking) DP - 2008 Nov 06 TI - Toward decision support for breast reconstruction: automated calculation of symmetry measure on clinical photographs. PG - 1045 AB - The quality of life of breast cancer survivors is maintained by minimizing adverse effects on their physical appearance. In this study, we present an automated method for computing a common measure of breast symmetry, the normalized Breast Retraction Assessment (pBRA), from routine clinical photographs taken to document breast reconstruction procedures. FAU - Dabeer, Mugdha AU - Dabeer M AD - University of Texas, Department of Biomedical Engineering, Austin, TX, USA. FAU - Kyrish, Matthew AU - Kyrish M FAU - Kim, Min Soon AU - Kim MS FAU - Reyes, Peter AU - Reyes P FAU - Udpa, Nitin AU - Udpa N FAU - Reece, Gregory P AU - Reece GP FAU - Markey, Mia K AU - Markey MK LA - eng GR - R21 CA109040/CA/NCI NIH HHS/United States GR - R21 CA109040-01A1/CA/NCI NIH HHS/United States PT - Journal Article DEP - 20081106 PL - United States TA - AMIA Annu Symp Proc JT - AMIA ... Annual Symposium proceedings. AMIA Symposium JID - 101209213 SB - IM MH - Breast/*pathology/*surgery MH - *Decision Support Systems, Clinical MH - Female MH - Humans MH - Image Interpretation, Computer-Assisted/*methods MH - Mastectomy/*methods MH - Pattern Recognition, Automated/*methods MH - Photography/*methods MH - Reconstructive Surgical Procedures/methods MH - Surgery, Computer-Assisted/*methods EDAT- 2008/11/13 09:00 MHDA- 2010/01/09 06:00 CRDT- 2008/11/13 09:00 PHST- 2008/03/14 [received] PHST- 2008/07/16 [revised] PST - epublish SO - AMIA Annu Symp Proc. 2008 Nov 6:1045. PMID- 18928767 OWN - NLM STAT- MEDLINE DA - 20081020 DCOM- 20090522 LR - 20081020 IS - 0009-739X (Print) IS - 0009-739X (Linking) VI - 84 IP - 4 DP - 2008 Oct TI - [Skin-sparing mastectomy: an alternative to conventional mastectomy in breast cancer]. PG - 181-7 AB - Women who require or desire mastectomy for breast cancer one option should be immediate breast reconstruction. Skin-sparing mastectomy (SSM) describes the surgery that maximises breast skin and infra- mammary fold preservation, significantly improves the symmetry and natural appearance and a more satisfied patient. In multiple studies, SSM seems to be oncologically safe in patients undergoing mastectomy for invasive T1-T2 tumours, multicentric tumours, ductal carcinoma in situ or risk-reduction. However, the technique should be avoided in patients with inflammatory breast cancer or in those with extensive tumour involvement of the skin. SSM with nipple areola complex preservation appears to be oncologically safe, providing that the tumour is not close to the nipple and the retro-areolar tissue is free of tumour. Though adjuvant radiotherapy is not an absolute contraindication to SSM, it should be used with caution since it decreases the final cosmetic result. FAU - Ramos Boyero, Manuel AU - Ramos Boyero M AD - Departamento de Cirugia, Unidad de Patologia Mamaria, Hospital Universitario de Salamanca, Salamanca, Espana. mramos@usal.es LA - spa PT - Comparative Study PT - English Abstract PT - Journal Article PT - Review TT - La mastectomia ahorradora de piel como alternativa a la mastectomia estandar en el cancer de mama. PL - Spain TA - Cir Esp JT - Cirugia espanola JID - 1254104 SB - IM MH - Breast Implants MH - Breast Neoplasms/drug therapy/radiotherapy/*surgery MH - Carcinoma in Situ/radiotherapy/*surgery MH - Carcinoma, Ductal, Breast/drug therapy/radiotherapy/*surgery MH - Data Interpretation, Statistical MH - Esthetics MH - Female MH - Follow-Up Studies MH - Humans MH - *Mastectomy, Subcutaneous/contraindications/methods MH - Neoplasm Recurrence, Local/surgery MH - Nipples MH - Radiotherapy, Adjuvant MH - Reconstructive Surgical Procedures MH - Retrospective Studies MH - Time Factors MH - Treatment Outcome RF - 59 EDAT- 2008/10/22 09:00 MHDA- 2009/05/23 09:00 CRDT- 2008/10/22 09:00 AID - S0009-739X(08)72617-4 [pii] PST - ppublish SO - Cir Esp. 2008 Oct;84(4):181-7. PMID- 18825616 OWN - NLM STAT- MEDLINE DA - 20081103 DCOM- 20090123 LR - 20160526 IS - 0743-684X (Print) IS - 0743-684X (Linking) VI - 24 IP - 8 DP - 2008 Nov TI - Recipient vessel exposure in the axilla during microvascular breast reconstruction. PG - 595-8 LID - 10.1055/s-0028-1090605 [doi] AB - Over the years, the favored recipient vessels for microvascular breast reconstruction have changed from the thoracodorsal to the internal mammary vessels, mainly due to the deep position and poor exposure of the vessels in the axilla and all the technical difficulties this reflects. We used the simple maneuver of arm adduction during microvascular anastomoses in the axilla and compared it with the conventional method of abducted arm regarding the exposure of the vessels, the position of the operator and the assistant, and the operative time. We found that this innovation considerably improved the exposure of the vessels and the operator's position, facilitating easier and faster anastomoses. FAU - Gravvanis, Andreas AU - Gravvanis A AD - St. Andrews Centre for Plastic Surgery, Broomfield Hospital, United Kingdom. gravvani@yahoo.com FAU - Caulfield, Robert H AU - Caulfield RH FAU - Ramakrishnan, Venkat AU - Ramakrishnan V FAU - Niranjan, Niri AU - Niranjan N LA - eng PT - Comparative Study PT - Journal Article DEP - 20080929 PL - United States TA - J Reconstr Microsurg JT - Journal of reconstructive microsurgery JID - 8502670 SB - IM MH - *Anastomosis, Surgical MH - *Axilla/surgery MH - Breast/*blood supply MH - Data Interpretation, Statistical MH - Female MH - Humans MH - Mammaplasty/*methods MH - Microsurgery/*methods MH - Middle Aged MH - Prospective Studies MH - Surgical Flaps/*blood supply MH - Time Factors MH - *Vascular Surgical Procedures EDAT- 2008/10/01 09:00 MHDA- 2009/01/24 09:00 CRDT- 2008/10/01 09:00 AID - 10.1055/s-0028-1090605 [doi] PST - ppublish SO - J Reconstr Microsurg. 2008 Nov;24(8):595-8. doi: 10.1055/s-0028-1090605. Epub 2008 Sep 29. PMID- 18816317 OWN - NLM STAT- MEDLINE DA - 20080925 DCOM- 20081110 LR - 20170220 IS - 1369-7625 (Electronic) IS - 1369-6513 (Linking) VI - 11 IP - 3 DP - 2008 Sep TI - Supporting participation in clinical research: decision aids for trial recruitment? PG - 205-7 LID - 10.1111/j.1369-7625.2008.00519.x [doi] FAU - Entwistle, Vikki AU - Entwistle V LA - eng PT - Comment PT - Editorial PL - England TA - Health Expect JT - Health expectations : an international journal of public participation in health care and health policy JID - 9815926 SB - IM CON - Health Expect. 2008 Sep;11(3):220-31. PMID: 18816319 CON - Health Expect. 2008 Sep;11(3):252-62. PMID: 18816321 MH - *Biomedical Research MH - Breast Neoplasms/prevention & control/secondary MH - Carcinoma in Situ/pathology MH - Clinical Protocols MH - *Decision Support Techniques MH - Female MH - Humans MH - Patient Education as Topic MH - *Patient Selection MH - *Randomized Controlled Trials as Topic MH - *Refusal to Participate MH - Risk Assessment PMC - PMC5060445 EDAT- 2008/09/26 09:00 MHDA- 2008/11/11 09:00 CRDT- 2008/09/26 09:00 AID - HEX519 [pii] AID - 10.1111/j.1369-7625.2008.00519.x [doi] PST - ppublish SO - Health Expect. 2008 Sep;11(3):205-7. doi: 10.1111/j.1369-7625.2008.00519.x. PMID- 18793856 OWN - NLM STAT- MEDLINE DA - 20081201 DCOM- 20090227 LR - 20161124 IS - 1532-3080 (Electronic) IS - 0960-9776 (Linking) VI - 17 IP - 6 DP - 2008 Dec TI - Patients' decision-making in a UK specialist centre with high mastectomy rates. PG - 574-9 LID - 10.1016/j.breast.2008.08.001 [doi] AB - A national audit identified one breast cancer unit as having the highest mastectomy rate in the UK: 50% compared to a national average of 14% for cancers <15mm in diameter. This anomaly needed investigation. A questionnaire was sent within 2 years of their surgery to 189 breast cancer patients probing perceived surgical choice, factors in decision-making and usefulness of information. One hundred thirty-one (69%) replied, of these 97 (74%) felt they had choice of surgery. Of these, the most important factor was minimising worry about recurrence. However, only 16% knew that recurrence rates were different between types of surgery. Sixty-one percent felt their healthcare professionals had surgical preferences for them, believed that clinical issues determined these preferences, but still knew the choice was theirs. The extent to which surgical choice is offered and patients are made aware that it is their choice, may account for the high mastectomy rate in this unit. FAU - Ballinger, Rachel S AU - Ballinger RS AD - Cancer Research UK Psychosocial Oncology Group, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9QG, UK. R.S.Ballinger@sussex.ac.uk FAU - Mayer, Karl Fortes AU - Mayer KF FAU - Lawrence, Gill AU - Lawrence G FAU - Fallowfield, Lesley AU - Fallowfield L LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20080914 PL - Netherlands TA - Breast JT - Breast (Edinburgh, Scotland) JID - 9213011 SB - IM MH - Attitude of Health Personnel MH - Breast Neoplasms/psychology/*surgery MH - *Decision Making MH - Female MH - Health Care Surveys MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Mastectomy/psychology/*utilization MH - Middle Aged MH - Patient Education as Topic/statistics & numerical data MH - Patient Participation/psychology/*statistics & numerical data MH - Patient Satisfaction/statistics & numerical data MH - Physician-Patient Relations MH - United Kingdom EDAT- 2008/09/17 09:00 MHDA- 2009/02/28 09:00 CRDT- 2008/09/17 09:00 PHST- 2008/07/24 [received] PHST- 2008/08/01 [accepted] AID - S0960-9776(08)00175-6 [pii] AID - 10.1016/j.breast.2008.08.001 [doi] PST - ppublish SO - Breast. 2008 Dec;17(6):574-9. doi: 10.1016/j.breast.2008.08.001. Epub 2008 Sep 14. PMID- 18789628 OWN - NLM STAT- MEDLINE DA - 20081118 DCOM- 20090220 LR - 20081118 IS - 0738-3991 (Print) IS - 0738-3991 (Linking) VI - 73 IP - 3 DP - 2008 Dec TI - Can people find patient decision aids on the Internet? PG - 557-60 LID - 10.1016/j.pec.2008.07.046 [doi] AB - OBJECTIVE: To determine if people could find patient decision aids (PtDAs) on the Internet using the most popular general search engines. METHODS: We chose five medical conditions for which English language PtDAs were available from at least three different developers. The search engines used were: Google (www.google.com), Yahoo! (www.yahoo.com), and MSN (www.msn.com). For each condition and search engine we ran six searches using a combination of search terms. We coded all non-sponsored Web pages that were linked from the first page of the search results. RESULTS: Most first page results linked to informational Web pages about the condition, only 16% linked to PtDAs. PtDAs were more readily found for the breast cancer surgery decision (our searches found seven of the nine developers). The searches using Yahoo and Google search engines were more likely to find PtDAs. The following combination of search terms: condition, treatment, decision (e.g. breast cancer surgery decision) was most successful across all search engines (29%). CONCLUSION: While some terms and search engines were more successful, few resulted in direct links to PtDAs. PRACTICE IMPLICATIONS: Finding PtDAs would be improved with use of standardized labelling, providing patients with specific Web site addresses or access to an independent PtDA clearinghouse. FAU - Morris, Debra AU - Morris D AD - Ottawa Health Research Institute, Ottawa, Canada. dmorris@ohri.ca FAU - Drake, Elizabeth AU - Drake E FAU - Saarimaki, Anton AU - Saarimaki A FAU - Bennett, Carol AU - Bennett C FAU - O'Connor, Annette AU - O'Connor A LA - eng PT - Evaluation Studies PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20080911 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Arthritis/therapy MH - Breast Neoplasms/surgery MH - *Decision Support Techniques MH - Female MH - Humans MH - Information Services/organization & administration MH - Information Storage and Retrieval/*methods/standards MH - Internet/*organization & administration MH - Leiomyoma/therapy MH - Low Back Pain/therapy MH - Male MH - Needs Assessment MH - Patient Education as Topic/*organization & administration MH - Patient Participation/methods/psychology MH - Prostatic Neoplasms/diagnosis MH - Vocabulary, Controlled EDAT- 2008/09/16 09:00 MHDA- 2009/02/21 09:00 CRDT- 2008/09/16 09:00 PHST- 2007/11/28 [received] PHST- 2008/07/22 [revised] PHST- 2008/07/23 [accepted] AID - S0738-3991(08)00396-0 [pii] AID - 10.1016/j.pec.2008.07.046 [doi] PST - ppublish SO - Patient Educ Couns. 2008 Dec;73(3):557-60. doi: 10.1016/j.pec.2008.07.046. Epub 2008 Sep 11. PMID- 18775622 OWN - NLM STAT- MEDLINE DA - 20081208 DCOM- 20090403 LR - 20151119 IS - 0738-3991 (Print) IS - 0738-3991 (Linking) VI - 74 IP - 1 DP - 2009 Jan TI - Concise evaluation of decision aids. PG - 104-9 LID - 10.1016/j.pec.2008.07.043 [doi] AB - OBJECTIVE: Decision aids purport to help patients make treatment related choices. Several instruments exist to evaluate decision aids. Our aim is to compare the responsiveness of several instruments. METHODS: Two different decision aids were randomized in patients at high risk for breast and ovarian cancer. Treatment choices were between prophylactic surgery and screening. Effect sizes were calculated to compare the responsiveness of the measures. RESULTS: One decision aid was randomized in 390 women, the other in 91 ensuing mutation carriers. Three factors were identified related to Information, Well-being and Decision Making. Within each factor, single item measures were as responsive as multi-item measures. CONCLUSION: Four single items, 'the amount of information received for decision making,' 'strength of preference,' 'I weighed the pros and cons,' and 'General Health,' were adequately responsive to the decision aids. PRACTICE IMPLICATIONS: These items might be considered for inclusion in questionnaires to evaluate decision aids. FAU - Stalmeier, Peep F M AU - Stalmeier PF AD - Department of Radiation Oncology, Radboud University Medical Center Nijmegen (PFMS, MSR), Nijmegen, The Netherlands. P.Stalmeier@ebh.umcn.nl FAU - Roosmalen, Marielle S AU - Roosmalen MS LA - eng PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20080904 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Adult MH - Breast Neoplasms/genetics/*prevention & control MH - *Choice Behavior MH - *Decision Support Techniques MH - Factor Analysis, Statistical MH - Female MH - Follow-Up Studies MH - Humans MH - Life Expectancy MH - Middle Aged MH - Netherlands MH - Pamphlets MH - Patient Acceptance of Health Care/*psychology/statistics & numerical data MH - Patient Education as Topic/*methods/standards MH - Patient Satisfaction/statistics & numerical data MH - Prognosis MH - Quality-Adjusted Life Years MH - Risk Assessment MH - Risk Factors MH - Surveys and Questionnaires/standards MH - Videotape Recording/standards EDAT- 2008/09/09 09:00 MHDA- 2009/04/04 09:00 CRDT- 2008/09/09 09:00 PHST- 2008/04/18 [received] PHST- 2008/07/03 [revised] PHST- 2008/07/12 [accepted] AID - S0738-3991(08)00385-6 [pii] AID - 10.1016/j.pec.2008.07.043 [doi] PST - ppublish SO - Patient Educ Couns. 2009 Jan;74(1):104-9. doi: 10.1016/j.pec.2008.07.043. Epub 2008 Sep 4. PMID- 18766034 OWN - NLM STAT- MEDLINE DA - 20080903 DCOM- 20080919 LR - 20150624 IS - 1529-4242 (Electronic) IS - 0032-1052 (Linking) VI - 122 IP - 3 DP - 2008 Sep TI - Interactive digital education aid in breast reconstruction. PG - 717-24 LID - 10.1097/PRS.0b013e318180ed06 [doi] AB - BACKGROUND: An interactive digital education aid for breast reconstruction patients was developed because of a perceived need to provide patients with more education regarding the treatment so that they can make better informed treatment decisions. A prospective randomized study was conducted to assess its effectiveness. METHODS: Breast cancer patients who were candidates for breast reconstruction were recruited and randomized into a control group and a study group. Both groups received routine assessment and education in the plastic surgery clinic, but the study group also watched the interactive digital education aid. Questionnaires assessing knowledge, anxiety, and satisfaction were administered (1) before the initial plastic surgery consultation, (2) immediately before surgery, and (3) 1 month after surgery. RESULTS: A total of 133 women participated, 66 in the control group and 67 in the study group. Women in both groups showed decreased anxiety, increased knowledge, and enhanced satisfaction with their decision-making ability associated with preoperative instructions about reconstructive surgery. However, the study group was significantly more satisfied than the control group with the method of receiving information and showed a less steep learning curve regarding the different techniques of breast reconstruction. They also tended to have a reduced mean level of anxiety and increased satisfaction with the treatment choice compared with the control group. CONCLUSIONS: An interactive digital education aid is a beneficial educational adjunct for patients contemplating breast reconstruction. Patients who use an interactive digital education aid demonstrate greater factual knowledge, reduced anxiety, and increased postoperative satisfaction compared with patients given preoperative instructions using standard methods alone. The benefit of an interactive digital education aid is expected to be higher in a broad-based practice setting outside of a comprehensive cancer center. FAU - Heller, Lior AU - Heller L AD - Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA. lheller@bcm.edu FAU - Parker, Patricia A AU - Parker PA FAU - Youssef, Adel AU - Youssef A FAU - Miller, Michael J AU - Miller MJ LA - eng PT - Journal Article PT - Randomized Controlled Trial PL - United States TA - Plast Reconstr Surg JT - Plastic and reconstructive surgery JID - 1306050 SB - AIM SB - IM MH - Anxiety/prevention & control MH - CD-I MH - Decision Making MH - Female MH - Humans MH - *Mammaplasty MH - Middle Aged MH - Patient Education as Topic/*methods MH - Patient Satisfaction MH - Patients/psychology MH - Prospective Studies EDAT- 2008/09/04 09:00 MHDA- 2008/09/20 09:00 CRDT- 2008/09/04 09:00 AID - 10.1097/PRS.0b013e318180ed06 [doi] AID - 00006534-200809000-00006 [pii] PST - ppublish SO - Plast Reconstr Surg. 2008 Sep;122(3):717-24. doi: 10.1097/PRS.0b013e318180ed06. PMID- 18755565 OWN - NLM STAT- MEDLINE DA - 20081118 DCOM- 20090220 LR - 20151119 IS - 0738-3991 (Print) IS - 0738-3991 (Linking) VI - 73 IP - 3 DP - 2008 Dec TI - Women's perceptions of their treatment decision-making about breast cancer treatment. PG - 431-6 LID - 10.1016/j.pec.2008.07.015 [doi] AB - OBJECTIVE: There is limited understanding about what treatment decision making (TDM) means to patients. The study objective was to identify any processes or stages of TDM as perceived by women with early stage breast cancer (ESBC). METHODS: Initial consultations with a surgeon or medical oncologist were videotaped. Subsequently, women viewed their consultation using a qualitative approach with video-stimulated recall (VSR) interviews. Interviews were taped, transcribed, and analyzed. RESULTS: There were 6 surgical and 15 medical oncology (MO) consultations. Most women described TDM as beginning soon after diagnosis and involving several processes including gathering information from informal and formal networks and identifying preferred treatment options before the specialist consultation. Many women wanted more information from their surgeon so they could engage in subsequent TDM with their medical oncologist. CONCLUSION: In this study, women with ESBC began TDM soon after diagnosis and used several iterative processes to arrive at a decision about their cancer treatment. VSR interviews can be useful to investigate TDM occurring during the consultation. PRACTICE IMPLICATIONS: Women with ESBC rely on information provided by their surgeons and family physicians to make treatment decisions about surgery and also to prepare them for subsequent discussions with medical oncologists about chemotherapy. FAU - O'Brien, Mary Ann AU - O'Brien MA AD - Supportive Cancer Care Research Unit, Juravinski Cancer Centre and McMaster University, Hamilton, ON, Canada. maobrien@mcmaster.ca FAU - Whelan, Timothy J AU - Whelan TJ FAU - Charles, Cathy AU - Charles C FAU - Ellis, Peter M AU - Ellis PM FAU - Gafni, Amiram AU - Gafni A FAU - Lovrics, Peter AU - Lovrics P FAU - Hasler, Adrianne AU - Hasler A FAU - Dimitry, Susan AU - Dimitry S LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20080828 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Aged MH - Breast Neoplasms/*psychology/therapy MH - Cooperative Behavior MH - *Decision Making MH - Female MH - Health Services Needs and Demand MH - Humans MH - Mastectomy MH - Medical Oncology MH - Middle Aged MH - Ontario MH - Patient Education as Topic MH - Patient Participation/methods/*psychology MH - Patient Selection MH - Physician's Role/psychology MH - Physician-Patient Relations MH - Qualitative Research MH - Risk Assessment MH - Surveys and Questionnaires MH - Videotape Recording MH - Women/education/*psychology EDAT- 2008/08/30 09:00 MHDA- 2009/02/21 09:00 CRDT- 2008/08/30 09:00 PHST- 2008/01/14 [received] PHST- 2008/06/10 [revised] PHST- 2008/07/04 [accepted] AID - S0738-3991(08)00352-2 [pii] AID - 10.1016/j.pec.2008.07.015 [doi] PST - ppublish SO - Patient Educ Couns. 2008 Dec;73(3):431-6. doi: 10.1016/j.pec.2008.07.015. Epub 2008 Aug 28. PMID- 18722073 OWN - NLM STAT- MEDLINE DA - 20081118 DCOM- 20090220 LR - 20081118 IS - 0738-3991 (Print) IS - 0738-3991 (Linking) VI - 73 IP - 3 DP - 2008 Dec TI - Presenting health risk information in different formats: the effect on participants' cognitive and emotional evaluation and decisions. PG - 443-7 LID - 10.1016/j.pec.2008.07.013 [doi] AB - OBJECTIVE: Effective communication of health risks plays an important role in enabling patients to make adequate decisions. There is little--though contradictory--evidence to indicate which format is most effective for communicating risks, and which risk format is preferred by counselees. METHODS: In an experiment, subjects were presented health scenarios and risk information in different formats (percentages, frequencies, and population figures) and asked to evaluate the risks and make a decision based on these. RESULTS: Different risk formats had different effects on respondents' evaluation of the health risks presented. Contrary to our expectation, population figures were not evaluated as being the easiest format for all decision problems. Population figures were shown to have the biggest affective impact, and risks presented as population figures were also evaluated as significantly greater than the risks presented in other formats. The format of the presented risks influenced their decision in only one out of four decision-making situations, although in a second situation there was a similar trend. CONCLUSION: This study suggests that the risk format plays a role in the decision-making process, although it remains unclear which format is the most effective in terms of understanding. PRACTICE IMPLICATIONS: More experimental studies based on a theoretical analysis of the factors that promote effective risk communication are needed in the general population as well as in clinical settings with patients actually experiencing the risks and making the decisions. FAU - Timmermans, Danielle R M AU - Timmermans DR AD - Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands. drm.timmermans@vumc.nl FAU - Ockhuysen-Vermey, Caroline F AU - Ockhuysen-Vermey CF FAU - Henneman, Lidewij AU - Henneman L LA - eng PT - Comparative Study PT - Evaluation Studies PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20080821 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Adult MH - Affect MH - Breast Neoplasms/genetics/prevention & control MH - Cognition MH - Colonic Neoplasms/genetics/prevention & control MH - *Data Interpretation, Statistical MH - *Decision Making MH - Down Syndrome/diagnosis/prevention & control MH - Female MH - Humans MH - Hyperlipoproteinemia Type II/drug therapy/genetics MH - Male MH - Mass Screening/psychology MH - Netherlands MH - Patient Education as Topic/*methods MH - Patient Participation/methods/*psychology MH - Patient Selection MH - Risk Assessment/*methods MH - Students/psychology MH - Universities EDAT- 2008/08/30 09:00 MHDA- 2009/02/21 09:00 CRDT- 2008/08/30 09:00 PHST- 2008/02/01 [received] PHST- 2008/06/29 [revised] PHST- 2008/07/04 [accepted] AID - S0738-3991(08)00348-0 [pii] AID - 10.1016/j.pec.2008.07.013 [doi] PST - ppublish SO - Patient Educ Couns. 2008 Dec;73(3):443-7. doi: 10.1016/j.pec.2008.07.013. Epub 2008 Aug 21. PMID- 18539887 OWN - NLM STAT- MEDLINE DA - 20080721 DCOM- 20080812 LR - 20161124 IS - 1527-1315 (Electronic) IS - 0033-8419 (Linking) VI - 248 IP - 2 DP - 2008 Aug TI - Detecting nonpalpable recurrent breast cancer: the role of routine mammographic screening of transverse rectus abdominis myocutaneous flap reconstructions. PG - 398-405 LID - 10.1148/radiol.2482071635 [doi] AB - PURPOSE: To perform a retrospective cohort study to determine the rates of recall and cancer detection and then to develop a decision analytic model to evaluate the effectiveness of routine screening of transverse rectus abdominis myocutaneous (TRAM) flap reconstructions. MATERIALS AND METHODS: This study was approved by the institutional review board, and the methods comply with HIPAA regulations. A retrospective search of the institutional mammographic results database was done to identify bilateral screening mammographic examinations obtained from January 1, 1999, through July 15, 2005. The search included the term TRAM; the recall and cancer detetion rates were then detected. Subsequently, a decision analytic model was constructed to evaluate a hypothetical cohort of women with TRAM flap reconstructions. RESULTS: Of 554 mammograms (265 TRAM flap reconstructions), 546 (98.6%) had negative results (Breast Imaging Reporting and Data System category 1 or 2). Eight (1.4%) had positive test results (Breast Imaging Reporting and Data System category 0, 3, 4, or 5). All suspicious lesions underwent biopsy and had benign pathologic results. No interval breast cancers were identified. The detection rate for nonpalpable recurrent breast cancer was 0% (exact 95% confidence interval: 0.0%, 1.4%). According to decision analysis, screening would help detect an estimated 12 additional recurrent cancers per 1000 women screened, providing an additional 1.6 days of life expectancy for the screened cohort. Under base-case conditions, screening of TRAM flap reconstructions is less effective than screening asymptomatic women in their 40s. Sensitivity analysis revealed that a benefit equivalent to that of screening asymptomatic women in their 40s was achievable under conditions related to estimates of screening effectiveness and cancer detection rate. CONCLUSION: Routine screening mammography of TRAM flap reconstructions has a very low detection rate for nonpalpable recurrent breast cancer. Decision analysis indicates that screening such women is less effective than screening asymptomatic women in their 40s for primary breast cancer. FAU - Lee, Janie M AU - Lee JM AD - Department of Radiology, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114, USA. jlee45@partners.org FAU - Georgian-Smith, Dianne AU - Georgian-Smith D FAU - Gazelle, G Scott AU - Gazelle GS FAU - Halpern, Elkan F AU - Halpern EF FAU - Rafferty, Elizabeth A AU - Rafferty EA FAU - Moore, Richard H AU - Moore RH FAU - Yeh, Eren D AU - Yeh ED FAU - D'Alessandro, Helen A AU - D'Alessandro HA FAU - Hitt, Rachel A AU - Hitt RA FAU - Kopans, Daniel B AU - Kopans DB LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20080606 PL - United States TA - Radiology JT - Radiology JID - 0401260 SB - AIM SB - IM MH - Adult MH - Aged MH - Breast Neoplasms/*diagnostic imaging/mortality/*surgery MH - Decision Support Techniques MH - Female MH - Humans MH - *Mammaplasty MH - Mammography MH - Mastectomy MH - Middle Aged MH - Neoplasm Recurrence, Local/*diagnostic imaging MH - Rectus Abdominis/*transplantation MH - Retrospective Studies MH - *Surgical Flaps MH - Treatment Outcome EDAT- 2008/06/10 09:00 MHDA- 2008/08/13 09:00 CRDT- 2008/06/10 09:00 AID - 2482071635 [pii] AID - 10.1148/radiol.2482071635 [doi] PST - ppublish SO - Radiology. 2008 Aug;248(2):398-405. doi: 10.1148/radiol.2482071635. Epub 2008 Jun 6. PMID- 18469211 OWN - NLM STAT- MEDLINE DA - 20080512 DCOM- 20080711 LR - 20101118 IS - 0077-8923 (Print) IS - 0077-8923 (Linking) VI - 1128 DP - 2008 Apr TI - Transparency in risk communication: graphical and analog tools. PG - 18-28 LID - 10.1196/annals.1399.004 [doi] AB - Why is it that the public can read and write but only a few understand statistical information? Why are elementary distinctions, such as that between absolute and relative risks, not better known? In the absence of statistical literacy, key democratic ideals, such as informed consent and shared decision making in health care, will remain science fiction. In this chapter, we deal with tools for transparency in risk communication. The focus is on graphical and analog representations of risk. Analog representations use a separate icon or sign for each individual in a population. Like numerical representations, some graphical forms are transparent, whereas others indiscernibly mislead the reader. We review cases of (1) tree diagrams for representing natural versus relative frequency, (2) decision trees for the representation of fast and frugal decision making, (3) bar graphs for representing absolute versus relative risk, (4) population diagrams for the analog representation of risk, and (5) a format of representation that employs colored tinker cubes for the encoding of information about individuals in a population. Graphs have long enjoyed the status of being "worth a thousand words" and hence of being more readily accessible to human understanding than long-winded symbolic representations. This is both true and false. Graphical tools can be just as well employed for transparent and nontransparent risk communications. FAU - Kurz-Milcke, Elke AU - Kurz-Milcke E AD - Institute of Mathematics and Computing, University of Education Ludwigsburg, Reuteallee 46, 71634 Ludwigsburg, Germany. kurzmilcke@ph-ludwigsburg.de FAU - Gigerenzer, Gerd AU - Gigerenzer G FAU - Martignon, Laura AU - Martignon L LA - eng PT - Journal Article PT - Review PL - United States TA - Ann N Y Acad Sci JT - Annals of the New York Academy of Sciences JID - 7506858 SB - IM MH - Biological Evolution MH - Breast Neoplasms/diagnosis/epidemiology MH - Communication MH - Computer Graphics MH - *Data Interpretation, Statistical MH - Decision Making MH - Female MH - HIV Infections/*diagnosis/epidemiology MH - HIV Seropositivity/diagnosis MH - Humans MH - Mass Screening MH - Models, Theoretical MH - Risk MH - *Risk Assessment RF - 19 EDAT- 2008/05/13 09:00 MHDA- 2008/07/12 09:00 CRDT- 2008/05/13 09:00 AID - 1128/1/18 [pii] AID - 10.1196/annals.1399.004 [doi] PST - ppublish SO - Ann N Y Acad Sci. 2008 Apr;1128:18-28. doi: 10.1196/annals.1399.004. PMID- 18348655 OWN - NLM STAT- MEDLINE DA - 20080319 DCOM- 20080812 LR - 20080319 IS - 0028-2685 (Print) IS - 0028-2685 (Linking) VI - 55 IP - 3 DP - 2008 TI - A decision-analytic model for early stage breast cancer: lumpectomy vs mastectomy. PG - 222-8 AB - The purpose was to construct a decision model that incorporated patient preferences over differing health state prospects and to analyze the decision context of early stage breast cancer patients in relation to two main surgical treatment options. A Markov chain was constructed to project the clinical history of breast carcinoma following surgery. A Multi Attribute Utility Model was developed for outcome evaluation. Transition probabilities were obtained by using subjective probability assessment. This study was performed on the sample population of female university students and utilities were elicited from these healthy volunteers. The results were validated by using Standard Gamble technique. Finally, Monte Carlo Simulation was utilized in Treeage-Pro 2006-Suit software program in order to calculate expected utility generated by each treatment option. The results showed that, if the subject had mastectomy, mean value for the quality adjusted life years gained was 6.42; on the other hand, if the preference was lumpectomy, it was 7.00 out of a possible 10 years. Sensitivity analysis on transition probabilities to local recurrence and salvaged states was performed and two threshold values were observed. Additionally, sensitivity analysis on utilities showed that the model was more sensitive to no evidence of disease state; however, was not sensitive to utilities of local recurrence and salvaged states. The decision model was developed with reasonable success for early stage breast cancer patients, and tested by using general public data. The results obtained from these data showed that lumpectomy was more favourable for these participants. FAU - Buyukdamgaci-Alogan, G AU - Buyukdamgaci-Alogan G AD - Scientific and Technological Research Council of Turkey, Ankara, Turkey. FAU - Elele, T AU - Elele T FAU - Hayran, M AU - Hayran M FAU - Erman, M AU - Erman M FAU - Kilickap, S AU - Kilickap S LA - eng PT - Evaluation Studies PT - Journal Article PL - Slovakia TA - Neoplasma JT - Neoplasma JID - 0377266 SB - IM MH - Breast Neoplasms/*surgery MH - *Decision Support Techniques MH - Female MH - Humans MH - Markov Chains MH - *Mastectomy MH - *Mastectomy, Segmental MH - *Models, Biological MH - Monte Carlo Method MH - Patient Satisfaction MH - Sensitivity and Specificity EDAT- 2008/03/20 09:00 MHDA- 2008/08/13 09:00 CRDT- 2008/03/20 09:00 PST - ppublish SO - Neoplasma. 2008;55(3):222-8. PMID- 18344816 OWN - NLM STAT- MEDLINE DA - 20080317 DCOM- 20080508 LR - 20080317 IS - 0741-5206 (Print) IS - 0741-5206 (Linking) VI - 28 IP - 1 DP - 2008 Jan-Mar TI - Breast reconstruction using tissue expanders: assessing patients' needs utilizing a holistic approach. PG - 27-32; quiz 33-4 LID - 10.1097/01.PSN.0000313944.82528.b8 [doi] AB - Breast cancer is the most common diagnosed cancer in women. One out of 8 women is diagnosed with this disease (). Today many women are candidates for breast reconstruction and opt for reconstructive surgery at the time of mastectomy. Plastic surgical nurses provide a vital link in assessing and assisting patients to acquire and assimilate the necessary information required to make informed decisions regarding reconstruction. Although there are a variety of options in breast reconstruction, the purpose of this article is to discuss tissue expansion after mastectomy for breast restoration. The article identifies the needs women may have both preoperatively and postoperatively. Orem's self-care theory model is used to describe roles nurses may assume to assist patients in decision making and performance of self-care activities during the reconstructive process. FAU - Spittler, Cheryl A AU - Spittler CA AD - Quinn Plastic Surgery Center, Overland Park, KS, USA. cherylaspittler@aol.com LA - eng PT - Journal Article PT - Review PL - United States TA - Plast Surg Nurs JT - Plastic surgical nursing : official journal of the American Society of Plastic and Reconstructive Surgical Nurses JID - 8403490 SB - N MH - Breast Neoplasms/nursing/psychology/surgery MH - Decision Making MH - Female MH - *Holistic Health MH - Humans MH - Informed Consent MH - Mammaplasty/instrumentation/*nursing/psychology MH - Mastectomy MH - Needs Assessment/*organization & administration MH - Nurse's Role MH - Nursing Assessment/*organization & administration MH - Nursing Theory MH - Patient Education as Topic MH - Perioperative Care/methods/*nursing/psychology MH - Self Care/methods/psychology MH - Spirituality MH - Tissue Expansion/instrumentation/*nursing/psychology MH - Tissue Expansion Devices/psychology RF - 20 EDAT- 2008/03/18 09:00 MHDA- 2008/05/09 09:00 CRDT- 2008/03/18 09:00 AID - 10.1097/01.PSN.0000313944.82528.b8 [doi] AID - 00006527-200801000-00008 [pii] PST - ppublish SO - Plast Surg Nurs. 2008 Jan-Mar;28(1):27-32; quiz 33-4. doi: 10.1097/01.PSN.0000313944.82528.b8. PMID- 18297781 OWN - NLM STAT- MEDLINE DA - 20080225 DCOM- 20080415 LR - 20170220 IS - 1369-7625 (Electronic) IS - 1369-6513 (Linking) VI - 11 IP - 1 DP - 2008 Mar TI - Development and evaluation of a decision aid for patients considering first-line chemotherapy for metastatic breast cancer. PG - 35-45 AB - OBJECTIVE: Treatment decisions in advanced breast cancer are complex, with enhanced quality of life and survival among important treatment goals. Patients with metastatic breast cancer face the decision of whether or not to have chemotherapy, and many wish to be involved in this decision. We report the development and evaluation of a decision aid (DA) designed to assist patients facing this treatment decision. DESIGN AND SAMPLE: Women with metastatic breast cancer (n = 17)and medical oncologists in Australia and Canada (n = 7) were invited to evaluate the DA. INTERVENTION: A DA was developed for patients with hormone resistant metastatic breast cancer considering chemotherapy. The DA presented options of supportive care, with or without chemotherapy. Potential benefits and side effects of different chemotherapy regimens, and evidence-based prognostic estimates were described,and a values clarification exercise included. MAIN OUTCOME MEASURES: Patient questionnaires evaluating information and decision involvement preferences, attitudes toward the DA and oncologist feedback regarding attitudes toward the DA. RESULTS: Seventeen patients participated; fifteen desired as much information about their illness as possible; sixteen wished to be actively involved in the decision-making process. The majority rated the DA as highly acceptable, clear and informative, and would recommend it to others facing this treatment decision. CONCLUSION: This is the first DA for patients with advanced metastatic breast cancer considering chemotherapy. A randomized trial is underway to evaluate its role in clinical decision-making. FAU - Chiew, Kimberly S AU - Chiew KS AD - Department of Medical Oncology and Hematology, Princess Margaret Hospital/University Health Network, University of Toronto, ON, Canada. FAU - Shepherd, Heather AU - Shepherd H FAU - Vardy, Janette AU - Vardy J FAU - Tattersall, Martin H N AU - Tattersall MH FAU - Butow, Phyllis N AU - Butow PN FAU - Leighl, Natasha B AU - Leighl NB LA - eng PT - Evaluation Studies PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Health Expect JT - Health expectations : an international journal of public participation in health care and health policy JID - 9815926 RN - 0 (Antineoplastic Agents) SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Antineoplastic Agents/therapeutic use MH - Australia MH - Breast Neoplasms/*drug therapy/pathology/*psychology MH - Canada MH - *Choice Behavior MH - *Decision Support Techniques MH - Female MH - Humans MH - Middle Aged MH - Neoplasm Metastasis MH - Patient Education as Topic/methods MH - Patient Participation MH - Pilot Projects MH - Quality of Life MH - Randomized Controlled Trials as Topic MH - Surveys and Questionnaires PMC - PMC5060427 EDAT- 2008/02/27 09:00 MHDA- 2008/04/16 09:00 CRDT- 2008/02/27 09:00 PST - ppublish SO - Health Expect. 2008 Mar;11(1):35-45. PMID- 18294057 OWN - NLM STAT- MEDLINE DA - 20080225 DCOM- 20080507 LR - 20091119 IS - 1090-6576 (Print) IS - 1090-6576 (Linking) VI - 11 IP - 4 DP - 2007 Winter TI - Attitudes toward genetic testing for cancer risk after genetic counseling and decision support: a qualitative comparison between hereditary cancer types. PG - 401-11 LID - 10.1089/gte.2007.0013 [doi] AB - This study aimed to qualitatively assess individuals' attitudes toward genetic testing for cancer risk after genetic counseling and decision support. As part of a larger study, 78 women considering genetic testing for hereditary breast/ovarian cancer (HBOC) risk and 22 individuals considering genetic testing for hereditary nonpolyposis colorectal cancer (HNPCC) completed an open-ended table of their perceived pros and cons of genetic testing. The most frequently reported pros were "to help manage my risk of developing cancer," "to help my family," and "to know my cancer risk." With regards to risk management, the HBOC group perceived genetic testing as most helpful in informing their general risk management practices, while the HN-PCC group focused on the potential to clarify their need for bowel cancer screening, suggesting that patients' perceptions of the benefits of genetic testing may differ across cancer syndromes. Individuals in both groups expressed concern about the potential psychological impact of genetic testing. We also found that some affected individuals may not fully comprehend the meaning of their potential test results. Eliciting patients' perceived pros and cons during genetic counseling is likely to be a valuable tool for improving patient care. This data also provides an improved evidence base for the development of patient education tools. FAU - Wakefield, Claire E AU - Wakefield CE AD - Department of Psychology, Macquarie University, NSW, Australia. c.wakefield@unsw.edu.au FAU - Kasparian, Nadine A AU - Kasparian NA FAU - Meiser, Bettina AU - Meiser B FAU - Homewood, Judi AU - Homewood J FAU - Kirk, Judy AU - Kirk J FAU - Tucker, Kathy AU - Tucker K LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Genet Test JT - Genetic testing JID - 9802546 SB - IM MH - Attitude to Health MH - Breast Neoplasms/*genetics/prevention & control/*psychology MH - Decision Support Systems, Clinical MH - Female MH - *Genetic Counseling MH - *Genetic Testing MH - Humans MH - Ovarian Neoplasms/*genetics/prevention & control/*psychology MH - Risk Assessment MH - Risk Factors EDAT- 2008/02/26 09:00 MHDA- 2008/05/08 09:00 CRDT- 2008/02/26 09:00 AID - 10.1089/gte.2007.0013 [doi] PST - ppublish SO - Genet Test. 2007 Winter;11(4):401-11. doi: 10.1089/gte.2007.0013. PMID- 18275401 OWN - NLM STAT- MEDLINE DA - 20080215 DCOM- 20080415 LR - 20170220 IS - 1369-7625 (Electronic) IS - 1369-6513 (Linking) VI - 11 IP - 1 DP - 2008 Mar TI - Implementing breast cancer decision aids in community sites: barriers and resources. PG - 46-53 LID - 10.1111/j.1369-7625.2007.00477.x [doi] AB - OBJECTIVE: To assess the feasibility of implementing four patient decision aids (PtDAs) for early stage breast cancer treatment decisions into routine clinical care in community settings. BACKGROUND: There is very limited information available about implementing decision aids into routine clinical practice and most of this information is based on academic centres; more information is needed about implementing them into routine clinical practice in community settings. DESIGN: Structured individual interviews. SETTING AND PARTICIPANTS: Providers from 12 sites, including nine community hospitals, a community oncology centre and two academic centres. MAIN OUTCOME MEASURES: Usage data, barriers to and resources for implementing the PtDAs. RESULTS: Nine of the 12 sites were using the PtDAs with patients. All of the sites were lending the PtDAs to patients, usually without a formal sign-out system. The keys to successful implementation included nurses' and social workers' interest in distributing the PtDAs and the success of the lending model. Barriers that limited or prevented sites from using the PtDA included a lack of physician support, a lack of an organized system for distributing the PtDAs and nurses' perceptions about patients' attitude towards participation in decision making. CONCLUSIONS: It is feasible to implement PtDAs for early stage breast cancer into routine clinical care in community settings, even with few resources available. FAU - Silvia, Kerry A AU - Silvia KA AD - Massachusetts General Hospital, Boston, MA 02114, USA. FAU - Ozanne, Elissa M AU - Ozanne EM FAU - Sepucha, Karen R AU - Sepucha KR LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Health Expect JT - Health expectations : an international journal of public participation in health care and health policy JID - 9815926 SB - IM MH - Breast Neoplasms/*psychology/therapy MH - *Choice Behavior MH - Community Health Services MH - *Decision Support Techniques MH - Feasibility Studies MH - Female MH - Humans MH - Interviews as Topic MH - Massachusetts MH - Patient Education as Topic/methods MH - Patient Participation/*methods MH - *Professional-Patient Relations MH - Program Development MH - Videotape Recording PMC - PMC5060426 EDAT- 2008/02/16 09:00 MHDA- 2008/04/16 09:00 CRDT- 2008/02/16 09:00 AID - HEX477 [pii] AID - 10.1111/j.1369-7625.2007.00477.x [doi] PST - ppublish SO - Health Expect. 2008 Mar;11(1):46-53. doi: 10.1111/j.1369-7625.2007.00477.x. PMID- 18242967 OWN - NLM STAT- MEDLINE DA - 20080222 DCOM- 20080529 LR - 20080222 IS - 0933-3657 (Print) IS - 0933-3657 (Linking) VI - 42 IP - 3 DP - 2008 Mar TI - An integrated framework for risk profiling of breast cancer patients following surgery. PG - 165-88 LID - 10.1016/j.artmed.2007.11.005 [doi] AB - OBJECTIVE: An integrated decision support framework is proposed for clinical oncologists making prognostic assessments of patients with operable breast cancer. The framework may be delivered over a web interface. It comprises a triangulation of prognostic modelling, visualisation of historical patient data and an explanatory facility to interpret risk group assignments using empirically derived Boolean rules expressed directly in clinical terms. METHODS AND MATERIALS: The prognostic inferences in the interface are validated in a multicentre longitudinal cohort study by modelling retrospective data from 917 patients recruited at Christie Hospital, Wilmslow between 1983 and 1989 and predicting for 931 patients recruited in the same centre during 1990-1993. There were also 291 patients recruited between 1984 and 1998 at the Clatterbridge Centre for Oncology and the Linda McCartney Centre, Liverpool, UK. RESULTS AND CONCLUSIONS: There are three novel contributions relating this paper to breast cancer cases. First, the widely used Nottingham prognostic index (NPI) is enhanced with additional clinical features from which prognostic assessments can be made more specific for patients in need of adjuvant treatment. This is shown with a cross matching of the NPI and a new prognostic index which also provides a two-dimensional visualisation of the complete patient database by risk of negative outcome. Second, a principled rule-extraction method, orthogonal search rule extraction, generates readily interpretable explanations of risk group allocations derived from a partial logistic artificial neural network with automatic relevance determination (PLANN-ARD). Third, 95% confidence intervals for individual predictions of survival are obtained by Monte Carlo sampling from the PLANN-ARD model. FAU - Jarman, Ian H AU - Jarman IH AD - School of Computing and Mathematical Sciences, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, UK. i.h.jarman@ljmu.ac.uk FAU - Etchells, Terence A AU - Etchells TA FAU - Martin, Jose D AU - Martin JD FAU - Lisboa, Paulo J G AU - Lisboa PJ LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20080201 PL - Netherlands TA - Artif Intell Med JT - Artificial intelligence in medicine JID - 8915031 SB - IM MH - Adult MH - Algorithms MH - Artificial Intelligence MH - Breast Neoplasms/mortality/*surgery MH - Confidence Intervals MH - *Decision Support Systems, Clinical MH - *Decision Support Techniques MH - Female MH - Health Status Indicators MH - Humans MH - Internet MH - *Mastectomy MH - Middle Aged MH - Models, Biological MH - Monte Carlo Method MH - Neural Networks (Computer) MH - *Patient Selection MH - Prognosis MH - Reproducibility of Results MH - Retrospective Studies MH - Risk Assessment MH - Treatment Outcome MH - User-Computer Interface EDAT- 2008/02/05 09:00 MHDA- 2008/05/30 09:00 CRDT- 2008/02/05 09:00 PHST- 2006/11/06 [received] PHST- 2007/11/29 [revised] PHST- 2007/11/30 [accepted] AID - S0933-3657(07)00150-9 [pii] AID - 10.1016/j.artmed.2007.11.005 [doi] PST - ppublish SO - Artif Intell Med. 2008 Mar;42(3):165-88. doi: 10.1016/j.artmed.2007.11.005. Epub 2008 Feb 1. PMID- 18211652 OWN - NLM STAT- MEDLINE DA - 20080123 DCOM- 20080325 LR - 20091119 IS - 1365-2753 (Electronic) IS - 1356-1294 (Linking) VI - 14 IP - 1 DP - 2008 Feb TI - Exploring the requirements for a decision aid on familial breast cancer in the UK context: a qualitative study with patients referred to a cancer genetics service. PG - 110-5 LID - 10.1111/j.1365-2753.2007.00811.x [doi] AB - RATIONALE: Patients concerned about a family history of breast cancer can face difficult decisions about screening, prophylactic surgery and genetic testing. Decision aids can facilitate patient decision making and currently include leaflets and computerized tools. These are largely aimed at the North American market. However, no decision aids concerning familial breast cancer exist in the UK. METHODS: Focus groups were held with 39 women over 18 years of age referred to a cancer genetics clinic, and who had been given a risk assessment for developing breast cancer. Each focus group examined three existing North American decision aids (1 paper-based and 2 CD-ROMs) and explored what a decision aid in a UK context should look like and the information it should contain. RESULTS: There was enthusiasm for the development of decision aids that suit the local context in terms of its health care policy, in paper-based and CD-ROM formats. This paper identifies areas of agreement and disagreement in terms of both content and presentation styles, and also reports some of the suggestions received about where, when and with whom decision aids should be used. Participants suggested that decision aids would be most effective when they allowed a user-selected range of formats. CONCLUSION: There is still significant unmet demand for information and decision support in the context of publicly funded health care. The patient perspective provides a unique insight into issues of design, style and communication. FAU - Iredale, Rachel AU - Iredale R AD - Institute of Medical Genetics, Cardiff University School of Medicine, Cardiff, UK. Rachel.Iredale@cardiffandvale.wales.nhs.uk FAU - Rapport, Frances AU - Rapport F FAU - Sivell, Stephanie AU - Sivell S FAU - Jones, Wendy AU - Jones W FAU - Edwards, Adrian AU - Edwards A FAU - Gray, Jonathon AU - Gray J FAU - Elwyn, Glyn AU - Elwyn G LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - J Eval Clin Pract JT - Journal of evaluation in clinical practice JID - 9609066 SB - IM MH - Adult MH - Breast Neoplasms/*genetics/*psychology MH - CD-ROM MH - *Decision Support Techniques MH - Female MH - Focus Groups MH - Genetic Counseling/*psychology MH - Genetic Testing/*psychology MH - Humans MH - *Patient Acceptance of Health Care MH - Pilot Projects MH - Qualitative Research MH - Referral and Consultation MH - Wales EDAT- 2008/01/24 09:00 MHDA- 2008/03/26 09:00 CRDT- 2008/01/24 09:00 AID - JEP811 [pii] AID - 10.1111/j.1365-2753.2007.00811.x [doi] PST - ppublish SO - J Eval Clin Pract. 2008 Feb;14(1):110-5. doi: 10.1111/j.1365-2753.2007.00811.x. PMID- 18211647 OWN - NLM STAT- MEDLINE DA - 20080123 DCOM- 20080325 LR - 20091119 IS - 1365-2753 (Electronic) IS - 1356-1294 (Linking) VI - 14 IP - 1 DP - 2008 Feb TI - Interactive patient decision aids for women facing genetic testing for familial breast cancer: a systematic web and literature review. PG - 70-4 LID - 10.1111/j.1365-2753.2007.00798.x [doi] AB - OBJECTIVE: A systematic review to identify and appraise interactive decision aids that are designed for consumer use, in the field of hereditary breast cancer and genetic testing. METHODS: An Internet (Google, Alta Vista) and literature search (Medline) was conducted for suitable decision aids. The decision aid had to (inclusion criteria): be about genetic testing for familial breast cancer; fulfil the criteria of a decision aid; use multimedia IT; be interactive (user does something that influences the decision pathway); and be for patient/public use. Exclusion criteria were decision aids that: had no interactivity (e.g. leaflet, video); discussed management decisions after gene status confirmed; non-English; aids that required membership/subscription. Once aids had been selected for further appraisal they were assessed against a recognized framework for the evaluation of decision aids--the International Patient Decision Aid Standards (IPDAS) criteria. RESULTS: On Google 595 web pages were assessed, as were 382 Google directory entries. Alta Vista revealed fewer results and revealed no new sites. Twenty-four web sites and four CD-ROMs with the most potential as stand alone decision aids were then selected for further assessment. On Medline 776 citations were reviewed, of these only one CD-ROM and no web sites were found. After initial appraisal only two CD-ROMs and one web site met the criteria for further consideration. Assessed against the IPDAS criteria, the decision aids scored poorly with no aid scoring more than 50%. CONCLUSIONS: Although there is a significant amount of interest in genetic testing to determine whether a woman is at high risk of breast cancer, the current genetic services are having difficulty coping with the demand. Alternatives such as decision aids have been suggested. There are many sources of information available, but few are truly interactive or designed for patient use. Of the three evaluated, all were from the USA and are likely to require modification for patients elsewhere. FAU - Williams, Lisa AU - Williams L AD - Department of General Practice, Centre for Health Sciences Research, School of Medicine, Cardiff University, Cardiff, UK. FAU - Jones, Wendy AU - Jones W FAU - Elwyn, Glyn AU - Elwyn G FAU - Edwards, Adrian AU - Edwards A LA - eng PT - Journal Article PT - Review PL - England TA - J Eval Clin Pract JT - Journal of evaluation in clinical practice JID - 9609066 SB - IM MH - Breast Neoplasms/*genetics MH - *Decision Support Techniques MH - Female MH - Genetic Testing/*psychology MH - Humans MH - Internet MH - Women/*psychology RF - 42 EDAT- 2008/01/24 09:00 MHDA- 2008/03/26 09:00 CRDT- 2008/01/24 09:00 AID - JEP798 [pii] AID - 10.1111/j.1365-2753.2007.00798.x [doi] PST - ppublish SO - J Eval Clin Pract. 2008 Feb;14(1):70-4. doi: 10.1111/j.1365-2753.2007.00798.x. PMID- 18165727 OWN - NLM STAT- MEDLINE DA - 20071231 DCOM- 20080321 LR - 20071231 IS - 0741-5206 (Print) IS - 0741-5206 (Linking) VI - 27 IP - 4 DP - 2007 Oct-Dec TI - The High Five Process: tissue-based planning for breast augmentation. PG - 197-201 LID - 10.1097/01.PSN.0000306185.95812.c3 [doi] AB - Despite popularity, breast augmentation has not advanced significantly in 20 years. The re-operation data for breast augmentation has been excessive at 15% to 20% in every Federal Drug Administration pre-market approval study for the past 15 years. Recently, a more scientific approach to breast augmentation has described a true process approach to this procedure. One element, tissue-based pre-operative planning, has been shown to reduce re-operation rate to less than 3% in published peer-reviewed studies. The High Five process was published in 2005 and codifies the 5 most important pre-operative decisions made during a breast augmentation procedure. Application into clinical practice of this planning system is discussed. FAU - Adams, William P AU - Adams WP AD - University of Texas Southwestern Medical Center in Dallas, Texas, USA. BA@dr-adams.com LA - eng PT - Case Reports PT - Journal Article PL - United States TA - Plast Surg Nurs JT - Plastic surgical nursing : official journal of the American Society of Plastic and Reconstructive Surgical Nurses JID - 8403490 SB - N MH - Adult MH - *Anthropometry/methods MH - Body Image MH - *Body Size MH - *Breast Implantation/education/instrumentation/psychology MH - *Breast Implants/classification/supply & distribution MH - Choice Behavior MH - *Decision Making, Computer-Assisted MH - Female MH - Humans MH - Patient Care Planning/organization & administration MH - Patient Education as Topic MH - Patient Participation/methods/psychology MH - Patient Selection MH - *Preoperative Care/methods/psychology MH - Reoperation MH - Surgery, Computer-Assisted EDAT- 2008/01/01 09:00 MHDA- 2008/03/22 09:00 CRDT- 2008/01/01 09:00 AID - 10.1097/01.PSN.0000306185.95812.c3 [doi] AID - 00006527-200710000-00007 [pii] PST - ppublish SO - Plast Surg Nurs. 2007 Oct-Dec;27(4):197-201. doi: 10.1097/01.PSN.0000306185.95812.c3. PMID- 18157830 OWN - NLM STAT- MEDLINE DA - 20080225 DCOM- 20080313 LR - 20080225 IS - 0008-543X (Print) IS - 0008-543X (Linking) VI - 112 IP - 3 DP - 2008 Feb 01 TI - Understanding the impact of breast reconstruction on the surgical decision-making process for breast cancer. PG - 489-94 AB - BACKGROUND: Reconstruction is rarely incorporated into the decision-making process for surgical breast cancer treatment. We examined the importance of knowing about reconstruction to patients' surgical decision-making for breast cancer. METHODS: We surveyed women aged < or =79 years with breast cancer (N = 1844) who were reported to the Detroit and Los Angeles Surveillance, Epidemiology, and End Results (SEER) cancer registries (response rate, 77.4%). The dependent variables were 1) patients' report of having a discussion about breast reconstruction with their general surgeon (yes/no), 2) whether or not this discussion had an impact on their willingness to be treated with a mastectomy (yes/no), and 3) whether the patient received a mastectomy (yes/no). The independent variables included age, race, education, tumor size, tumor behavior, and presence of comorbidities. Chi-square, Student t test, and logistic regression were used for analyses. RESULTS: Only 33% of patients had a general surgeon discuss breast reconstruction with them during the surgical decision-making process for their cancer. Surgeons were significantly more likely to have this discussion with younger, more educated patients with larger tumors. Knowing about reconstructive options significantly increased patients' willingness to consider a mastectomy (OR, 2.06; P <.01). In addition, this discussion influenced surgical treatment. Patients who discussed reconstruction with their general surgeon were 4 times more likely to receive a mastectomy compared with those who did not (OR, 4.48; P < .01). CONCLUSIONS: Most general surgeons do not discuss reconstruction with their breast cancer patients before surgical treatment. When it occurs, this discussion significantly impacts women's treatment choice, making many more likely to choose mastectomy. This highlights the importance of multidisciplinary care models to facilitate an informed surgical treatment decision-making process. FAU - Alderman, Amy K AU - Alderman AK AD - Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan 48109-0340, USA. aalder@umich.edu FAU - Hawley, Sarah T AU - Hawley ST FAU - Waljee, Jennifer AU - Waljee J FAU - Mujahid, Mahasin AU - Mujahid M FAU - Morrow, Monica AU - Morrow M FAU - Katz, Steven J AU - Katz SJ LA - eng GR - N01-PC-35139/PC/NCI NIH HHS/United States GR - N01-PC-65064/PC/NCI NIH HHS/United States GR - R01 CA8837-A1/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PL - United States TA - Cancer JT - Cancer JID - 0374236 SB - AIM SB - IM MH - Aged MH - Breast Neoplasms/psychology/*surgery MH - California MH - *Decision Making MH - Female MH - Health Care Surveys MH - Humans MH - Logistic Models MH - *Mammaplasty MH - *Mastectomy MH - Michigan MH - Middle Aged MH - Patient Education as Topic MH - Physician-Patient Relations MH - Referral and Consultation MH - SEER Program EDAT- 2007/12/25 09:00 MHDA- 2008/03/14 09:00 CRDT- 2007/12/25 09:00 AID - 10.1002/cncr.23214 [doi] PST - ppublish SO - Cancer. 2008 Feb 1;112(3):489-94. PMID- 17909370 OWN - NLM STAT- MEDLINE DA - 20071002 DCOM- 20071120 LR - 20071002 IS - 0025-7079 (Print) IS - 0025-7079 (Linking) VI - 45 IP - 10 Supl 2 DP - 2007 Oct TI - Heterogeneity and the interpretation of treatment effect estimates from risk adjustment and instrumental variable methods. PG - S123-30 AB - OBJECTIVES: To contrast the interpretations of treatment effect estimates using risk adjustment and instrumental variable (IV) estimation methods using observational data when the effects of treatment are heterogeneous across patients. We demonstrate these contrasts by examining the effect of breast conserving surgery plus irradiation (BCSI) relative to mastectomy on early stage breast cancer (ESBC) survival. METHODS: We estimated discrete time survival models for 6185 ESBC patients in the 1989-1994 Iowa Cancer Registry via IV estimation using 2 distinct instruments (distance of the patient's residence from the nearest radiation center, and local area BCSI rate) and controlling for cancer stage, grade, and location; age; comorbidity; hospital access; payer; diagnosis year; and area poverty level. We then estimated comparable risk adjustment survival models using linear probability methods with robust standard errors. RESULTS: Risk adjustment models yielded average survival estimates similar to trial results. With favorable BCSI selection, these estimates represent an upper bound of the true effect for patients receiving BCSI. IV estimates showed a BCSI survival risk for patients whose surgery choices were affected by the instruments and these estimates varied with the instrument specification. CONCLUSIONS: When treatment benefits are heterogeneous across patients, treatment effect estimates from observational data can still be useful to policymakers, but they must be interpreted correctly. Risk adjustment methods yield estimates that can assess whether the patients who received treatment benefited from the treatment, but the direction of bias must be considered. In contrast, IV estimates can assess the effect of treatment rate changes, but characteristics of patients whose choices were affected by the instruments must be considered when making such inferences. FAU - Brooks, John M AU - Brooks JM AD - Program in Pharmaceutical Socioeconomics, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA. john-brooks@uiowa.edu FAU - Chrischilles, Elizabeth A AU - Chrischilles EA LA - eng GR - N01-PC-85063-20/PC/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PL - United States TA - Med Care JT - Medical care JID - 0230027 SB - IM MH - Aged MH - Breast Neoplasms/mortality/pathology/*radiotherapy/*surgery MH - Confounding Factors (Epidemiology) MH - Data Interpretation, Statistical MH - Female MH - Humans MH - Iowa/epidemiology MH - Linear Models MH - Mastectomy/*methods MH - Mastectomy, Segmental MH - Middle Aged MH - *Models, Statistical MH - Observation/*methods MH - Radiotherapy, Adjuvant MH - Registries/statistics & numerical data MH - Retrospective Studies MH - Risk Adjustment/*statistics & numerical data MH - Survival Rate EDAT- 2007/10/25 09:00 MHDA- 2007/12/06 09:00 CRDT- 2007/10/25 09:00 AID - 10.1097/MLR.0b013e318070c069 [doi] AID - 00005650-200710002-00021 [pii] PST - ppublish SO - Med Care. 2007 Oct;45(10 Supl 2):S123-30. PMID- 17954796 OWN - NLM STAT- MEDLINE DA - 20071023 DCOM- 20071120 LR - 20161124 IS - 0003-9926 (Print) IS - 0003-9926 (Linking) VI - 167 IP - 19 DP - 2007 Oct 22 TI - Informed choice in mammography screening: a randomized trial of a decision aid for 70-year-old women. PG - 2039-46 AB - BACKGROUND: Many women who have participated in mammography screening are now approaching 70 years of age. These women are advised to consider both the benefits and harms of continuing to be screened. Doing so may be difficult for individual women, and there are no evaluated decision support tools to assist them. METHODS: To assess the effect of a decision aid (DA) about whether to continue or stop mammography screening for women aged 70 years, a population-based, randomized controlled trial was conducted in New South Wales, Australia. Women aged 70 years who had regularly participated in mammography screening were eligible to participate in the trial. Women received a DA providing balanced, quantitative information or standard information available from the screening program. The main outcomes were the percentage of women making an informed choice about whether to continue or stop screening and the percentage of women participating in the screening. RESULTS: Women who received the DA (the intervention group) were better informed than the control group (mean increase in knowledge score out of 10, 2.62 for the intervention group vs 0.68 for the control group; P < .001), and a significantly greater percentage made an informed choice (73.5% vs 48.8%; P < .001). The DA did not increase anxiety and slightly reduced decisional conflict. There was no difference in the percentage of women who participated in screening within 1 month. CONCLUSIONS: This DA increased knowledge and assisted women to make an informed choice. It did not alter participation in screening. The DA is an effective way to assist women to make a decision about continuing mammography screening and seems to be a feasible intervention within a population screening program. FAU - Mathieu, Erin AU - Mathieu E AD - Screening and Test Evaluation Program, School of Public Health, University of Sydney, Sydney, Australia. FAU - Barratt, Alexandra AU - Barratt A FAU - Davey, Heather M AU - Davey HM FAU - McGeechan, Kevin AU - McGeechan K FAU - Howard, Kirsten AU - Howard K FAU - Houssami, Nehmat AU - Houssami N LA - eng PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PL - United States TA - Arch Intern Med JT - Archives of internal medicine JID - 0372440 SB - AIM SB - IM CIN - Arch Intern Med. 2007 Oct 22;167(19):2027-8. PMID: 17954794 MH - Aged MH - Breast Neoplasms/*diagnostic imaging MH - Choice Behavior MH - *Decision Support Techniques MH - Female MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Mammography/statistics & numerical data/*utilization MH - New South Wales MH - Outcome Assessment (Health Care) MH - Patient Education as Topic MH - Patient Participation MH - Patient Satisfaction EDAT- 2007/10/24 09:00 MHDA- 2007/12/06 09:00 CRDT- 2007/10/24 09:00 AID - 167/19/2039 [pii] AID - 10.1001/archinte.167.19.2039 [doi] PST - ppublish SO - Arch Intern Med. 2007 Oct 22;167(19):2039-46. PMID- 17932905 OWN - NLM STAT- MEDLINE DA - 20071126 DCOM- 20080109 LR - 20071126 IS - 0008-543X (Print) IS - 0008-543X (Linking) VI - 110 IP - 11 DP - 2007 Dec 01 TI - Decision analysis to assess the efficacy of routine sentinel lymphadenectomy in patients undergoing prophylactic mastectomy. PG - 2542-50 AB - BACKGROUND: Patients who have invasive breast cancer identified after prophylactic mastectomy (PM) require axillary lymph node dissection (ALND) for lymph node staging (ie, directed ALND). Because the majority of these patients will be lymph node negative, sentinel lymphadenectomy (SLND) has been advocated at the time of PM to avoid the sequelae of unnecessary ALND. The objective of this study was to compare the efficacy of 2 surgical strategies, routine SLND versus directed ALND, in PM patients. METHODS: A decision-analytic model was created to compare the 2 surgical strategies. Model estimates were derived from a systematic literature review. The endpoints that were examined to compare the 2 strategies were the number of SLNDs performed per breast cancer detected, the number of SLNDs attempted to avoid 1 ALND in a lymph node-negative patient with occult invasive cancer, and the number of axillary complications associated with each strategy. RESULTS: The prevalence of invasive cancer in patients undergoing PM was estimated at 1.9%. At this rate, 37 SLNDs were performed per 1 breast cancer detected, and 73 SLNDs were required to avoid 1 ALND in a lymph node-negative PM patient. In 1 model scenario, the probability of complications per breast cancer detected was 9-fold greater with the SLND strategy than with the directed ALND strategy (2.7 vs 0.3). The complication rates for the 2 strategies become equivalent in the model scenario when the prevalence of occult invasive cancer was projected to 28%. CONCLUSIONS: Routine SLND for patients undergoing PM is not warranted given the large number of procedures required to benefit 1 patient and the potential complications associated with performing SLND in all patients. FAU - Boughey, Judy C AU - Boughey JC AD - Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77230-1402, USA. FAU - Cormier, Janice N AU - Cormier JN FAU - Xing, Yan AU - Xing Y FAU - Hunt, Kelly K AU - Hunt KK FAU - Meric-Bernstam, Funda AU - Meric-Bernstam F FAU - Babiera, Gildy V AU - Babiera GV FAU - Ross, Merrick I AU - Ross MI FAU - Kuerer, Henry M AU - Kuerer HM FAU - Singletary, Sonja E AU - Singletary SE FAU - Bedrosian, Isabelle AU - Bedrosian I LA - eng PT - Comparative Study PT - Journal Article PL - United States TA - Cancer JT - Cancer JID - 0374236 SB - AIM SB - IM MH - Axilla MH - Breast Neoplasms/*prevention & control/*surgery MH - *Decision Support Techniques MH - Female MH - Humans MH - *Lymph Node Excision MH - *Mastectomy MH - Sentinel Lymph Node Biopsy EDAT- 2007/10/13 09:00 MHDA- 2008/01/10 09:00 CRDT- 2007/10/13 09:00 AID - 10.1002/cncr.23067 [doi] PST - ppublish SO - Cancer. 2007 Dec 1;110(11):2542-50. PMID- 17911785 OWN - NLM STAT- MEDLINE DA - 20071003 DCOM- 20071128 LR - 20080710 IS - 0926-9630 (Print) IS - 0926-9630 (Linking) VI - 129 IP - Pt 1 DP - 2007 TI - A data mining approach to analyze non-compliance with a guideline for the treatment of breast cancer. PG - 591-5 AB - Postmastectomy radiotherapy (PMRT) is prescribed in order to reduce the local recurrence of breast cancer and improve overall survival. A guideline supports the trade-off between benefits and adverse effects of PMRT. However, this guideline is not always followed in practice. This study tries to find a method for revealing patterns of non-compliance between the actual treatment and the PMRT guideline. Data from breast cancer patients admitted to Linkoping University Hospital between 1990 and 2000 were analyzed in this study. Cases that were not treated in accordance with the guideline were selected and analyzed by decision tree induction (DTI). Thereafter, four resulting rules, as representations for groups of patients, were compared to the guideline. Finding patterns of non-compliance with guidelines by means of rules can be an appropriate alternative to manual methods, i.e. a case-by-case comparison when studying very large datasets. The resulting rules can be used in a knowledge base of a guideline-based decision support system to alert when inconsistencies with the guidelines may appear. FAU - Razavi, Amir R AU - Razavi AR AD - Department of Biomedical Engineering, Division of Medical Informatics, Linkoping University, Sweden. amirreza.razavi@imt.liu.se FAU - Gill, Hans AU - Gill H FAU - Ahlfeldt, Hans AU - Ahlfeldt H FAU - Shahsavar, Nosrat AU - Shahsavar N LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - Netherlands TA - Stud Health Technol Inform JT - Studies in health technology and informatics JID - 9214582 SB - T MH - Breast Neoplasms/*radiotherapy/surgery MH - Data Interpretation, Statistical MH - *Decision Trees MH - *Guideline Adherence MH - Humans MH - Information Storage and Retrieval MH - Mastectomy MH - Practice Guidelines as Topic MH - Radiotherapy, Adjuvant/utilization EDAT- 2007/10/04 09:00 MHDA- 2007/12/06 09:00 CRDT- 2007/10/04 09:00 PST - ppublish SO - Stud Health Technol Inform. 2007;129(Pt 1):591-5. PMID- 17896717 OWN - NLM STAT- MEDLINE DA - 20070927 DCOM- 20071102 LR - 20071115 IS - 0028-9604 (Print) IS - 0028-9604 (Linking) VI - 141 IP - 17 DP - 2003 Apr 28 TI - What do patients want? PG - 63-4 FAU - Halpert, Julie AU - Halpert J LA - eng PT - News PL - United States TA - Newsweek JT - Newsweek JID - 9877127 SB - K MH - Adult MH - Anecdotes as Topic MH - *Decision Making MH - Female MH - Humans MH - Mammaplasty/*methods MH - *Patient Education as Topic MH - *Patient Participation MH - *Physician-Patient Relations EDAT- 2007/09/28 09:00 MHDA- 2007/11/06 09:00 CRDT- 2007/09/28 09:00 PST - ppublish SO - Newsweek. 2003 Apr 28;141(17):63-4. PMID- 17896084 OWN - NLM STAT- MEDLINE DA - 20070926 DCOM- 20080130 LR - 20131121 IS - 0179-7158 (Print) IS - 0179-7158 (Linking) VI - 183 IP - 10 DP - 2007 Oct TI - [On the interaction of adjuvant radiotherapy and tamoxifen treatment for breast cancer]. PG - 535-44 AB - BACKGROUND: Tamoxifen (TAM) is well established in the adjuvant therapy of breast cancer. However, the timing of TAM therapy, concurrent or after radiotherapy, is controversial. METHOD: Literature is reviewed with respect to experimental and clinical data on interaction of TAM and radiation on tumor control and radiation side effects. RESULTS: In vitro data support the concept of antagonistic effects of concurrent TAM and radiation on tumor cells, but in animal models a synergistic effect was seen. Considering the modulation of TAM effects by estrogen and growth factor receptors, two-dimensional systems may not be suitable for studying the interaction of TAM and radiation. From a clinical perspective, a tumor-protective effect of TAM therapy concurrent with radiation was not evident. However, prospective studies addressing this question adequately are not available at the time. CONCLUSION: Although some studies indicate an enhancement of lung and subcutaneous fibrosis after TAM therapy, the side effects are mild and at this point do not seem to warrant withholding TAM. FAU - Hoeller, Ulrike AU - Hoeller U AD - Klinik fur Strahlentherapie, Radioonkologie und Nuklearmedizin, Vivantes Klinikum Neukolln, Berlin. ulrike.hoeller@vivantes.de FAU - Borgmann, Kerstin AU - Borgmann K FAU - Feyer, Petra AU - Feyer P FAU - Souchon, Rainer AU - Souchon R CN - Organgruppe "Mammakarzinom" der DEGRO LA - ger PT - Comparative Study PT - English Abstract PT - Journal Article PT - Review TT - Zur Interaktion von Strahlentherapie und Tamoxifen beim Mammakarzinom. PL - Germany TA - Strahlenther Onkol JT - Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] JID - 8603469 RN - 0 (Antineoplastic Agents, Hormonal) RN - 094ZI81Y45 (Tamoxifen) SB - IM MH - Age Factors MH - Animals MH - Antineoplastic Agents, Hormonal/adverse effects/pharmacology/*therapeutic use MH - Breast Neoplasms/*drug therapy/mortality/*radiotherapy/surgery MH - Clinical Trials, Phase III as Topic MH - Combined Modality Therapy MH - Data Interpretation, Statistical MH - Female MH - Humans MH - Lung/radiation effects MH - Lung Diseases/chemically induced/etiology MH - Mastectomy MH - Middle Aged MH - Neoplasms, Experimental MH - Prospective Studies MH - Pulmonary Fibrosis/chemically induced/etiology MH - Radiotherapy/adverse effects MH - Radiotherapy Dosage MH - Radiotherapy, Adjuvant MH - Randomized Controlled Trials as Topic MH - Retrospective Studies MH - Risk Factors MH - Tamoxifen/adverse effects/pharmacology/*therapeutic use MH - Time Factors MH - Tumor Cells, Cultured/drug effects/radiation effects RF - 77 EDAT- 2007/09/27 09:00 MHDA- 2008/01/31 09:00 CRDT- 2007/09/27 09:00 PHST- 2007/01/08 [received] PHST- 2007/07/24 [accepted] AID - 10.1007/s00066-007-1710-5 [doi] PST - ppublish SO - Strahlenther Onkol. 2007 Oct;183(10):535-44. PMID- 17889495 OWN - NLM STAT- MEDLINE DA - 20071112 DCOM- 20080219 LR - 20071112 IS - 0738-3991 (Print) IS - 0738-3991 (Linking) VI - 69 IP - 1-3 DP - 2007 Dec TI - Information acquisition for women facing surgical treatment for breast cancer: influencing factors and selected outcomes. PG - 5-19 AB - OBJECTIVE: To examine, summarize, and critically assess the literature focusing on information use by early-stage breast cancer patients. METHODS: Empirical articles reporting the information needs, sources used/preferred, and intervention-related outcomes experienced by patients in the context of making a treatment choice were chosen. Several healthcare databases were searched. Articles were limited to those published in English between January 1, 1986 and March 31, 2006. RESULTS: A total of 25 articles met the inclusion criteria. Information needs were consistent, and highest rankings were for (in order): information about chances for a cure, stage of disease, and treatment options. Results were equivocal regarding the factors found to influence information need: age, time since diagnosis, and preferred role in decision-making. The highest ranked information sources accessed and preferred were physicians. Age, education, and type of treatment chosen influenced source choice. Patients using consumer decision aids (CDAs) had less decisional conflict, higher satisfaction with the decision made and the decision process, and higher knowledge levels. CONCLUSION: Information needs and source use were influenced by several personal and contextual factors. PRACTICE IMPLICATIONS: A better understanding of source use could provide more effective ways of disseminating information to patients. FAU - O'Leary, Katherine A AU - O'Leary KA AD - Knowledge Utilization Studies Program, University of Alberta, Canada. koleary@ualberta.ca FAU - Estabrooks, Carole A AU - Estabrooks CA FAU - Olson, Karin AU - Olson K FAU - Cumming, Ceinwen AU - Cumming C LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review DEP - 20070924 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - *Attitude to Health MH - *Breast Neoplasms/psychology/surgery MH - Decision Making MH - Decision Support Techniques MH - Female MH - Health Knowledge, Attitudes, Practice MH - Health Services Needs and Demand MH - Humans MH - Internal-External Control MH - *Mastectomy/education/methods/psychology MH - Models, Educational MH - Models, Psychological MH - *Patient Education as Topic MH - Patient Participation/psychology MH - Patient Selection MH - Power (Psychology) MH - Research Design MH - Social Support MH - *Women/education/psychology RF - 71 EDAT- 2007/09/25 09:00 MHDA- 2008/02/20 09:00 CRDT- 2007/09/25 09:00 PHST- 2007/01/03 [received] PHST- 2007/07/23 [revised] PHST- 2007/08/09 [accepted] AID - S0738-3991(07)00308-4 [pii] AID - 10.1016/j.pec.2007.08.002 [doi] PST - ppublish SO - Patient Educ Couns. 2007 Dec;69(1-3):5-19. Epub 2007 Sep 24. PMID- 17874951 OWN - NLM STAT- MEDLINE DA - 20070918 DCOM- 20071130 LR - 20070918 IS - 0882-7974 (Print) IS - 0882-7974 (Linking) VI - 22 IP - 3 DP - 2007 Sep TI - Why older adults make more immediate treatment decisions about cancer than younger adults. PG - 505-24 AB - Literature relevant to medical decision making was reviewed, and a model was outlined for testing. Two studies examined whether older adults make more immediate decisions than younger adults about treatments for prostate or breast cancer in authentic scenarios. Findings clearly showed that older adults were more likely to make immediate decisions than younger adults. The research is important because it not only demonstrates the consistency of this age-related effect across disease domains, gender, ethnic groups, and prevalent education levels but begins to investigate a model to explain the effect. Major reasons for the effect focus on treatment knowledge, interest and engagement, and cognitive resources. Treatment knowledge, general cancer knowledge, interest, and cognitive resources relate to different ways of processing treatment information and preferences for immediate versus delayed decision making. Adults with high knowledge of treatments on a reliable test tended to make immediate treatment decisions, which supports the knowledge explanation. Adults with more cognitive resources and more interest tended to delay their treatment decisions. Little support was found for a cohort explanation for the relationship between age and preference for immediate medical decision making. CI - (PsycINFO Database Record (c) 2007 APA, all rights reserved). FAU - Meyer, Bonnie J F AU - Meyer BJ AD - Department of Educational and School Psychology and Special Education, University Park Campus, Pennsylvania State University, University Park, PA 16802, USA. bjm8@psu.edu FAU - Talbot, Andrew P AU - Talbot AP FAU - Ranalli, Carlee AU - Ranalli C LA - eng GR - AG 000048/AG/NIA NIH HHS/United States GR - R01 AG 09957/AG/NIA NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PL - United States TA - Psychol Aging JT - Psychology and aging JID - 8904079 SB - IM MH - Adolescent MH - Adult MH - Age Factors MH - Aged MH - Aged, 80 and over MH - Biopsy/psychology MH - Brachytherapy/psychology MH - Breast Neoplasms/diagnosis/*psychology/therapy MH - *Decision Making MH - Decision Trees MH - Female MH - Health Knowledge, Attitudes, Practice MH - Health Surveys MH - Humans MH - Male MH - Mastectomy, Segmental/psychology MH - Middle Aged MH - Ohio MH - Patient Education as Topic MH - Patient Participation MH - Pennsylvania MH - Problem Solving MH - Prostatectomy/psychology MH - Prostatic Neoplasms/diagnosis/*psychology/therapy MH - Sex Factors EDAT- 2007/09/19 09:00 MHDA- 2007/12/06 09:00 CRDT- 2007/09/19 09:00 AID - 2007-13103-009 [pii] AID - 10.1037/0882-7974.22.3.505 [doi] PST - ppublish SO - Psychol Aging. 2007 Sep;22(3):505-24. PMID- 17847124 OWN - NLM STAT- MEDLINE DA - 20080402 DCOM- 20080505 LR - 20131121 IS - 1099-1611 (Electronic) IS - 1057-9249 (Linking) VI - 17 IP - 4 DP - 2008 Apr TI - Choices in cancer treatment: a qualitative study of the older women's (>70 years) perspective. PG - 410-6 AB - PURPOSE: Primary endocrine therapy (PET) is the treatment of primary, operable breast cancer with drugs, such as tamoxifen, rather than surgery. It is in widespread use in the UK with 40% of women over 70 years old being treated in this way. PET is associated with inferior rates of local control compared with the standard surgical therapies, but there is no difference in overall survival. There has been no published research regarding the attitudes of older women concerning these two alternative approaches to treatment; what may influence their treatment choice or their experience of either treatment modality. This study aimed to address these questions. METHOD: In-depth qualitative interviews were undertaken to explore the views of a group of 21 purposively selected older women (>70 years old), who had been treated by PET or surgery for breast cancer. The interviews were transcribed verbatim and analysed using Framework Analysis. RESULTS: Both surgery and PET were well tolerated and had high satisfaction ratings from most women. This was the case even for those who had complications following surgery or needed a change of management in the PET group. Older women expressed no age-specific fears for operative procedures. The women were passive information seekers and relied heavily on 'expert' advice in making their treatment choices. Neither social support or age were factors in their decision-making. Their main concern was to ensure that their quality of life and independence remained unaffected. CONCLUSION: Older women have no strong preference for either treatment option but are concerned that the treatment is effective and causes minimal disruption to their quality of life and independence. This study suggests that medical consultations may need to be adapted to reflect the passive acceptance of 'expert' advice in the majority of women in this age group. CI - Copyright 2007 John Wiley & Sons, Ltd. FAU - Husain, Lopa Sadia AU - Husain LS AD - Academic Surgical Oncology Unit, University of Sheffield, Sheffield, UK. FAU - Collins, Karen AU - Collins K FAU - Reed, Malcolm AU - Reed M FAU - Wyld, Lynda AU - Wyld L LA - eng PT - Journal Article PL - England TA - Psychooncology JT - Psycho-oncology JID - 9214524 RN - 0 (Antineoplastic Agents, Hormonal) RN - 094ZI81Y45 (Tamoxifen) SB - IM MH - Aged, 80 and over MH - Antineoplastic Agents, Hormonal/*therapeutic use MH - Breast Neoplasms/pathology/*psychology/*therapy MH - *Choice Behavior MH - Communication MH - Comorbidity MH - Decision Making MH - Humans MH - Internal-External Control MH - Interview, Psychological MH - Lymph Node Excision/psychology MH - Mastectomy/*psychology MH - Neoplasm Staging MH - Palliative Care/psychology MH - Patient Education as Topic MH - Patient Participation MH - Physician-Patient Relations MH - Prognosis MH - Sick Role MH - Tamoxifen/*therapeutic use EDAT- 2007/09/12 09:00 MHDA- 2008/05/06 09:00 CRDT- 2007/09/12 09:00 AID - 10.1002/pon.1242 [doi] PST - ppublish SO - Psychooncology. 2008 Apr;17(4):410-6. PMID- 17718858 OWN - NLM STAT- MEDLINE DA - 20070827 DCOM- 20071203 LR - 20070827 IS - 0009-9163 (Print) IS - 0009-9163 (Linking) VI - 72 IP - 3 DP - 2007 Sep TI - Development and testing of a decision aid for breast cancer prevention for women with a BRCA1 or BRCA2 mutation. PG - 208-17 AB - For women who carry a mutation in BRCA1 or BRCA2, the risk of breast cancer is up to 87% by the age of 70. There are options available to reduce the risk of breast cancer; however, each option has both risks and benefits, which makes decision making difficult. The objective is to develop and pilot test a decision aid for breast cancer prevention for women with a BRCA1 or BRCA2 mutation. The decision aid was developed and evaluated in three stages. In the first stage, the decision aid was developed and reviewed by cancer genetics experts. The second stage was a review of the decision aid by women with a BRCA1 or BRCA2 mutation for acceptability and feasibility. The final stage was a pre-test--post-test evaluation of the decision aid. Twenty-one women completed the pre-test questionnaire and 20 completed the post-test questionnaire. After using the decision aid, there was a significant decline in mean decisional conflict scores (p = 0.001), a significant improvement in knowledge scores (p = 0.004), and fewer women uncertain about prophylactic mastectomy (p = 0.003) and prophylactic oophorectomy (p = 0.009). Use of the decision aid decreased decisional conflict to levels suggestive of implementation of a decision. In addition, knowledge levels increased and choice predisposition changed with fewer women being uncertain about each option. This has significant clinical implications as it implies that with greater uptake of cancer prevention options by women with a BRCA1 or BRCA2 mutation, fewer women will develop and/or die of hereditary breast cancer. FAU - Metcalfe, K A AU - Metcalfe KA AD - Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada M5T 1P8. kelly.metcalfe@utoronto.ca FAU - Poll, A AU - Poll A FAU - O'Connor, A AU - O'Connor A FAU - Gershman, S AU - Gershman S FAU - Armel, S AU - Armel S FAU - Finch, A AU - Finch A FAU - Demsky, R AU - Demsky R FAU - Rosen, B AU - Rosen B FAU - Narod, S A AU - Narod SA LA - eng PT - Evaluation Studies PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - Denmark TA - Clin Genet JT - Clinical genetics JID - 0253664 SB - IM MH - Breast Neoplasms/*genetics/*prevention & control MH - *Decision Support Techniques MH - Female MH - *Genes, BRCA1 MH - *Genes, BRCA2 MH - Genetic Counseling MH - Humans MH - Mutation MH - Pilot Projects EDAT- 2007/08/28 09:00 MHDA- 2007/12/06 09:00 CRDT- 2007/08/28 09:00 AID - CGE859 [pii] AID - 10.1111/j.1399-0004.2007.00859.x [doi] PST - ppublish SO - Clin Genet. 2007 Sep;72(3):208-17. PMID- 17666977 OWN - NLM STAT- MEDLINE DA - 20070801 DCOM- 20070918 LR - 20161019 IS - 1538-9804 (Electronic) IS - 0162-220X (Linking) VI - 30 IP - 4 DP - 2007 Jul-Aug TI - What women wish they knew before prophylactic mastectomy. PG - 285-91; quiz 292-3 AB - Although prophylactic mastectomy significantly reduces the incidence and recurrence of breast cancer, little is known about women's information needs before the procedure. We surveyed 967 women, from 6 healthcare systems, with bilateral or contralateral prophylactic mastectomy performed between 1979 and 1999. There were 2 open-ended questions: "What one thing do you wish you had known before your prophylactic mastectomy" and "Is there anything else you would like to share with us?" Three researchers categorized responses, and informational needs were ascertained. Seventy-one percent (684 women) responded, of which 81% answered one or both open-ended questions. There were 386 comments (made by 293 women) that related to information needs; 79% of women had bilateral prophylactic mastectomy and 58% had contralateral prophylactic mastectomy. Most concerns (69%) were related to reconstruction: the longevity; look and feel of implants, pain, numbness, scarring, and reconstruction options. Many women wished they had seen photographs to better prepare them for the final result. Our findings suggest that information needs of many women undergoing prophylactic mastectomy, particularly those selecting bilateral prophylactic mastectomy, have not been sufficiently addressed. Clinicians and health educators should be aware of patient needs and must counsel women accordingly. FAU - Rolnick, Sharon J AU - Rolnick SJ AD - HealthPartners Research Foundation, Minneapolis, MN 55440-1524, USA. Cheri.J.Rolnick@healthpartners.com FAU - Altschuler, Andrea AU - Altschuler A FAU - Nekhlyudov, Larissa AU - Nekhlyudov L FAU - Elmore, Joann G AU - Elmore JG FAU - Greene, Sarah M AU - Greene SM FAU - Harris, Emily L AU - Harris EL FAU - Herrinton, Lisa J AU - Herrinton LJ FAU - Barton, Mary B AU - Barton MB FAU - Geiger, Ann M AU - Geiger AM FAU - Fletcher, Suzanne W AU - Fletcher SW LA - eng GR - U19 CA079689-01/CA/NCI NIH HHS/United States GR - R01-CA090323/CA/NCI NIH HHS/United States GR - U19 CA79689-030/CA/NCI NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural PL - United States TA - Cancer Nurs JT - Cancer nursing JID - 7805358 SB - IM SB - N MH - Adaptation, Psychological MH - Adult MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/*prevention & control MH - *Decision Making MH - Female MH - Humans MH - *Mammaplasty/adverse effects/psychology MH - *Mastectomy/adverse effects/psychology MH - Middle Aged MH - Needs Assessment MH - *Patient Education as Topic MH - *Patient Satisfaction MH - United States EDAT- 2007/08/02 09:00 MHDA- 2007/09/19 09:00 CRDT- 2007/08/02 09:00 AID - 10.1097/01.NCC.0000281733.40856.c4 [doi] AID - 00002820-200707000-00005 [pii] PST - ppublish SO - Cancer Nurs. 2007 Jul-Aug;30(4):285-91; quiz 292-3. PMID- 17628037 OWN - NLM STAT- MEDLINE DA - 20080402 DCOM- 20080505 LR - 20080402 IS - 1099-1611 (Electronic) IS - 1057-9249 (Linking) VI - 17 IP - 4 DP - 2008 Apr TI - Latina a Latina: developing a breast cancer decision support intervention. PG - 383-91 AB - Latinas have the fastest rising incidence of breast cancer. Yet, little data are available about Latinas' breast cancer treatment experiences. Aims were to: (1) identify factors in Latinas' treatment decision making and (2) develop and pilot a decision support intervention. Thirty-seven Latinas diagnosed with breast cancer participated. Qualitative data were used to identify intervention messages. Most women desired help in asking questions. Women were most concerned about chemotherapy side effects. Cultural values (e.g. personalismo, familismo) helped structure intervention messages. In phase two, participants completed a face-to-face skill-building session with a trained breast cancer survivor. Women found the intervention acceptable and reported better communication and decision-making skills. Interventions that focus on cultural strengths may improve Latinas treatment experiences and informed decision making. CI - Copyright 2007 John Wiley & Sons, Ltd. FAU - Sheppard, Vanessa B AU - Sheppard VB AD - Cancer Control Program, Georgetown University, Washington, DC, USA. FAU - Figueiredo, Melissa AU - Figueiredo M FAU - Canar, Janet AU - Canar J FAU - Goodman, Michelle AU - Goodman M FAU - Caicedo, Larisa AU - Caicedo L FAU - Kaufman, Adriana AU - Kaufman A FAU - Norling, Gretchen AU - Norling G FAU - Mandelblatt, Jeanne AU - Mandelblatt J LA - eng GR - U01 CA86114-04/CA/NCI NIH HHS/United States GR - U10 CA084131-03S1/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PL - England TA - Psychooncology JT - Psycho-oncology JID - 9214524 SB - IM MH - Adult MH - Aged MH - Breast Neoplasms/drug therapy/*psychology MH - Chemotherapy, Adjuvant/psychology MH - Communication MH - Cultural Competency MH - Culture MH - *Decision Making MH - Female MH - Health Behavior MH - Hispanic Americans/*psychology MH - Humans MH - Mentors MH - Middle Aged MH - Patient Education as Topic MH - *Peer Group MH - Pilot Projects MH - Problem Solving MH - Self Efficacy MH - *Social Support MH - Survivors/psychology EDAT- 2007/07/14 09:00 MHDA- 2008/05/06 09:00 CRDT- 2007/07/14 09:00 AID - 10.1002/pon.1239 [doi] PST - ppublish SO - Psychooncology. 2008 Apr;17(4):383-91. PMID- 17406006 OWN - NLM STAT- MEDLINE DA - 20070531 DCOM- 20070731 LR - 20071115 IS - 0002-9262 (Print) IS - 0002-9262 (Linking) VI - 165 IP - 12 DP - 2007 Jun 15 TI - Using probabilistic corrections to account for abstractor agreement in medical record reviews. PG - 1454-61 AB - The quality of medical record abstracts is often characterized in a reliability substudy. These results usually indicate agreement, but not the extent to which lack of agreement affects associations observed in the complete data. In this study, medical records were reviewed and abstracted for patients diagnosed with stage I or stage II breast cancer between 1990 and 1994 at one of six US Cancer Research Network sites. For a subsample, interrater reliability data were available. The authors calculated conventional hazard ratios and 95% confidence intervals for the association of demographic, tumor, and treatment characteristics with recurrence rate. These conventional estimates of effect were compared with three sets of estimates and 95% simulation intervals that took account of the uncertainty assessed by lack of agreement in the reliability substudy. The rate of recurrence was associated with increasing cancer stage and with treatment modality but not with demographic characteristics. The hazard ratios and simulation intervals that took account of the reliability data showed that the simulation interval grew wider as the sources of uncertainty taken into account grew more complete, but the associations expected a priori remained readily apparent. While many investigators use reliability data only as a metric for data quality, a more thorough approach can also quantitatively depict the uncertainty in the observed associations. FAU - Lash, Timothy L AU - Lash TL AD - Boston University School of Public Health, Boston, MA 02118, USA. tlash@bu.edu FAU - Fox, Matthew P AU - Fox MP FAU - Thwin, Soe Soe AU - Thwin SS FAU - Geiger, Ann M AU - Geiger AM FAU - Buist, Diana S M AU - Buist DS FAU - Wei, Feifei AU - Wei F FAU - Field, Terry S AU - Field TS FAU - Yood, Marianne Ulcickas AU - Yood MU FAU - Frost, Floyd J AU - Frost FJ FAU - Quinn, Virginia P AU - Quinn VP FAU - Prout, Marianne N AU - Prout MN FAU - Silliman, Rebecca A AU - Silliman RA LA - eng GR - R01 CA093772/CA/NCI NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural DEP - 20070403 PL - United States TA - Am J Epidemiol JT - American journal of epidemiology JID - 7910653 SB - IM MH - *Abstracting and Indexing as Topic MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/*epidemiology/pathology/surgery MH - Comorbidity MH - *Data Interpretation, Statistical MH - Female MH - Humans MH - Mastectomy/methods MH - *Medical Records MH - Neoplasm Recurrence, Local/epidemiology MH - *Probability MH - United States/epidemiology EDAT- 2007/04/05 09:00 MHDA- 2007/08/01 09:00 CRDT- 2007/04/05 09:00 AID - kwm034 [pii] AID - 10.1093/aje/kwm034 [doi] PST - ppublish SO - Am J Epidemiol. 2007 Jun 15;165(12):1454-61. Epub 2007 Apr 3. PMID- 17371175 OWN - NLM STAT- MEDLINE DA - 20070320 DCOM- 20070717 LR - 20151119 IS - 0885-8195 (Print) IS - 0885-8195 (Linking) VI - 21 IP - 3 DP - 2006 Fall TI - Entertainment education for informed breast cancer treatment decisions in low-literate women: development and initial evaluation of a patient decision aid. PG - 133-9 AB - BACKGROUND: We report on the development and initial evaluation of a novel computerized decision support system (CDSS) that utilizes concepts from entertainment education (edutainment) to assist low-literate, multiethnic women in making initial surgical treatment decisions. METHOD: We randomly assigned 51 patients diagnosed with early stage breast cancer to use the decision aid. RESULTS: Patients who viewed the CDSS improved their knowledge of breast cancer treatment; found the application easy to use and understand, informative, and enjoyable; and were less worried about treatment. CONCLUSION: The system clearly reached its intended objectives to create a usable decision aid for low-literate, novice computer users. FAU - Jibaja-Weiss, Maria L AU - Jibaja-Weiss ML AD - Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas 77098, USA. mariaj@bcm.edu FAU - Volk, Robert J AU - Volk RJ FAU - Granch, Thomas S AU - Granch TS FAU - Nefe, Nancy E AU - Nefe NE FAU - Spann, Stephen J AU - Spann SJ FAU - Aoki, Noriaki AU - Aoki N FAU - Robinson, Emily K AU - Robinson EK FAU - Freidman, Lois C AU - Freidman LC FAU - Beck, J Robert AU - Beck JR LA - eng PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, U.S. Gov't, Non-P.H.S. PL - England TA - J Cancer Educ JT - Journal of cancer education : the official journal of the American Association for Cancer Education JID - 8610343 SB - IM MH - Breast Neoplasms/pathology/*therapy MH - Continental Population Groups/education MH - *Decision Making MH - *Decision Making, Computer-Assisted MH - *Decision Support Techniques MH - Educational Status MH - Ethnic Groups/education MH - Female MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Middle Aged MH - Neoplasm Staging MH - *Patient Education as Topic/methods MH - Patient Satisfaction MH - *Program Development MH - *Program Evaluation MH - Research Design MH - Surveys and Questionnaires MH - Texas MH - User-Computer Interface EDAT- 2007/03/21 09:00 MHDA- 2007/07/18 09:00 CRDT- 2007/03/21 09:00 AID - 10.1207/s15430154jce2103_8 [doi] PST - ppublish SO - J Cancer Educ. 2006 Fall;21(3):133-9. PMID- 17369570 OWN - NLM STAT- MEDLINE DA - 20070319 DCOM- 20070405 LR - 20071115 IS - 1527-7755 (Electronic) IS - 0732-183X (Linking) VI - 25 IP - 9 DP - 2007 Mar 20 TI - Decision aids and breast cancer: do they influence choice for surgery and knowledge of treatment options? PG - 1067-73 AB - PURPOSE: To describe the effect of decision aids on the choice for surgery and knowledge of surgical therapy among women with early-stage breast cancer. METHODS: A systematic review was conducted between years 1966 to 2006 of all studies designed to assess the effect of decision aids on surgical therapy. MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health (CINAHL), the Cochrane Network, HAPI databases, and bibliographies were searched. Of the 123 studies screened, 11 studies met criteria. Meta-analyses were performed to assess the pooled relative risk for surgical choice and the pooled mean difference in patient knowledge. RESULTS: Results from randomized controlled trials indicated that women who used a decision aid were 25% more likely to choose breast-conserving surgery over mastectomy (risk ratio, 1.25; 95% CI, 1.11 to 1.40). Decision aids significantly increased patient knowledge by 24% (P = .024). The data also suggested that decision aids decreased decisional conflict and increased satisfaction with the decision-making process. Decision aids were well received by surgeons and patients, facilitated patients' desire for shared decision making, and were feasible to implement into practice. CONCLUSION: Decision aids are important adjuncts for counseling women with early-stage breast cancer. Their use increases the likelihood that women will choose breast-conserving surgery, and enhances patient knowledge of treatment options. FAU - Waljee, Jennifer F AU - Waljee JF AD - Section of General Surgery and Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA. filip@med.umich.edu FAU - Rogers, Mary A M AU - Rogers MA FAU - Alderman, Amy K AU - Alderman AK LA - eng PT - Journal Article PT - Meta-Analysis PT - Review PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 SB - IM MH - Attitude of Health Personnel MH - Breast Neoplasms/pathology/*surgery/therapy MH - Choice Behavior MH - Conflict (Psychology) MH - Counseling/*methods MH - *Decision Support Techniques MH - Female MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - *Mastectomy/methods MH - Neoplasm Staging MH - Odds Ratio MH - *Patient Education as Topic MH - Patient Participation MH - Patient Satisfaction MH - Physician-Patient Relations MH - Quality of Life MH - Treatment Outcome RF - 48 EDAT- 2007/03/21 09:00 MHDA- 2007/04/06 09:00 CRDT- 2007/03/21 09:00 AID - 25/9/1067 [pii] AID - 10.1200/JCO.2006.08.5472 [doi] PST - ppublish SO - J Clin Oncol. 2007 Mar 20;25(9):1067-73. PMID- 17341306 OWN - NLM STAT- PubMed-not-MEDLINE DA - 20070322 DCOM- 20070723 LR - 20091118 IS - 1472-6874 (Electronic) IS - 1472-6874 (Linking) VI - 7 DP - 2007 Mar 06 TI - Time to decide about risk-reducing mastectomy: a case series of BRCA1/2 gene mutation carriers. PG - 3 AB - BACKGROUND: The purpose of this research was to explore women's decision-making experiences related to the option of risk-reducing mastectomy (RM), using a case series of three women who are carriers of a BRCA1/2 gene mutation. METHODS: Data was collected in a pilot study that assessed the response of women to an information booklet about RM and decision-making support strategies. A detailed analysis of three women's descriptions of their decision-making processes and outcomes was conducted. RESULTS: All three women were carriers of a BRCA1/2 gene mutation and, although undecided, were leaning towards RM when initially assessed. Each woman reported a different RM decision outcome at last follow-up. Case #1 decided not to have RM, stating that RM was "too radical" and early detection methods were an effective strategy for dealing with breast cancer risk. Case #2 remained undecided about RM and, over time, she became less prepared to make a decision because she felt she did not have sufficient information about surgical effects. Case #3 had undergone RM by the time of her second follow-up interview and reported that she felt "a load off (her) mind now". CONCLUSION: RM decision making may shift over time and require decision support over an extended period. FAU - McCullum, Mary AU - McCullum M AD - Hereditary Cancer Program, BC Cancer Agency, Vancouver, BC, Canada. mmccullum@bccancer.bc.ca FAU - Bottorff, Joan L AU - Bottorff JL FAU - Kelly, Mary AU - Kelly M FAU - Kieffer, Stephanie A AU - Kieffer SA FAU - Balneaves, Lynda G AU - Balneaves LG LA - eng PT - Journal Article DEP - 20070306 PL - England TA - BMC Womens Health JT - BMC women's health JID - 101088690 PMC - PMC1829393 OID - NLM: PMC1829393 EDAT- 2007/03/08 09:00 MHDA- 2007/03/08 09:01 CRDT- 2007/03/08 09:00 PHST- 2006/07/17 [received] PHST- 2007/03/06 [accepted] AID - 1472-6874-7-3 [pii] AID - 10.1186/1472-6874-7-3 [doi] PST - epublish SO - BMC Womens Health. 2007 Mar 6;7:3. PMID- 17341292 OWN - NLM STAT- MEDLINE DA - 20070517 DCOM- 20070613 LR - 20140907 IS - 1465-542X (Electronic) IS - 1465-5411 (Linking) VI - 9 IP - 2 DP - 2007 TI - Confirmation of double-peaked time distribution of mortality among Asian breast cancer patients in a population-based study. PG - R21 AB - INTRODUCTION: Double-peaked time distributions of the mortality hazard function have been reported for breast cancer patients from Western populations treated with mastectomy alone. These are thought to reflect accelerated tumour growth at micrometastatic sites mediated by angiogenesis after primary tumour removal as well as tumor dormancy. Similar data are not available for Asian populations. We sought to investigate whether differences exist in the pattern of mortality hazard function between Western breast cancer patients and their Asian counterparts in Singapore, which may suggest underlying differences in tumor biology between the two populations. METHODS: We performed a retrospective cohort study of female unilateral breast cancer patients diagnosed in Singapore between October 1994 and June 1999. Data regarding patient demographics, tumour characteristics and death were available. Overall survival curves were calculated using the Kaplan-Meier method. The hazard rate was calculated as the conditional probability of dying in a time interval, given that the patient was alive at the beginning of the interval. The life table method was used to calculate the yearly hazard rates. RESULTS: In the 2,105 women identified, 956 patients (45.4%) had mastectomy alone. Demographic characteristics were as follows: 86.5% were Chinese, 45.2% were postmenopausal, 38.9% were hormone receptor positive, 54.6% were node negative and 44.1% had high histological grade. We observed a double-peaked mortality hazard pattern, with a first peak in mortality achieving its maximum between years 2 and 4 after mastectomy, and a second large peak in mortality during year 9. Analyses by subgroups revealed a similar pattern regardless of T stage, or node or menopausal status. This pattern was also noted in high-grade tumors but not in those that were well to moderately differentiated. The double-peaked pattern observed in Singaporean women was quantitatively and qualitatively similar to those reported in Western series. CONCLUSION: Our study confirms the existence of a double-peaked process in Asian patients, and it gives further support to the tumour dormancy hypothesis after mastectomy. FAU - Gao, Fei AU - Gao F AD - Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre, Singapore. ctegfe@nccs.com.sg FAU - Tan, Say Beng AU - Tan SB FAU - Machin, David AU - Machin D FAU - Wong, Nan Soon AU - Wong NS LA - eng PT - Journal Article PL - England TA - Breast Cancer Res JT - Breast cancer research : BCR JID - 100927353 SB - IM MH - Aged MH - Asian Continental Ancestry Group MH - Breast Neoplasms/*ethnology/*mortality/therapy MH - Cohort Studies MH - Data Interpretation, Statistical MH - Female MH - Humans MH - Mastectomy MH - Middle Aged MH - Proportional Hazards Models MH - Research Design MH - Retrospective Studies MH - Survival Analysis MH - Time Factors PMC - PMC1868926 OID - NLM: PMC1868926 EDAT- 2007/03/08 09:00 MHDA- 2007/06/15 09:00 CRDT- 2007/03/08 09:00 PHST- 2006/10/09 [received] PHST- 2007/01/31 [revised] PHST- 2007/03/06 [accepted] AID - bcr1658 [pii] AID - 10.1186/bcr1658 [doi] PST - ppublish SO - Breast Cancer Res. 2007;9(2):R21. PMID- 17319855 OWN - NLM STAT- MEDLINE DA - 20070226 DCOM- 20070417 LR - 20071115 IS - 1075-122X (Print) IS - 1075-122X (Linking) VI - 13 IP - 2 DP - 2007 Mar-Apr TI - Pilot trial of a computerized decision aid for breast cancer prevention. PG - 147-54 AB - This study sought to evaluate a shared decision-making aid for breast cancer prevention care designed to help women make appropriate prevention decisions by presenting information about risk in context. The decision aid was implemented in a high-risk breast cancer prevention program and pilot-tested in a randomized clinical trial comparing standard consultations to use of the decision aid. Physicians completed training with the decision aid prior to enrollment. Thirty participants enrolled (15 per group) and completed measures of clinical feasibility and effectiveness prior to, immediately after, and at 9 months after their consultations. The decision aid was feasible to use during the consultations as measured by consultation duration, user satisfaction, patient knowledge, and decisional conflict. The mean consultation duration was not significantly different between groups (24 minutes for intervention group versus 21 minutes for control group, p = 0.42). The majority found the decision aid acceptable and useful and would recommend it to others. Both groups showed an improvement in breast cancer prevention knowledge postvisit, which was significant in the intervention group (p = 0.01) but not the control group (p = 0.13). However, the knowledge scores returned to baseline at follow-up in both groups. Decision preference for patients who chose chemoprevention post consultations remained constant at follow-up for the intervention group, but not for the control group. The decision framework provides access to key information during consultations and facilitates the integration of emerging biomarkers in this setting. Initial results suggest that the decision aid is feasible for use in the consultation room. The tendency for the decision choices and knowledge scores to return to baseline at follow-up suggests the need for initial and ongoing prevention decision support. FAU - Ozanne, Elissa M AU - Ozanne EM AD - Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. elissa@mgh-ita.org FAU - Annis, Caroline AU - Annis C FAU - Adduci, Kelly AU - Adduci K FAU - Showstack, Jonathan AU - Showstack J FAU - Esserman, Laura AU - Esserman L LA - eng PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PL - United States TA - Breast J JT - The breast journal JID - 9505539 SB - IM CIN - Breast J. 2007 Sep-Oct;13(5):539-40; author reply 540-2. PMID: 17760687 MH - Adult MH - Aged MH - Breast Neoplasms/*prevention & control MH - *Decision Making, Computer-Assisted MH - Feasibility Studies MH - Female MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Middle Aged MH - Patient Education as Topic/*methods MH - Patient Participation MH - Patient Satisfaction MH - Pilot Projects MH - Risk Assessment MH - San Francisco EDAT- 2007/02/27 09:00 MHDA- 2007/04/18 09:00 CRDT- 2007/02/27 09:00 AID - TBJ395 [pii] AID - 10.1111/j.1524-4741.2007.00395.x [doi] PST - ppublish SO - Breast J. 2007 Mar-Apr;13(2):147-54. PMID- 17278032 OWN - NLM STAT- MEDLINE DA - 20070413 DCOM- 20071031 LR - 20161124 IS - 0174-1551 (Print) IS - 0174-1551 (Linking) VI - 30 IP - 3 DP - 2007 May-Jun TI - Subcutaneous venous port implantation in patients with bilateral breast surgery. PG - 405-9 AB - The purpose of this study was to evaluate the long-term follow-up results of subcutaneous venous ports implanted in patients with bilateral mastectomies. We retrospectively reviewed the hospital charts and the electronic database of 17 patients with bilateral mastectomies whom had venous port implantation in our interventional radiology suit. A total of 17 ports were implanted to the paramedian (n = 3) and anterolateral (standard; n = 12) chest wall, on the trapezius muscle (n = 1), and to the antecubital fossa (n = 1). The mean age was 48.29 years (range: 35-60 years). The mean time interval from time of surgery to port implantation was 34 months (range: 1-84 months). The mean follow-up time was 15 months (range: 7-39 months). Follow-up parameters and classification of the complications was defined according to the SIR guidelines. No procedure-related complication occurred. A single case of mild late infection was noted and the infection rate was 0.19/1000 catheter days. Infusion chemotherapy administration was still going on in eight patients. Two patients died during the follow-up and four patients were lost after 6 months. Port removal was performed in three patients at follow-up because of the end of treatment. One trapezius port and one paramedian port weres among the removed ports without any problem. Although we have a limited number of patients, port placement to the anterior chest wall, either paramedian or anterolateral, on the trapezius muscle or to the antecubital fossa depending on the extent of the bilateral breast surgeries that can be performed with low complication rates by a careful patient and anatomical location selection by involving the patients in the decision-making process. We believe that patient education and knowledge of possible complications have high importance in follow-up. FAU - Peynircioglu, Bora AU - Peynircioglu B AD - Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey. borapeynir@gmail.com FAU - Arslan, E Bengi AU - Arslan EB FAU - Cil, Barbaros E AU - Cil BE FAU - Geyik, Serdar AU - Geyik S FAU - Hazirolan, Tuncay AU - Hazirolan T FAU - Konan, Ali AU - Konan A FAU - Balkanci, Ferhun AU - Balkanci F LA - eng PT - Comparative Study PT - Journal Article PL - United States TA - Cardiovasc Intervent Radiol JT - Cardiovascular and interventional radiology JID - 8003538 SB - IM MH - Adult MH - Antineoplastic Combined Chemotherapy Protocols/*therapeutic use MH - Breast Neoplasms/diagnostic imaging/*drug therapy/surgery MH - *Catheters, Indwelling MH - Cellulitis/diagnostic imaging/etiology MH - Chemotherapy, Adjuvant MH - Combined Modality Therapy MH - Device Removal MH - Female MH - Follow-Up Studies MH - Humans MH - Infusions, Intravenous MH - Lymphedema/diagnostic imaging/etiology MH - *Mastectomy, Modified Radical MH - *Mastectomy, Radical MH - *Mastectomy, Simple MH - Middle Aged MH - Neoplasms, Multiple Primary/diagnostic imaging/*drug therapy/surgery MH - Radiography MH - Retrospective Studies EDAT- 2007/02/06 09:00 MHDA- 2007/11/01 09:00 CRDT- 2007/02/06 09:00 AID - 10.1007/s00270-006-0301-7 [doi] PST - ppublish SO - Cardiovasc Intervent Radiol. 2007 May-Jun;30(3):405-9. PMID- 17266888 OWN - NLM STAT- MEDLINE DA - 20070201 DCOM- 20070329 LR - 20161124 IS - 0025-7753 (Print) IS - 0025-7753 (Linking) VI - 128 IP - 1 DP - 2007 Jan 13 TI - [Breast cancer diagnosed in a screening programme. Does it differ from those diagnosed in routine practice detection?]. PG - 18-20 FAU - Naveiro Rilo, Jose Cesareo AU - Naveiro Rilo JC AD - Unidad Docente de Medicina Familiar y Comunitaria, Abad Vinayo 1, 24008 Leon, Spain. jnaveiro@gaple03.sacyl.es FAU - Peral Casado, Alfredo AU - Peral Casado A FAU - Flores Zurutuza, Lourdes AU - Flores Zurutuza L FAU - Buron Llamazares, Juan Luis AU - Buron Llamazares JL LA - spa PT - Comparative Study PT - Evaluation Studies PT - Journal Article TT - Cancer de mama diagnosticado mediante un programa de deteccion precoz. inverted question markDifiere del diagnosticado en el marco asistencial habitual? PL - Spain TA - Med Clin (Barc) JT - Medicina clinica JID - 0376377 SB - IM CIN - Med Clin (Barc). 2007 Jun 30;129(5):199. PMID: 17669342 MH - Adult MH - Age Factors MH - Aged MH - Breast Neoplasms/*diagnosis/diagnostic imaging/drug therapy/mortality/radiotherapy/surgery MH - Combined Modality Therapy MH - Data Interpretation, Statistical MH - Early Diagnosis MH - Female MH - Humans MH - Lymphatic Metastasis/diagnosis MH - Mammography MH - *Mass Screening MH - Mastectomy MH - Middle Aged MH - Neoplasm Metastasis MH - Prognosis MH - Retrospective Studies MH - Time Factors EDAT- 2007/02/03 09:00 MHDA- 2007/03/30 09:00 CRDT- 2007/02/03 09:00 AID - S0025-7753(07)72467-3 [pii] PST - ppublish SO - Med Clin (Barc). 2007 Jan 13;128(1):18-20. PMID- 17156967 OWN - NLM STAT- MEDLINE DA - 20070219 DCOM- 20070504 LR - 20161019 IS - 0738-3991 (Print) IS - 0738-3991 (Linking) VI - 65 IP - 3 DP - 2007 Mar TI - Factors associated with patient involvement in surgical treatment decision making for breast cancer. PG - 387-95 AB - OBJECTIVE: To evaluate factors associated with women's reported level of involvement in breast cancer surgical treatment decision making, and the factors associated with the match between actual and preferred involvement in this decision. METHODS: Survey data from breast cancer patients in Detroit and Los Angeles was merged with surgeon data for an analytic dataset of 1101 patients and 277 surgeons. Decisional involvement and the match between actual and preferred amount of involvement were analyzed as three-level dependent variables using multinomial logistic regression controlling for clustering within surgeons. Independent variables included patient demographic and clinical factors, surgeon demographic and practice factors, cancer program designation, and two measures of patient-surgeon communication. RESULTS: We found variation in women's actual decisional involvement and match between actual and preferred involvement. Women with a surgeon-based or patient-based (versus shared) decision were significantly (p < or = 0.05) younger. Women who had too little decisional involvement (versus the right amount) were younger, while women with too much involvement had less education. Patient-surgeon communication variables were significantly associated with both involvement and match, and higher surgeon volume as associated with too little involvement. CONCLUSION: Patient factors and patient-surgeon communication influence women's perception of their involvement in breast cancer surgical treatment decision making. PRACTICE IMPLICATIONS: Decision tools are needed across surgeons and practice settings to elicit patients' preferences for involvement in treatment decisions for breast cancer. FAU - Hawley, Sarah T AU - Hawley ST AD - Division of General Medicine, Department of Internal Medicine, University of Michigan, United States. sarahawl@med.umich.edu FAU - Lantz, Paula M AU - Lantz PM FAU - Janz, Nancy K AU - Janz NK FAU - Salem, Barbara AU - Salem B FAU - Morrow, Monica AU - Morrow M FAU - Schwartz, Kendra AU - Schwartz K FAU - Liu, Lihua AU - Liu L FAU - Katz, Steven J AU - Katz SJ LA - eng GR - R01 CA088370/CA/NCI NIH HHS/United States GR - R01 CA8837-A1/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20061206 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Adult MH - Age Factors MH - Aged MH - *Breast Neoplasms/psychology/surgery MH - Communication MH - Cooperative Behavior MH - *Decision Making MH - Decision Support Techniques MH - Educational Status MH - Female MH - Health Services Needs and Demand MH - Humans MH - Logistic Models MH - Los Angeles MH - Mastectomy/methods/*psychology MH - Michigan MH - Middle Aged MH - Patient Education as Topic MH - Patient Participation/methods/*psychology MH - Physician's Role/*psychology MH - Physician-Patient Relations MH - Radiotherapy, Adjuvant/psychology MH - SEER Program MH - Women/education/*psychology PMC - PMC1839840 MID - NIHMS19297 OID - NLM: NIHMS19297 OID - NLM: PMC1839840 EDAT- 2006/12/13 09:00 MHDA- 2007/05/05 09:00 CRDT- 2006/12/13 09:00 PHST- 2006/03/31 [received] PHST- 2006/08/23 [revised] PHST- 2006/09/28 [accepted] AID - S0738-3991(06)00326-0 [pii] AID - 10.1016/j.pec.2006.09.010 [doi] PST - ppublish SO - Patient Educ Couns. 2007 Mar;65(3):387-95. Epub 2006 Dec 6. PMID- 17099197 OWN - NLM STAT- MEDLINE DA - 20061113 DCOM- 20070228 LR - 20071115 IS - 0272-989X (Print) IS - 0272-989X (Linking) VI - 26 IP - 6 DP - 2006 Nov-Dec TI - Impact of an educational video on patient decision making in early breast cancer treatment. PG - 589-98 AB - Previous research suggests that patient education programs promoting shared decision making (SDM) may improve patient satisfaction and outcomes, yet controlled clinical trials are lacking. The authors evaluate the impact of an early breast cancer treatment educational video on patients' decisional preferences and behavior. Newly diagnosed stage I/stage II breast cancer patients were assigned to SDM video program or control groups in alternating months. Surveys were administered prior to the provider visit and 1 week following the treatment decision. Variables assessed included autonomy preferences, perceived involvement in care, satisfaction, and treatment choice. There were no significant intervention effects on informational/decisional preferences, anxiety, knowledge, or satisfaction. Although 25% of SDM patients chose mastectomy compared to 14% of controls, this difference was not statistically significant. Eventhough enthusiasm for SDM programs remains high among some patients and providers, this study found only modest benefits. FAU - Wilkins, Edwin G AU - Wilkins EG AD - Section of Plastic Surgery,University of Michigan Medical School, Ann Arbor, MI 48109, USA. ewilkins@umich.edu FAU - Lowery, Julie C AU - Lowery JC FAU - Copeland, Laurel A AU - Copeland LA FAU - Goldfarb, Sherry L AU - Goldfarb SL FAU - Wren, Patricia A AU - Wren PA FAU - Janz, Nancy K AU - Janz NK LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Med Decis Making JT - Medical decision making : an international journal of the Society for Medical Decision Making JID - 8109073 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/pathology/psychology/*therapy MH - Choice Behavior MH - *Decision Making MH - Female MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Mastectomy/psychology MH - Middle Aged MH - Neoplasm Staging MH - Patient Care Team MH - *Patient Education as Topic MH - *Patient Participation MH - Patient Satisfaction MH - Personality Inventory MH - Prospective Studies MH - Quality of Life/psychology MH - *Video Recording EDAT- 2006/11/14 09:00 MHDA- 2007/03/01 09:00 CRDT- 2006/11/14 09:00 AID - 26/6/589 [pii] AID - 10.1177/0272989X06295355 [doi] PST - ppublish SO - Med Decis Making. 2006 Nov-Dec;26(6):589-98. PMID- 17051118 OWN - NLM STAT- MEDLINE DA - 20061019 DCOM- 20061031 LR - 20150624 IS - 1529-4242 (Electronic) IS - 0032-1052 (Linking) VI - 118 IP - 6 DP - 2006 Nov TI - Achieving a zero percent reoperation rate at 3 years in a 50-consecutive-case augmentation mammaplasty premarket approval study. PG - 1453-7 AB - BACKGROUND: Excessively high reoperation rates in breast augmentation premarket approval studies are a major concern of patients and the U.S. Food and Drug Administration. Over the past two decades, reoperation rates have remained between 13 and 20 percent at 3 years in three different premarket approval studies for three different types of implant devices, indicating that high reoperation rates are not device dependent. The hypothesis of this study was that implementing specific peer-reviewed and published processes can significantly reduce reoperation rates in a premarket approval study. METHODS: Fifty consecutive primary breast augmentation patients were enrolled in a premarket approval study for the Inamed Style 410 form stable, cohesive gel implant. All patients were treated specifically according to the premarket approval protocol. The series was monitored throughout the study by an independent clinical review organization and by a U.S. Food and Drug Administration inspection of the patient records on site at the author's practice. Specific content and processes were applied to patient management in patient education and informed consent, patient and surgeon decision-making processes, preoperative assessment and operative planning, implant selection based on individual patient tissue characteristics, surgical techniques, and postoperative care techniques. RESULTS: Follow-up was 100 percent (50 of 50 patients) at 1 year, 98 percent (49 of 50 patients) at 2 years (one patient could not be reached), and 94 percent (47 of 50 patients) at 3 years. No reoperations were performed on any patient followed at 3 years in the 50-consecutive-patient series. CONCLUSION: Implementing the peer-reviewed and published processes described in this study, no reoperations were performed in a prospective 50-consecutive-case series of primary augmentation mammaplasty patients in a premarket approval study with 94 percent follow-up at 3 years. FAU - Tebbetts, John B AU - Tebbetts JB AD - johnbt@airmail.net LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Plast Reconstr Surg JT - Plastic and reconstructive surgery JID - 1306050 RN - 0 (Silicone Gels) SB - AIM SB - IM MH - Adult MH - *Breast Implants MH - Device Approval MH - Female MH - Humans MH - Mammaplasty/*methods MH - Middle Aged MH - Patient Satisfaction MH - Prospective Studies MH - Reoperation/statistics & numerical data MH - *Silicone Gels MH - United States MH - United States Food and Drug Administration EDAT- 2006/10/20 09:00 MHDA- 2006/11/01 09:00 CRDT- 2006/10/20 09:00 AID - 10.1097/01.prs.0000239602.99867.07 [doi] AID - 00006534-200611000-00025 [pii] PST - ppublish SO - Plast Reconstr Surg. 2006 Nov;118(6):1453-7. PMID- 17023138 OWN - NLM STAT- MEDLINE DA - 20070115 DCOM- 20070420 LR - 20151119 IS - 0738-3991 (Print) IS - 0738-3991 (Linking) VI - 65 IP - 2 DP - 2007 Feb TI - An approach to measuring the quality of breast cancer decisions. PG - 261-9 AB - OBJECTIVE: To explore an approach to measuring the quality of decisions made in the treatment of early stage breast cancer, focusing on patients' decision-specific knowledge and the concordance between patients' stated preferences for treatment outcomes and treatment received. METHODS: Candidate knowledge and value items were identified after an extensive review of the published literature as well as reports on 27 focus groups and 46 individual interviews with breast cancer survivors. Items were subjected to cognitive interviews with six additional patients. A preliminary decision quality measure consisting of five knowledge items and four value items was pilot tested with 35 breast cancer survivors who also completed the control preferences scale and the decisional conflict scale (DCS). RESULTS: Preference for control and knowledge did not vary by treatment. The mean of the participants' knowledge scores was 54%. There was no correlation between the knowledge scores and the informed subscale of the DCS (Pearson r = .152, n = 32, p = 0.408). Patients who preferred to keep their breast were over five times as likely to have breast-conserving surgery than those who did not (OR 5.33, 95% CI (1.2, 24.5), p = 0.06). Patients who wanted to avoid radiation were six times as likely to choose mastectomy than those who did not (OR 6.4, 95% CI (1.34, 30.61), p = 0.04). CONCLUSION: Measuring decision quality by assessing patients' decision-specific knowledge and concordance between their values and treatment received, is feasible and important. Further work is necessary to overcome the methodological challenges identified in this pilot work. PRACTICE IMPLICATIONS: Guidelines for early stage breast cancer emphasize the importance of including patients' preferences in decisions about treatment. The ability of doctors and patients to make decisions that reflect the considered preferences of well-informed patients can and should be measured. FAU - Sepucha, Karen AU - Sepucha K AD - Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. ksepucha@partners.org FAU - Ozanne, Elissa AU - Ozanne E FAU - Silvia, Kerry AU - Silvia K FAU - Partridge, Ann AU - Partridge A FAU - Mulley, Albert G Jr AU - Mulley AG Jr LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20061004 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Adult MH - Aged MH - Aged, 80 and over MH - *Breast Neoplasms/psychology/therapy MH - Conflict (Psychology) MH - *Decision Making MH - Educational Measurement MH - Female MH - Focus Groups MH - Health Knowledge, Attitudes, Practice MH - Humans MH - Internal-External Control MH - Massachusetts MH - Mastectomy/psychology MH - Middle Aged MH - *Patient Education as Topic MH - Patient Participation/methods/*psychology MH - Pilot Projects MH - Practice Guidelines as Topic MH - Social Values MH - Surveys and Questionnaires MH - Survivors/*psychology MH - Treatment Outcome EDAT- 2006/10/07 09:00 MHDA- 2007/04/21 09:00 CRDT- 2006/10/07 09:00 PHST- 2006/03/15 [received] PHST- 2006/08/04 [revised] PHST- 2006/08/14 [accepted] AID - S0738-3991(06)00266-7 [pii] AID - 10.1016/j.pec.2006.08.007 [doi] PST - ppublish SO - Patient Educ Couns. 2007 Feb;65(2):261-9. Epub 2006 Oct 4. PMID- 16962910 OWN - NLM STAT- MEDLINE DA - 20060911 DCOM- 20061208 LR - 20090626 IS - 0738-3991 (Print) IS - 0738-3991 (Linking) VI - 63 IP - 1-2 DP - 2006 Oct TI - Print information to inform decisions about mammography screening participation in 16 countries with population-based programs. PG - 126-37 AB - OBJECTIVE: To profile and compare the content and presentation of written communications related to informed decision-making about mammography. METHODS: Materials from 16 screening programs organized at the national or regional level were analyzed according to five major information domains suggested by the international literature. RESULTS: A majority of countries provided information on the program (interval, cost and quality). There was considerable variability in comprehensiveness of elements in the domains, e.g., test characteristics (false positive/negative) and pros and cons of screening. The majority noted the likelihood of recall for further tests, few commented on the risks of additional tests or finding unimportant tumors. The audit also found variation in presentation (words and pictures). CONCLUSIONS: Presentation of comprehensive, but balanced information on screening benefits and risks is complex and daunting. Issues such as framing effects, coupled with debate about screening efficacy are challenging to the design of effective information tools. The objective of increasing screening prevalence at the population level must be balanced with objectively presenting complete and clear information. Additional research is needed on how information (and mode of presentation) impact screening decisions. PRACTICE IMPLICATIONS: Public health officials need to articulate their objectives and review written communication according to important decision-making domains. FAU - Zapka, Jane G AU - Zapka JG AD - University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA. jane.zapka@umassmed.edu FAU - Geller, Berta M AU - Geller BM FAU - Bulliard, Jean-Luc AU - Bulliard JL FAU - Fracheboud, Jacques AU - Fracheboud J FAU - Sancho-Garnier, Helene AU - Sancho-Garnier H FAU - Ballard-Barbash, Rachel AU - Ballard-Barbash R CN - IBSN Communications Working Group LA - eng PT - Comparative Study PT - Evaluation Studies PT - Journal Article PT - Research Support, N.I.H., Extramural PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Australia MH - Breast Neoplasms/diagnosis/etiology MH - Canada MH - Community Health Planning MH - *Decision Making MH - Decision Support Techniques MH - Europe MH - Health Care Surveys MH - Humans MH - Informed Consent/*psychology/statistics & numerical data MH - Israel MH - Japan MH - Mammography/adverse effects/*psychology/statistics & numerical data MH - Mass Screening/adverse effects/*psychology/statistics & numerical data MH - New Zealand MH - Patient Acceptance of Health Care/*psychology/statistics & numerical data MH - Patient Education as Topic/*organization & administration MH - Program Evaluation MH - Risk Assessment MH - Risk Factors MH - Teaching Materials/standards EDAT- 2006/09/12 09:00 MHDA- 2006/12/12 09:00 CRDT- 2006/09/12 09:00 PHST- 2005/02/04 [received] PHST- 2005/09/09 [revised] PHST- 2005/09/17 [accepted] AID - S0738-3991(05)00273-9 [pii] AID - 10.1016/j.pec.2005.09.012 [doi] PST - ppublish SO - Patient Educ Couns. 2006 Oct;63(1-2):126-37. PMID- 16945498 OWN - NLM STAT- MEDLINE DA - 20061204 DCOM- 20070223 LR - 20151119 IS - 0738-3991 (Print) IS - 0738-3991 (Linking) VI - 65 IP - 1 DP - 2007 Jan TI - Exploring the black box of a decision aid: what information do patients select from an interactive Cd-Rom on treatment options in breast cancer? PG - 122-30 AB - OBJECTIVE: It is thought that patients fare better when they participate in treatment decision-making, and when they have more control over the amount and type of information they receive. To facilitate informed decision-making, interactive decision aids have been introduced in health care. This article describes how much, and which information patients select from an interactive decision aid on breast cancer. To explore whether the interactive system facilitates that different patients receive different information, associations between patients' characteristics and information selection are inspected. METHODS: The interactive decision aid was provided to 106 patients after an initial discussion with their surgeon about their diagnosis and treatment options. Information regarding patients' age, completed education, treatment preference, psychological functioning, decision uncertainty and decision style was collected with a written, structured questionnaire. The questionnaire was completed before patients used the interactive decision aid. To create categories, a median-split procedure was employed on the scores of the continuous background variables. The information patients selected from the interactive decision aid were registered into logfiles. Associations between patients' background variables and information selection were investigated by means of univariate statistics. RESULTS: Patients (n=97; 92%) used the interactive decision aid intensively. On average, patients spent almost 70min searching for information and selected 21 information topics. Overall, treatment related information was clearly more selected than other types of information. Age, education, and decision style factors were associated with information selection. CONCLUSION: The interactive breast cancer decision aid was utilized intensively. The interactive system was found to facilitate that different patients received different amounts and types of information. PRACTICE IMPLICATIONS: Interactive decision aids may improve information giving to patients, and as a result, the quality of care. To safeguard informed-choice, decision aids should be used in conjunction with other communication strategies. Decision aids should be available continuously and throughout the patients' disease journey. The Internet may help to achieve broad dissemination and enduring access. FAU - Molenaar, Sjaak AU - Molenaar S AD - Academic Medical Center, University of Amsterdam, Department of Medical Psychology (Room J3-401), P.O. Box 22 660, 1100 DD Amsterdam, The Netherlands. J.Molenaar@AMC.UvA.NL FAU - Sprangers, Mirjam AU - Sprangers M FAU - Oort, Frans AU - Oort F FAU - Rutgers, Emiel AU - Rutgers E FAU - Luiten, Ernest AU - Luiten E FAU - Mulder, Jan AU - Mulder J FAU - van Meeteren, Marjolijn AU - van Meeteren M FAU - de Haes, Hanneke AU - de Haes H LA - eng PT - Journal Article DEP - 20060901 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Adaptation, Psychological MH - Adult MH - Aged MH - Aged, 80 and over MH - Avoidance Learning MH - Breast Neoplasms/*psychology/surgery MH - *CD-ROM/standards MH - Choice Behavior MH - Communication MH - Computer-Assisted Instruction/*methods MH - *Decision Support Techniques MH - Female MH - Health Services Needs and Demand MH - Humans MH - Informed Consent MH - Internal-External Control MH - Mastectomy/education/psychology MH - Mastectomy, Segmental/education/psychology MH - Middle Aged MH - Netherlands MH - Patient Education as Topic/*methods MH - Patient Participation/methods/psychology MH - Surveys and Questionnaires MH - Uncertainty MH - User-Computer Interface EDAT- 2006/09/02 09:00 MHDA- 2007/02/24 09:00 CRDT- 2006/09/02 09:00 PHST- 2006/05/24 [received] PHST- 2006/06/27 [accepted] AID - S0738-3991(06)00221-7 [pii] AID - 10.1016/j.pec.2006.06.022 [doi] PST - ppublish SO - Patient Educ Couns. 2007 Jan;65(1):122-30. Epub 2006 Sep 1. PMID- 16911140 OWN - NLM STAT- MEDLINE DA - 20060816 DCOM- 20061220 LR - 20170219 IS - 1369-6513 (Print) IS - 1369-6513 (Linking) VI - 9 IP - 3 DP - 2006 Sep TI - Decision aids in routine practice: lessons from the breast cancer initiative. PG - 255-64 AB - BACKGROUND: Many decision aids have been developed to help patients make treatment and screening decisions; however, little is known about implementing them into routine clinical practice. OBJECTIVE: To assess the feasibility of implementing a patient decision aid (PtDA) for the early stage breast cancer surgical decision into routine clinical care. DESIGN: Structured individual interviews. SETTING AND PARTICIPANTS: A convenience sample of providers from nine sites, including two community resource centres, a community hospital and six academic centres. MAIN OUTCOME MEASURES: Usage data, barriers to and resources for implementing the PtDAs. RESULTS: Six of the nine sites were using the PtDAs with patients. Two sites were primarily using a scheduling system and four sites relied on a lending system. For the academic centres, the keys to successful implementation included integrating the PtDA into the flow of patients through the centre and having physicians who recommended it to patients. At the community centres, the keys to successful implementation included an informed staff and the flexibility to get the PtDAs to patients in different ways. Barriers that limited or prevented sites from using the PtDA included a lack of clinical support, a lack of system support, competing priorities and scheduling problems. CONCLUSIONS: It is feasible to implement a breast cancer PtDA into routine clinical care at academic centres and community resource centres. Future research should assess the effectiveness of PtDAs in routine clinical care as well as resources and barriers to their implementation in community hospitals. FAU - Silvia, Kerry A AU - Silvia KA AD - Health Decision Research Unit, Massachusetts General Hospital, Boston, MA 02114, USA. FAU - Sepucha, Karen R AU - Sepucha KR LA - eng PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't PL - England TA - Health Expect JT - Health expectations : an international journal of public participation in health care and health policy JID - 9815926 SB - IM MH - Academic Medical Centers MH - Adult MH - Breast Neoplasms/*psychology/*surgery MH - Community Health Centers MH - *Decision Support Techniques MH - Feasibility Studies MH - Female MH - Humans MH - Interviews as Topic PMC - PMC5060360 EDAT- 2006/08/17 09:00 MHDA- 2006/12/21 09:00 CRDT- 2006/08/17 09:00 AID - HEX393 [pii] AID - 10.1111/j.1369-7625.2006.00393.x [doi] PST - ppublish SO - Health Expect. 2006 Sep;9(3):255-64. PMID- 16911136 OWN - NLM STAT- MEDLINE DA - 20060816 DCOM- 20061220 LR - 20170219 IS - 1369-6513 (Print) IS - 1369-6513 (Linking) VI - 9 IP - 3 DP - 2006 Sep TI - Preliminary testing of a just-in-time, user-defined values clarification exercise to aid lower literate women in making informed breast cancer treatment decisions. PG - 218-31 AB - OBJECTIVE: To report on the initial testing of a values clarification exercise utilizing a jewellery box within a computerized patient decision aid (CPtDA) designed to assist women in making a surgical breast cancer treatment decision. DESIGN: Pre-post design, with patients interviewed after diagnosis, and then after completing the CPtDA sometime later at their preoperative visit. SAMPLE: Fifty-one female patients, who are low literate and naive computer users, newly diagnosed with early stage breast cancer from two urban public hospitals. INTERVENTION: A computerized decision aid that combines entertainment-education (edutainment) with enhanced (factual) content. An interactive jewellery box is featured to assist women in: (1) recording and reflecting over issues of concern with possible treatments, (2) deliberating over surgery decision, and (3) communicating with physician and significant others. OUTCOMES: Patients' use of the jewellery box to store issues during completion of the CPtDA, and perceived clarity of values in making a treatment decision, as measured by a low literacy version of the Decisional Conflict Scale (DCS). RESULTS: Over half of the participants utilized the jewellery box to store issues they found concerning about the treatments. On average, users flagged over 13 issues of concern with the treatments. Scores on the DCS Uncertainty and Feeling Unclear about Values subscales were lower after the intervention compared to before the decision was made. CONCLUSIONS: A values clarification exercise using an interactive jewellery box may be a promising method for promoting informed treatment decision making by low literacy breast cancer patients. FAU - Jibaja-Weiss, Maria L AU - Jibaja-Weiss ML AD - Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX 77098, USA. mariaj@bcm.tmc.edu FAU - Volk, Robert J AU - Volk RJ FAU - Friedman, Lois C AU - Friedman LC FAU - Granchi, Thomas S AU - Granchi TS FAU - Neff, Nancy E AU - Neff NE FAU - Spann, Stephen J AU - Spann SJ FAU - Robinson, Emily K AU - Robinson EK FAU - Aoki, Noriaki AU - Aoki N FAU - Robert Beck, J AU - Robert Beck J LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PL - England TA - Health Expect JT - Health expectations : an international journal of public participation in health care and health policy JID - 9815926 SB - IM MH - Adult MH - Aged MH - Breast Neoplasms/*psychology/*therapy MH - *Decision Making, Computer-Assisted MH - *Educational Status MH - Humans MH - Middle Aged MH - Patient Education as Topic MH - Time Factors MH - Women/*psychology PMC - PMC5060365 EDAT- 2006/08/17 09:00 MHDA- 2006/12/21 09:00 CRDT- 2006/08/17 09:00 AID - HEX386 [pii] AID - 10.1111/j.1369-7625.2006.00386.x [doi] PST - ppublish SO - Health Expect. 2006 Sep;9(3):218-31. PMID- 16873078 OWN - NLM STAT- MEDLINE DA - 20060728 DCOM- 20060808 LR - 20110405 IS - 1769-6917 (Electronic) IS - 0007-4551 (Linking) VI - 93 IP - 7 DP - 2006 Jul TI - [Patient treatment preferences elicitation process: a French perspective]. PG - 691-7 AB - This paper deals with the physician-patient encounter. In France, the current legal framework allows patients to be informed (patients'rights to health information) and to participate to decisions regarding their own health. In such a context, this paper aims to give the reader the broad key components of the so-called 'patient treatment preferences elicitation process'in breast cancer, our research area. We first present the general context, with a definition of the different physician-patient models. We then present decision aids, tools that aim to provide high-quality information to patients in the decision-making process. Finally, based on our previous studies and on examples drawn from the international literature, we present the empirical process of patients'preferences elicitation which not only increases patients'knowledge of and satisfaction with the decision made, but also allows patients to be part of their disease management. Far from being a phenomenon in the air supported by a legal system, this method developed in the 90s allows patients and more generally healthcare users to be autonomous without constraining them to a choice. FAU - Moumjid, Nora AU - Moumjid N AD - Centre regional de lutte contre le cancer Leon-Berard, Lyon. FAU - Bremond, Alain AU - Bremond A LA - fre PT - English Abstract PT - Journal Article TT - Revelation des preferences des patients en matiere de decision de traitement en oncologie: un point de vue actuel. PL - France TA - Bull Cancer JT - Bulletin du cancer JID - 0072416 SB - IM MH - Breast Neoplasms/psychology/*therapy MH - Communication MH - Decision Making MH - *Decision Support Techniques MH - Humans MH - *Patient Participation MH - *Patient Satisfaction MH - *Physician-Patient Relations EDAT- 2006/07/29 09:00 MHDA- 2006/08/09 09:00 CRDT- 2006/07/29 09:00 PHST- 2006/02/07 [received] PHST- 2006/05/15 [accepted] PST - ppublish SO - Bull Cancer. 2006 Jul;93(7):691-7. PMID- 16870385 OWN - NLM STAT- MEDLINE DA - 20070115 DCOM- 20070420 LR - 20071115 IS - 0738-3991 (Print) IS - 0738-3991 (Linking) VI - 65 IP - 2 DP - 2007 Feb TI - Breast cancer disparities and decision-making among U.S. women. PG - 158-65 AB - OBJECTIVE: The impact of breast cancer is immense for all women, but the literature reveals an even greater impact on women of color and among socially and economically disadvantaged populations. Persistent differences in incidence and outcome are undoubtedly due to multiple factors, but one element in poor outcome may be treatment choice. Those treatments shown to be related to best outcomes are less likely to be chosen by certain groups of women. The effects of economic and cultural factors on breast cancer treatment choice have not been thoroughly explored; these factors must be understood if health care professionals are to intervene effectively to address disparities and improve breast cancer outcomes for all women. METHODS: A review of the breast cancer literature was conducted in order to: (1) describe breast cancer disparities in the United States; (2) delineate factors that might contribute to those disparities; (3) assess possible mitigating factors for predominant causes; (4) begin to decide how health care interventions might allay the factors that contribute to disparities in breast cancer incidence and mortality. RESULTS: Breast cancer incidence and outcome disparities in the United States are due to multiple interacting factors. These include information about treatment, different types of treatment, the emotional context of decision-making, and patient preference for level of involvement. Treatment decision-making is complex. CONCLUSION: Health literacy and level of decision-making involvement, both embedded in social and economic reality, are key components in breast cancer treatment decision-making and may contribute to breast cancer disparities in the United States. Current models of shared decision-making may not be generalizable to all breast cancer patients. PRACTICE IMPLICATIONS: Optimal breast cancer outcomes for all women depend on culturally and ethnically appropriate professional support. FAU - Polacek, Georgia N L Johnston AU - Polacek GN AD - Department of Health and Kinesiology, University of Texas, San Antonio, 6900 N. Loop 1604 W., San Antonio, TX 78249, USA. Georgia.polacek@utsa.edu FAU - Ramos, Mary Carol AU - Ramos MC FAU - Ferrer, Robert L AU - Ferrer RL LA - eng PT - Journal Article PT - Review DEP - 20060725 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Attitude to Health/*ethnology MH - Breast Neoplasms/*ethnology/mortality/*therapy MH - Cause of Death MH - Chemotherapy, Adjuvant MH - *Decision Making MH - Female MH - Health Knowledge, Attitudes, Practice MH - Health Services Accessibility MH - Health Services Needs and Demand MH - Humans MH - Incidence MH - Mastectomy MH - Minority Groups/education/*psychology/statistics & numerical data MH - Patient Education as Topic MH - Radiotherapy, Adjuvant MH - Registries MH - Risk Factors MH - Socioeconomic Factors MH - Treatment Outcome MH - United States/epidemiology MH - Vulnerable Populations/ethnology/statistics & numerical data MH - Women/education/*psychology RF - 84 EDAT- 2006/07/28 09:00 MHDA- 2007/04/21 09:00 CRDT- 2006/07/28 09:00 PHST- 2005/11/16 [received] PHST- 2006/05/11 [revised] PHST- 2006/06/05 [accepted] AID - S0738-3991(06)00185-6 [pii] AID - 10.1016/j.pec.2006.06.003 [doi] PST - ppublish SO - Patient Educ Couns. 2007 Feb;65(2):158-65. Epub 2006 Jul 25. PMID- 16860523 OWN - NLM STAT- MEDLINE DA - 20061122 DCOM- 20070323 LR - 20151119 IS - 0738-3991 (Print) IS - 0738-3991 (Linking) VI - 64 IP - 1-3 DP - 2006 Dec TI - An informed decision? Breast cancer patients and their knowledge about treatment. PG - 303-12 AB - OBJECTIVE: Although involving women in breast cancer treatment decisions is advocated, there is little understanding of whether women have the information they need to make informed decisions. The objective of the current study was to evaluate women's knowledge of survival and recurrence rates for mastectomy and breast conserving surgery (BCS) and the factors associated with this knowledge. METHODS: We used a population-based sample of women diagnosed with breast cancer in metropolitan Los Angeles and Detroit between December 2001 and January 2003. All women with ductal carcinoma in situ and a random sample of women with invasive disease were selected (N=2382), of which 1844 participated (77.4%). All participants were mailed surveys. The main outcome measures were knowledge of survival and recurrence rates by surgical treatment type. RESULTS: Only 16% of women knew that recurrence rates were different for mastectomy and BCS, and 48% knew that the survival rates were equivalent across treatment. Knowledge about survival and recurrence was improved by exposure to the Internet and health pamphlets (p<0.01). Women who had a female (versus male) surgeon, and/or a surgeon who explained both treatments (rather than just one treatment) demonstrated higher survival knowledge (p<0.01). The majority of women had inadequate knowledge with which to make informed decisions about breast cancer surgical treatment. CONCLUSION: Previous explanations for poor knowledge, such as irrelevance of knowledge to decision making and lack of access to information, were not shown to be plausible explanations for the low levels of knowledge observed in this sample. PRACTICE IMPLICATIONS: These results suggest a need for fundamental changes in patient education to ensure that women are able to make informed decisions about their breast cancer treatment. These changes may include an increase in the use of decision aids and in decreasing the speed at which treatment decisions are made. FAU - Fagerlin, Angela AU - Fagerlin A AD - VA Health Services Research & Development Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. fagerlin@umich.edu FAU - Lakhani, Indu AU - Lakhani I FAU - Lantz, Paula M AU - Lantz PM FAU - Janz, Nancy K AU - Janz NK FAU - Morrow, Monica AU - Morrow M FAU - Schwartz, Kendra AU - Schwartz K FAU - Deapen, Dennis AU - Deapen D FAU - Salem, Barbara AU - Salem B FAU - Liu, Lihua AU - Liu L FAU - Katz, Steven J AU - Katz SJ LA - eng GR - N01-PC-35139/PC/NCI NIH HHS/United States GR - N01-PC-65064/PC/NCI NIH HHS/United States GR - R01 CA8837-A1/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20060724 PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Adult MH - Aged MH - *Attitude to Health MH - *Breast Neoplasms/mortality/psychology/surgery MH - Carcinoma, Ductal, Breast/psychology MH - Carcinoma, Intraductal, Noninfiltrating/psychology MH - Decision Making MH - Educational Measurement MH - Female MH - Health Knowledge, Attitudes, Practice MH - Health Services Needs and Demand MH - Humans MH - Informed Consent/*psychology MH - Los Angeles/epidemiology MH - Male MH - Mastectomy/adverse effects/methods/psychology MH - Michigan/epidemiology MH - Middle Aged MH - Neoplasm Recurrence, Local/epidemiology MH - *Patient Education as Topic/organization & administration MH - Prospective Studies MH - Surveys and Questionnaires MH - Survival Rate MH - Treatment Outcome MH - *Women/education/psychology EDAT- 2006/07/25 09:00 MHDA- 2007/03/24 09:00 CRDT- 2006/07/25 09:00 PHST- 2005/08/11 [received] PHST- 2006/03/10 [revised] PHST- 2006/03/10 [accepted] AID - S0738-3991(06)00092-9 [pii] AID - 10.1016/j.pec.2006.03.010 [doi] PST - ppublish SO - Patient Educ Couns. 2006 Dec;64(1-3):303-12. Epub 2006 Jul 24. PMID- 16779296 OWN - NLM STAT- MEDLINE DA - 20060616 DCOM- 20070215 LR - 20161122 IS - 1942-597X (Electronic) IS - 1559-4076 (Linking) DP - 2005 TI - Towards quantifying the aesthetic outcomes of breast cancer treatment: assessment of surgical scars. PG - 1009 AB - Our long-term goal is to develop decision aids that will improve breast cancer treatment by explicitly taking aesthetics in the consideration. Essentially all breast cancer treatment involves surgery, which inevitably leaves scars. However, the extent and type of scarring is not the same for different surgeries (e.g., different forms of reconstruction.) We present our preliminary experiences in using image processing techniques to quantify scar characteristics in clinical photographs. FAU - Kim, Min Soon AU - Kim MS AD - Department of Biomedical Engineering, The University of Texas at Austin, TX, USA. FAU - Rodney, William N AU - Rodney WN FAU - Peng, Joshua AU - Peng J FAU - Reece, Gregory P AU - Reece GP FAU - Markey, Mia K AU - Markey MK LA - eng GR - R21 CA109040/CA/NCI NIH HHS/United States GR - R21 CA109040-01A1/CA/NCI NIH HHS/United States PT - Journal Article PL - United States TA - AMIA Annu Symp Proc JT - AMIA ... Annual Symposium proceedings. AMIA Symposium JID - 101209213 SB - IM MH - Breast Neoplasms/*surgery MH - Cicatrix/*classification MH - Decision Support Techniques MH - *Esthetics MH - Female MH - Humans MH - *Image Processing, Computer-Assisted MH - *Mammaplasty MH - Mastectomy MH - Observer Variation MH - Pilot Projects PMC - PMC1560447 OID - NLM: PMC1560447 EDAT- 2006/06/17 09:00 MHDA- 2007/02/16 09:00 CRDT- 2006/06/17 09:00 AID - 58154 [pii] PST - ppublish SO - AMIA Annu Symp Proc. 2005:1009. PMID- 16704673 OWN - NLM STAT- MEDLINE DA - 20060517 DCOM- 20060705 LR - 20170219 IS - 0017-9124 (Print) IS - 0017-9124 (Linking) VI - 41 IP - 3 Pt 2 DP - 2006 Jun TI - A comparative analysis of mandated benefit laws, 1949-2002. PG - 1081-103 AB - OBJECTIVE: To understand and compare the trends in mandated benefits laws in the United States. DATA SOURCES/STUDY SETTING: Mandated benefit laws enacted in 50 states and the District of Columbia for the period 1949-2002 were compiled from multiple published compendia. STUDY DESIGN: Laws that require private insurers and health plans to cover particular services, types of diseases, or care by specific providers in 50 states and the District of Columbia are compared for the period 1949-2002. Legislation is compared by year, by average and total frequency, by state, by type (provider, health care service, or preventive), and according to whether it requires coverage or an offer of coverage. DATA COLLECTION/EXTRACTION METHOD: Data from published tables were entered into a spreadsheet and analyzed using statistical software. PRINCIPAL FINDINGS: A total of 1,471 laws mandated coverage for 76 types of providers and services. The most common type of mandated coverage is for specific health care services (670 laws for 34 different services), followed by laws for services offered by specific professionals and other providers (507 mandated benefits laws for 25 types of providers), and coverage for specific preventive services (295 laws for 17 benefits). On average, a mandated benefit law has been adopted or significantly revised by 19 states, and each state has approximately 29 mandates. Only two benefits (minimum maternity stay and breast reconstruction) are mandated in all 51 jurisdictions and these were also federally mandated benefits. The mean number of total mandated benefit laws adopted or significantly revised per year was 17 per year in the 1970s, 36 per year in the 1980s, 59 per year in the 1990s, and 76 per year between 2000 and 2002. Since 1990, mandate adoption increased substantially, with around 55 percent of all mandated benefit laws enacted between 1990 and 2002. CONCLUSIONS: There was a large increase in the number of mandated benefits laws during the managed care "backlash" of the 1990s. Many states now use mandated benefits to prescribe not only what services and benefits would be provided but how, where, and when services will be provided. FAU - Laugesen, Miriam J AU - Laugesen MJ AD - Department of Health Services, UCLA School of Public Health, 31-293A CHS, Box 1772, Los Angeles, CA 90095-1772, USA. FAU - Paul, Rebecca R AU - Paul RR FAU - Luft, Harold S AU - Luft HS FAU - Aubry, Wade AU - Aubry W FAU - Ganiats, Theodore G AU - Ganiats TG LA - eng PT - Comparative Study PT - Historical Article PT - Journal Article PL - United States TA - Health Serv Res JT - Health services research JID - 0053006 SB - IM MH - Data Interpretation, Statistical MH - History, 20th Century MH - Humans MH - Insurance Benefits/history/*legislation & jurisprudence/*trends MH - *Insurance, Health MH - Mandatory Programs/*legislation & jurisprudence/trends MH - United States PMC - PMC1713218 OID - NLM: PMC1713218 EDAT- 2006/05/18 09:00 MHDA- 2006/07/06 09:00 CRDT- 2006/05/18 09:00 AID - HESR521 [pii] AID - 10.1111/j.1475-6773.2006.00521.x [doi] PST - ppublish SO - Health Serv Res. 2006 Jun;41(3 Pt 2):1081-103. PMID- 16549852 OWN - NLM STAT- MEDLINE DA - 20060321 DCOM- 20060411 LR - 20091119 IS - 1539-3704 (Electronic) IS - 0003-4819 (Linking) VI - 144 IP - 6 DP - 2006 Mar 21 TI - Cost-effectiveness of preventive strategies for women with a BRCA1 or a BRCA2 mutation. PG - 397-406 AB - BACKGROUND: For BRCA1 or BRCA2 mutation carriers, decision analysis indicates that prophylactic surgery or chemoprevention leads to better survival than surveillance alone. OBJECTIVE: To evaluate the cost-effectiveness of the preventive strategies that are available to unaffected women carrying a single BRCA1 or BRCA2 mutation with high cancer penetrance. DESIGN: Markov modeling with Monte Carlo simulations and probabilistic sensitivity analyses. DATA SOURCES: Breast and ovarian cancer incidence and mortality rates, preference ratings, and costs derived from the literature; the Surveillance, Epidemiology, and End Results (SEER) Program; and the Health Care Financing Administration (now the Centers for Medicare & Medicaid Services). TARGET POPULATION: Unaffected carriers of a single BRCA1 or BRCA2 mutation 35 to 50 years of age. TIME HORIZON: Lifetime. PERSPECTIVE: Health policy, societal. INTERVENTIONS: Tamoxifen, oral contraceptives, bilateral salpingo-oophorectomy, mastectomy, both surgeries, or surveillance. OUTCOME MEASURES: Cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: For mutation carriers 35 years of age, both surgeries (prophylactic bilateral mastectomy and oophorectomy) had an incremental cost-effectiveness ratio over oophorectomy alone of 2352 dollars per life-year for BRCA1 and 100 dollars per life-year for BRCA2. With quality adjustment, oophorectomy dominated all other strategies for BRCA1 and had an incremental cost-effectiveness ratio of 2281 dollars per life-year for BRCA2. RESULTS OF SENSITIVITY ANALYSIS: Older age at intervention increased the cost-effectiveness of prophylactic mastectomy for BRCA1 mutation carriers to 73,755 dollars per life-year. Varying the penetrance, mortality rates, costs, discount rates, and preferences had minimal effects on outcomes. LIMITATIONS: Results are dependent on the accuracy of model assumptions. CONCLUSION: On the basis of this model, the most cost-effective strategies for BRCA mutation carriers, with and without quality adjustment, were oophorectomy alone and oophorectomy and mastectomy, respectively. FAU - Anderson, Kristin AU - Anderson K AD - Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Joseph L. Mailman School of Public Health, Columbia University, and New York Presbyterian Hospital, New York, New York 10032, USA. FAU - Jacobson, Judith S AU - Jacobson JS FAU - Heitjan, Daniel F AU - Heitjan DF FAU - Zivin, Joshua Graff AU - Zivin JG FAU - Hershman, Dawn AU - Hershman D FAU - Neugut, Alfred I AU - Neugut AI FAU - Grann, Victor R AU - Grann VR LA - eng GR - K05 CA89155/CA/NCI NIH HHS/United States GR - K07 CA-95597/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - United States TA - Ann Intern Med JT - Annals of internal medicine JID - 0372351 SB - AIM SB - IM SPIN- Ann Intern Med. 2006 Mar 21;144(6):I40. PMID: 16549849 MH - Adult MH - Age Factors MH - Aged MH - Breast Neoplasms/*genetics/*prevention & control MH - Computer Simulation MH - Cost-Benefit Analysis MH - Female MH - *Genes, BRCA1 MH - *Genes, BRCA2 MH - Genetic Testing/economics MH - Heterozygote MH - Humans MH - Markov Chains MH - Mastectomy/*economics MH - Middle Aged MH - Monte Carlo Method MH - Mutation MH - Ovarian Neoplasms/*genetics/*prevention & control MH - Ovariectomy/*economics EDAT- 2006/03/22 09:00 MHDA- 2006/04/12 09:00 CRDT- 2006/03/22 09:00 AID - 144/6/397 [pii] PST - ppublish SO - Ann Intern Med. 2006 Mar 21;144(6):397-406. PMID- 16327616 OWN - NLM STAT- MEDLINE DA - 20051205 DCOM- 20060222 LR - 20150624 IS - 1529-4242 (Electronic) IS - 0032-1052 (Linking) VI - 116 IP - 7 DP - 2005 Dec TI - Five critical decisions in breast augmentation using five measurements in 5 minutes: the high five decision support process. PG - 2005-16 AB - BACKGROUND: Surgeons' decisions impact patient outcomes and implant effects on tissues over time. Tissue assessment systems that provide quantitative, objective data enable objective rather than subjective decisions. First-generation dimensional systems for breast augmentation defined a desired result dimensionally and recommended an implant to force tissues to the desired result. A second-generation system, the TEPID system, defines measurements to match the implant to the patient's tissue characteristics, instead of forcing tissues to a desired result. This study defines a third-generation decision support process that prioritizes five critical decisions, identifies five key measurements, and completes all preoperative assessment and operative planning decisions in breast augmentation in 5 minutes or less. METHODS: Key decision parameters and data from more than 2300 primary augmentations planned using the TEPID system were analyzed to define the five most critical decisions that affect reoperation rates and risks of uncorrectable deformities and to define a decision support process using five critical measurements. RESULTS: In 1664 cases with up to 7 years of follow-up, the overall reoperation rate was 3 percent, and the reoperation rate for implant size exchange was 0.2 percent. The junior author's (Adams) clinical experience includes more than 300 augmentations with up to 6 years of follow-up using this system, with an overall reoperation rate of 2.8 percent. CONCLUSION: The High Five decision support process prioritizes five critical decisions in breast augmentation and enables surgeons to address all preoperative assessment and operative planning decisions in breast augmentation in 5 minutes or less. FAU - Tebbetts, John B AU - Tebbetts JB AD - Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA. jbt@plastic-surgery.com FAU - Adams, William P AU - Adams WP LA - eng PT - Journal Article PL - United States TA - Plast Reconstr Surg JT - Plastic and reconstructive surgery JID - 1306050 SB - AIM SB - IM RPI - Plast Reconstr Surg. 2006 Dec;118(7 Suppl):35S-45S. PMID: 17099482 MH - Decision Making MH - *Decision Support Techniques MH - Female MH - Humans MH - *Mammaplasty/methods MH - Reoperation EDAT- 2005/12/06 09:00 MHDA- 2006/02/24 09:00 CRDT- 2005/12/06 09:00 AID - 00006534-200512000-00025 [pii] PST - ppublish SO - Plast Reconstr Surg. 2005 Dec;116(7):2005-16. PMID- 16217509 OWN - NLM STAT- MEDLINE DA - 20051011 DCOM- 20060221 LR - 20150624 IS - 1529-4242 (Electronic) IS - 0032-1052 (Linking) VI - 116 IP - 5 DP - 2005 Oct TI - Formal decision trees in plastic surgery. PG - 1550-3 FAU - Lloyd, Mark AU - Lloyd M FAU - Parikh, Apul AU - Parikh A FAU - Clarke, Alex AU - Clarke A FAU - Withey, Simon AU - Withey S FAU - Carson, Ewart AU - Carson E FAU - Simmons, Jon AU - Simmons J FAU - McEvoy, Helen AU - McEvoy H FAU - Butler, Peter E M AU - Butler PE LA - eng PT - Editorial PL - United States TA - Plast Reconstr Surg JT - Plastic and reconstructive surgery JID - 1306050 SB - AIM SB - IM MH - Decision Support Techniques MH - *Decision Trees MH - Humans MH - Mammaplasty MH - *Outcome Assessment (Health Care) MH - Quality of Life MH - *Surgery, Plastic EDAT- 2005/10/12 09:00 MHDA- 2006/02/24 09:00 CRDT- 2005/10/12 09:00 AID - 00006534-200510000-00060 [pii] PST - ppublish SO - Plast Reconstr Surg. 2005 Oct;116(5):1550-3. PMID- 16200038 OWN - NLM STAT- MEDLINE DA - 20051003 DCOM- 20051223 LR - 20161124 IS - 0033-8362 (Print) IS - 0033-8362 (Linking) VI - 110 IP - 3 DP - 2005 Sep TI - Breast cancer: high resolution CT in association with spirometric tests in the assessment of post-radiation pulmonary fibrosis. PG - 156-69 FAU - Sacco, Mariano AU - Sacco M AD - Istituto di Radiodiagnostica e Radiologia Interventistica, Ospedale Maggiore della Carita, Universita del Piemonte Orientale, Novara. FAU - Murgante, Francesco AU - Murgante F FAU - Attanasio, Silvia AU - Attanasio S FAU - Fossaceca, Rita AU - Fossaceca R FAU - Brambilla, Marco AU - Brambilla M FAU - Krengli, Marco AU - Krengli M FAU - Carriero, Alessandro AU - Carriero A LA - eng LA - ita PT - Comparative Study PT - Journal Article PL - Italy TA - Radiol Med JT - La Radiologia medica JID - 0177625 SB - IM MH - Adult MH - Aged MH - Breast/pathology MH - Breast Neoplasms/drug therapy/pathology/*radiotherapy/surgery MH - Carcinoma, Ductal, Breast/drug therapy/pathology/*radiotherapy/surgery MH - Carcinoma, Lobular/drug therapy/pathology/*radiotherapy/surgery MH - Combined Modality Therapy MH - Data Interpretation, Statistical MH - Female MH - Follow-Up Studies MH - Humans MH - Mastectomy, Segmental MH - Middle Aged MH - Neoplasm Staging MH - Pulmonary Fibrosis/*diagnostic imaging/etiology MH - Radiation Pneumonitis/*diagnostic imaging MH - *Radiography, Thoracic MH - Radiotherapy/adverse effects MH - Radiotherapy Dosage MH - Spirometry MH - Time Factors MH - Tomography, X-Ray Computed/*methods EDAT- 2005/10/04 09:00 MHDA- 2005/12/24 09:00 CRDT- 2005/10/04 09:00 PST - ppublish SO - Radiol Med. 2005 Sep;110(3):156-69. PMID- 16170484 OWN - NLM STAT- MEDLINE DA - 20050919 DCOM- 20051130 LR - 20061115 IS - 0179-7158 (Print) IS - 0179-7158 (Linking) VI - 181 IP - 9 DP - 2005 Sep TI - Sites of failure in breast cancer patients with extracapsular invasion of axillary lymph node metastases. No need for axillary irradiation?! PG - 574-9 AB - BACKGROUND AND PURPOSE: Extracapsular spread (ECS) is frequent, but the specific sites of relapse are seldom given in the literature. In this study it was evaluated, if ECS might be an indicator for axillary irradiation. PATIENTS AND METHODS: After a retrospective review of pathology reports, the information about ECS was available in 254 lymph node-positive patients: ECS was absent in 34% (ECS-negative; n = 87) and present in 66% (ECS-positive; n = 167). All patients were irradiated locally, 78 patients got periclavicular and 74 axillary irradiation (median total dose: 50.4 Gy). 240/254 patients (94.5%) received systemic treatment/s. Mean follow-up was 46 months. RESULTS: The regional relapse rate was 4.6% without ECS versus 9.6% with ECS. The 5-year axillary relapse-free survival was 100% in ECS-negative and 90% in ECS-positive patients (p = 0.01), whereas corresponding values for periclavicular relapse-free survival (with ECS: 91% +/- 4%; without ECS: 94% +/- 3%; p = 0.77) and local relapse-free survival (with ECS: 86% +/- 4%; without ECS: 91% +/- 3%; p = 0.69) were not significantly different. chi(2)-tests revealed a high correlation of ECS with T-stage, number of positive lymph nodes and progesterone receptor status, comparisons with estrogen receptor, grade, or age were not significant. In multivariate analysis number of positive lymph nodes was solely significant for regional failure. Dividing the patients into those with one to three and those with four or more positive lymph nodes, ECS lost its significance for axillary failure. CONCLUSION: ECS was accompanied by an enhanced axillary failure rate in univariate analysis, which was no longer true after adjusting for the number of positive lymph nodes. FAU - Gruber, Gunther AU - Gruber G AD - Department of Radiation Oncology, Inselspital, University of Berne, Switzerland. guenther.gruber@ksa.ch FAU - Menzi, Samuel AU - Menzi S FAU - Forster, Andrea AU - Forster A FAU - Berclaz, Gilles AU - Berclaz G FAU - Altermatt, Hans-Jorg AU - Altermatt HJ FAU - Greiner, Richard H AU - Greiner RH LA - eng PT - Comparative Study PT - Evaluation Studies PT - Journal Article PL - Germany TA - Strahlenther Onkol JT - Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] JID - 8603469 RN - 0 (Receptors, Estrogen) RN - 0 (Receptors, Progesterone) SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Axilla/radiation effects MH - Breast Neoplasms/drug therapy/*radiotherapy/surgery MH - Combined Modality Therapy MH - Data Interpretation, Statistical MH - Female MH - Follow-Up Studies MH - Humans MH - Lymph Node Excision MH - Lymph Nodes/*radiation effects MH - *Lymphatic Metastasis/radiotherapy MH - Mastectomy, Modified Radical MH - Mastectomy, Segmental MH - Middle Aged MH - Neoplasm Recurrence, Local MH - Radiotherapy Dosage MH - Receptors, Estrogen/analysis MH - Receptors, Progesterone/analysis MH - Retrospective Studies MH - Survival Analysis MH - Time Factors MH - Treatment Failure EDAT- 2005/09/20 09:00 MHDA- 2005/12/13 09:00 CRDT- 2005/09/20 09:00 PHST- 2004/10/05 [received] PHST- 2005/06/23 [revised] AID - 10.1007/s00066-005-1367-x [doi] PST - ppublish SO - Strahlenther Onkol. 2005 Sep;181(9):574-9. PMID- 16170483 OWN - NLM STAT- MEDLINE DA - 20050919 DCOM- 20051130 LR - 20161124 IS - 0179-7158 (Print) IS - 0179-7158 (Linking) VI - 181 IP - 9 DP - 2005 Sep TI - Radiation induced lung reactions in breast cancer therapy. Modulating factors and consequential effects. PG - 567-73 AB - BACKGROUND AND PURPOSE: Radiologic reactions in lung, usually subclinical, are a frequent side effect of radiotherapy for breast cancer. This study was initiated to identify effects of age and tamoxifen on radiation pneumonitis and consequent fibrosis. PATIENTS AND METHODS: Retrospectively, 451 patients irradiated postoperatively between 1992 and 1995 at the Department of Radiotherapy of Carl-Thiem-Klinikum (Cottbus, Germany) were analyzed. The median age was 58 years. After mastectomy (n = 296), 25 x 2.0 Gy were applied; breast-conserving surgery (n = 155) was followed by 30 x 2.0 Gy. In 221 patients, adjuvant tamoxifen was given. Follow-up included thorax radiography after 15 weeks and 1 year. In patients with reversible observations in standard chest radiography from 15 weeks to 1 year, CT or high-resolution (HR-)CT scans were analyzed after 4-7 years. RESULTS: Clinical symptoms of pneumonitis were seen in 25 patients (5.5%), all with radiologic changes. Early radiologic changes were detected in 134 patients (29.7%). Age (> 58 years; p = 0.0127) and tamoxifen (p = 0.0001) were found as significant parameters of early pneumopathy. Late radiologic changes were seen in 94/425 patients (22.1%), all after a positive early reaction (p = 0.001). CONCLUSION: A low incidence of clinically symptomatic pneumonitis was observed, while the vast majority of patients presented with early radiologic changes. Higher age and tamoxifen treatment significantly increased the incidence of early pneumopathy. Local fibrotic responses must be expected in all patients with early reactions, indicating a strong consequential component of the late reaction. FAU - Dorr, Wolfgang AU - Dorr W AD - Department of Radiotherapy and Radiooncology, Medical Faculty Carl Gustav Carus, University of Technology, Dresden, Germany. doerr@rcs.urz.tu-dresden.de FAU - Bertmann, Simone AU - Bertmann S FAU - Herrmann, Thomas AU - Herrmann T LA - eng PT - Comparative Study PT - Journal Article PL - Germany TA - Strahlenther Onkol JT - Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] JID - 8603469 RN - 0 (Antineoplastic Agents, Hormonal) RN - 094ZI81Y45 (Tamoxifen) SB - IM MH - Adult MH - Age Factors MH - Aged MH - Aged, 80 and over MH - Antineoplastic Agents, Hormonal/administration & dosage/adverse effects/therapeutic use MH - Breast Neoplasms/drug therapy/*radiotherapy/surgery MH - Chemotherapy, Adjuvant MH - Cohort Studies MH - Combined Modality Therapy MH - Data Interpretation, Statistical MH - Female MH - Follow-Up Studies MH - Humans MH - Incidence MH - Lung/radiation effects MH - Mastectomy MH - Mastectomy, Segmental MH - Middle Aged MH - Postoperative Care MH - Pulmonary Fibrosis/diagnostic imaging/epidemiology/etiology MH - Radiation Pneumonitis/diagnostic imaging/epidemiology/*etiology MH - Radiography, Thoracic MH - Radiotherapy Dosage MH - Retrospective Studies MH - Tamoxifen/administration & dosage/adverse effects/therapeutic use MH - Time Factors MH - Tomography, X-Ray Computed EDAT- 2005/09/20 09:00 MHDA- 2005/12/13 09:00 CRDT- 2005/09/20 09:00 PHST- 2005/05/03 [received] PHST- 2005/05/13 [revised] AID - 10.1007/s00066-005-1457-9 [doi] PST - ppublish SO - Strahlenther Onkol. 2005 Sep;181(9):567-73. PMID- 16161722 OWN - NLM STAT- MEDLINE DA - 20050915 DCOM- 20051017 LR - 20141120 IS - 0379-1629 (Print) IS - 0379-1629 (Linking) VI - 26 DP - 2001 TI - [Evaluation of prognostic factors in breast cancer EC I-II and the importance of local recurrence]. PG - 35-9 AB - OBJECTIVE: [corrected] We evaluated the prognostic factors in patients with breast cancer EC-I-II treated in the Instituto Nacional de Cancerologia in Mexico and compared patients with or without local or/and systemic recurrence. METHOD: This is a retrospective study in patients treated with conservative surgery between 1983 and 1993 with a diagnosis of invasive breast cancer and tumors <4 cm All pathological variables were analyzed and we performed studies on c-erb.B2, P53, estrogene and progesterone receivers, cellular ploidy and cellular percentage on face "S" of the cellular cycle. All these variables were compared in two groups, one with recurrences and the other without recurrences, with the same symptoms and demographics characteristics. RESULTS: From 1270 patients with breast cancer EC I-II, 139 patients were submitted to conservative surgery, 14 patients of this group recurred and were compared with 32 patients that did not, out of a total of 46 patients. We found that SBR greater than five (P = 0.046), poor differentiated tumors (P = 0.04), tumors with vascular permeability (P = 0.020) and with intraductal characteristics of a comedocarcinoma (P = 0.004) had a worse prognosis and increased the risk of local recurrences. CONCLUSIONS: In patients with breast cancer the pathological variants are more important than the so called secondary prognostic variables. Besides the pathological variants, it is acceptable only the use of hormonal receptors and the presence of c-erb-b2. FAU - Castillero, C AU - Castillero C AD - Cirujano Oncologo, Instituto Omcologico Nacional. LA - spa PT - Comparative Study PT - English Abstract PT - Evaluation Studies PT - Journal Article TT - Evaluacion de factores pronosticos en cancer de mama EC I-II y la importancia de la recurrencia local. PL - Panama TA - Rev Med Panama JT - Revista medica de Panama JID - 7706654 RN - 0 (Receptors, Estrogen) RN - 0 (Receptors, Progesterone) RN - 0 (Tumor Suppressor Protein p53) RN - EC 2.7.10.1 (Receptor, ErbB-2) SB - IM MH - Adenocarcinoma/*diagnosis/genetics/metabolism/pathology/surgery MH - Breast/pathology MH - Breast Neoplasms/*diagnosis/genetics/metabolism/pathology/surgery MH - Data Interpretation, Statistical MH - Female MH - Follow-Up Studies MH - Humans MH - Mastectomy, Segmental MH - *Neoplasm Recurrence, Local MH - Prognosis MH - Receptor, ErbB-2 MH - Receptors, Estrogen MH - Receptors, Progesterone MH - Risk Factors MH - Time Factors MH - Tumor Suppressor Protein p53 EDAT- 2005/09/16 09:00 MHDA- 2005/10/18 09:00 CRDT- 2005/09/16 09:00 PST - ppublish SO - Rev Med Panama. 2001;26:35-9. PMID- 16096220 OWN - NLM STAT- MEDLINE DA - 20050812 DCOM- 20051206 LR - 20061115 IS - 0301-4460 (Print) IS - 0301-4460 (Linking) VI - 32 IP - 2 DP - 2005 Mar-Apr TI - The GRAIDS Trial: the development and evaluation of computer decision support for cancer genetic risk assessment in primary care. PG - 218-27 AB - The development and evaluation of computer decision support for the assessment of cancer genetic risk in primary care is reported with two series of studies described: the RAGs (Risk Assessment in Genetics) studies and the GRAIDS (Genetic Risk Assessment in an Intranet and Decision Support) Trial. In the GRAIDS Trial, 45 general practices in Eastern England have been recruited and randomised. Comparison practices attend an educational session and receive clinical guidelines about familial breast and colorectal cancer. In the intervention practices a lead clinician is trained in cancer genetics and use of the GRAIDS software. The GRAIDS software is a simple pedigree-drawing program that implements clinical guidelines for familial breast and colorectal cancer and presents individualised information about breast cancer risk in a range of formats. Outcome measures of the trial include: frequency of software use, practitioners' attitudes towards the software, total number of referrals to secondary care about familial cancer and the proportion that meet regional referral criteria, and a patient-centred measure of informed decision making. The family history will become an increasingly important tool in primary care to assess genetic risk. This research evaluates an approach to support high-quality advice about cancer genetics in primary care which could be applied more broadly as our understanding of complex disease genetics increases. FAU - Emery, J AU - Emery J AD - School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Perth, Australia. jemery@cyllene.uwa.edu.au LA - eng PT - Clinical Trial PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PL - England TA - Ann Hum Biol JT - Annals of human biology JID - 0404024 SB - IM MH - Attitude of Health Personnel MH - Attitude to Computers MH - Breast Neoplasms/*genetics/prevention & control MH - Colorectal Neoplasms/*genetics/prevention & control MH - *Decision Making, Computer-Assisted MH - England MH - Female MH - Genetics/education MH - Humans MH - Outcome Assessment (Health Care)/methods MH - *Primary Health Care MH - Risk Assessment/*methods EDAT- 2005/08/13 09:00 MHDA- 2005/12/13 09:00 CRDT- 2005/08/13 09:00 AID - KV54180331N067L0 [pii] AID - 10.1080/03014460500074921 [doi] PST - ppublish SO - Ann Hum Biol. 2005 Mar-Apr;32(2):218-27. PMID- 16045423 OWN - NLM STAT- MEDLINE DA - 20050727 DCOM- 20051129 LR - 20161102 IS - 1930-7810 (Electronic) IS - 0278-6133 (Linking) VI - 24 IP - 4S DP - 2005 Jul TI - Decision making and decision support for hereditary breast-ovarian cancer susceptibility. PG - S78-84 AB - Genetic testing for disease susceptibility has the potential to revolutionize health care by allowing for individually tailored disease prevention strategies. To achieve this promise, patients and physicians must use the information obtained through genetic testing to make medical decisions that are consistent with patient preferences and that lead to reduced disease morbidity and mortality. However, decisions associated with genetic testing can be complex. In this article, the authors review decision making associated with genetic testing and the medical management of hereditary breast-ovarian cancer susceptibility. They focus on decisions regarding BRCA1/2 testing and prophylactic surgery among BRCA1 and BRCA2 mutation carriers. They highlight the role of patient preferences and decision support in this population. The studies reviewed indicate that although patients' preferences do predict genetic testing and management decisions, other factors also influence their decision making. In particular, the authors discuss the role of anxiety and worry in relation to testing and surgery decisions. FAU - Schwartz, Marc D AU - Schwartz MD AD - Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA. schwartm@georgetown.edu FAU - Peshkin, Beth N AU - Peshkin BN FAU - Tercyak, Kenneth P AU - Tercyak KP FAU - Taylor, Kathryn L AU - Taylor KL FAU - Valdimarsdottir, Heiddis AU - Valdimarsdottir H LA - eng GR - R01 CA082346/CA/NCI NIH HHS/United States PT - Journal Article PT - Review PL - United States TA - Health Psychol JT - Health psychology : official journal of the Division of Health Psychology, American Psychological Association JID - 8211523 SB - IM MH - Breast Neoplasms/*genetics/therapy MH - DNA Mutational Analysis MH - *Decision Making MH - Female MH - Genes, BRCA1 MH - Genes, BRCA2 MH - *Genetic Predisposition to Disease MH - Genetic Testing MH - Humans MH - Ovarian Neoplasms/*genetics/therapy MH - Patient Acceptance of Health Care/psychology MH - Patient Participation/psychology MH - United States RF - 50 EDAT- 2005/07/28 09:00 MHDA- 2005/12/13 09:00 CRDT- 2005/07/28 09:00 AID - 2005-08085-012 [pii] AID - 10.1037/0278-6133.24.4.S78 [doi] PST - ppublish SO - Health Psychol. 2005 Jul;24(4S):S78-84. PMID- 15951457 OWN - NLM STAT- MEDLINE DA - 20050613 DCOM- 20051129 LR - 20071115 IS - 0272-989X (Print) IS - 0272-989X (Linking) VI - 25 IP - 3 DP - 2005 May-Jun TI - Decreased use of adjuvant breast cancer therapy in a randomized controlled trial of a decision aid with individualized risk information. PG - 301-7 AB - OBJECTIVE: Oncology patients often seek involvement in their medical consultations. Such involvement is endorsed by most health care providers and mirrored in practice guidelines. However, oncologists exhibit great variation in how they provide patients with disease-relevant information, and many remain reluctant to do so at all. The authors examined the impact of a patient-specific decision aid on women's decisions about adjuvant therapy for breast cancer. METHOD: 386 women with breast cancer were randomized to receive either an informational pamphlet about adjuvant therapy (usual care) or a patient-specific, evidence-based decision aid about adjuvant therapy. The authors compared rates of adjuvant therapy between the groups controlling for age, education, marital status, race, tumor severity, and practice type of their physician (university-based or community-based). RESULTS: Among women with low tumor severity, only 58% (35/60) of women in the decision aid group chose adjuvant therapy, compared to 87% (33/38) of their counterparts in usual care (P<0.01). CONCLUSIONS: This study illustrates the important impact of medical decision aids on treatment choices, particularly for patients for whom treatment has little benefit. In the case of adjuvant therapy for breast cancer, providing individualized, evidence-based risk information for shared decision making resulted in fewer women with low tumor severity choosing adjuvant treatment. FAU - Peele, Pamela B AU - Peele PB AD - Department of Health Policy & Management, Graduate School of Public Health, University of Pittsburgh, PA 15261, USA. peele@pitt.edu FAU - Siminoff, Laura A AU - Siminoff LA FAU - Xu, Ying AU - Xu Y FAU - Ravdin, Peter M AU - Ravdin PM LA - eng GR - R01-CA711040/CA/NCI NIH HHS/United States PT - Clinical Trial PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, P.H.S. PL - United States TA - Med Decis Making JT - Medical decision making : an international journal of the Society for Medical Decision Making JID - 8109073 RN - 0 (Antineoplastic Agents) SB - IM MH - Aged MH - Algorithms MH - Antineoplastic Agents/*therapeutic use MH - Breast Neoplasms/classification/*drug therapy/surgery MH - Chemotherapy, Adjuvant/*utilization MH - *Decision Support Techniques MH - Female MH - Humans MH - Middle Aged MH - Models, Statistical MH - Ohio MH - Patient Acceptance of Health Care/*statistics & numerical data MH - *Patient Education as Topic MH - Physicians/classification/statistics & numerical data MH - *Risk Assessment MH - *Severity of Illness Index MH - Socioeconomic Factors MH - Texas EDAT- 2005/06/14 09:00 MHDA- 2005/12/13 09:00 CRDT- 2005/06/14 09:00 AID - 25/3/301 [pii] AID - 10.1177/0272989X05276851 [doi] PST - ppublish SO - Med Decis Making. 2005 May-Jun;25(3):301-7. PMID- 15893210 OWN - NLM STAT- MEDLINE DA - 20050516 DCOM- 20050818 LR - 20151119 IS - 0738-3991 (Print) IS - 0738-3991 (Linking) VI - 57 IP - 3 DP - 2005 Jun TI - The decision evaluation scales. PG - 286-93 AB - There are several instruments to assess how patients evaluate their medical treatment choice. These are used to evaluate decision aids. Our objective is to investigate which psychological factors play a role when patients evaluate their medical treatment choices. A pool of 36 items was constructed, covering concepts such as uncertainty about and satisfaction with the decision, informed choice, effective decision making, responsibility for the decision, perceived riskiness of the choice, and social support regarding the decision. This pool was presented to patients at high risk for breast and ovarian cancer, awaiting a genetic test result, and facing the choice between prophylactic surgery or screening. Additional measures were assessed for validation purposes. Factor and Rasch analyses were used for factor and item selection. Construct validity of emerging scales was assessed by relating them with the additional measures. Three factors summarised the psychological factors concerning decision evaluation: Satisfaction-Uncertainty, Informed Choice, and Decision Control. Reliabilities (Cronbach's alpha) of the three scales were 0.79, 0.85, and 0.75, respectively. Construct validity hypotheses were confirmed. The first two scales were similar to previously developed scales. Of these three scales, the Decision Control scale correlated most strongly with the well-being measures, was associated with partner's agreement and physician's preferences as perceived by patients, and with a negative emotional reaction to the information material. In conclusion, the Decision Control scale is a new scale to evaluate decision aids, and it appears to be rooted in health psychological theories. FAU - Stalmeier, Peep F M AU - Stalmeier PF AD - Medical Technology Assessment, University Medical Centre Nijmegen, Postbus 9101, 6500 HB Nijmegen, The Netherlands. p.stalmeier@mta.umcn.nl FAU - Roosmalen, Marielle S AU - Roosmalen MS FAU - Verhoef, Lia C G AU - Verhoef LC FAU - Hoekstra-Weebers, Josette E H M AU - Hoekstra-Weebers JE FAU - Oosterwijk, Jan C AU - Oosterwijk JC FAU - Moog, Ute AU - Moog U FAU - Hoogerbrugge, Nicoline AU - Hoogerbrugge N FAU - van Daal, Willem A J AU - van Daal WA LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Validation Studies PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Adult MH - Breast Neoplasms/genetics/*therapy MH - *Choice Behavior MH - *Decision Support Techniques MH - Factor Analysis, Statistical MH - Female MH - Genetic Testing/psychology MH - Hospitals, University MH - Humans MH - Informed Consent MH - Internal-External Control MH - Middle Aged MH - Negativism MH - Netherlands MH - Ovarian Neoplasms/genetics/*therapy MH - Patient Education as Topic MH - Patient Participation/methods/*psychology MH - Patient Satisfaction MH - Psychometrics MH - Risk Assessment MH - Social Support MH - Surveys and Questionnaires/*standards MH - Uncertainty EDAT- 2005/05/17 09:00 MHDA- 2005/08/19 09:00 CRDT- 2005/05/17 09:00 PHST- 2004/04/19 [received] PHST- 2004/05/25 [revised] PHST- 2004/07/27 [accepted] AID - S0738-3991(04)00252-6 [pii] AID - 10.1016/j.pec.2004.07.010 [doi] PST - ppublish SO - Patient Educ Couns. 2005 Jun;57(3):286-93. PMID- 15793468 OWN - NLM STAT- MEDLINE DA - 20050328 DCOM- 20051130 LR - 20150624 IS - 1529-4242 (Electronic) IS - 0032-1052 (Linking) VI - 115 IP - 4 DP - 2005 Apr TI - Brody's article on "the perfect breast". PG - 1204-5; author reply 1206-7 FAU - Adams, William P Jr AU - Adams WP Jr LA - eng PT - Comment PT - Letter PL - United States TA - Plast Reconstr Surg JT - Plastic and reconstructive surgery JID - 1306050 SB - AIM SB - IM CON - Plast Reconstr Surg. 2004 Apr 15;113(5):1500-3. PMID: 15060370 MH - Breast Implantation MH - *Breast Implants MH - Decision Making MH - Female MH - Humans MH - Patient Education as Topic MH - *Patient Satisfaction EDAT- 2005/03/29 09:00 MHDA- 2005/12/13 09:00 CRDT- 2005/03/29 09:00 AID - 00006534-200504010-00036 [pii] PST - ppublish SO - Plast Reconstr Surg. 2005 Apr;115(4):1204-5; author reply 1206-7. PMID- 15755969 OWN - NLM STAT- MEDLINE DA - 20050309 DCOM- 20050331 LR - 20071115 IS - 0732-183X (Print) IS - 0732-183X (Linking) VI - 23 IP - 8 DP - 2005 Mar 10 TI - Physician/patient decision aids for adjuvant therapy. PG - 1627-30 FAU - Whelan, Timothy J AU - Whelan TJ AD - Juravinski Cancer Centre, 699 Concession St, Room 3-62, Hamilton, Ontario, L8V 5C2 Canada. tim.whelan@hrcc.on.ca FAU - Loprinzi, Charles AU - Loprinzi C LA - eng PT - Journal Article PT - Review PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 RN - 0 (Antineoplastic Agents) SB - IM MH - Antineoplastic Agents/adverse effects/*therapeutic use MH - Breast Neoplasms/*drug therapy MH - Chemotherapy, Adjuvant MH - *Communication MH - *Decision Making MH - Female MH - Humans MH - Patient Education as Topic/*methods MH - *Physician's Role MH - Prognosis RF - 23 EDAT- 2005/03/10 09:00 MHDA- 2005/04/01 09:00 CRDT- 2005/03/10 09:00 AID - 23/8/1627 [pii] AID - 10.1200/JCO.2005.10.072 [doi] PST - ppublish SO - J Clin Oncol. 2005 Mar 10;23(8):1627-30. PMID- 15718344 OWN - NLM STAT- MEDLINE DA - 20050218 DCOM- 20050311 LR - 20071115 IS - 0732-183X (Print) IS - 0732-183X (Linking) VI - 23 IP - 6 DP - 2005 Feb 20 TI - The choice of bilateral prophylactic mastectomy. PG - 1330-1; author reply 1331-2 FAU - Eisinger, F AU - Eisinger F FAU - Huiart, L AU - Huiart L FAU - Sobol, H AU - Sobol H LA - eng PT - Comment PT - Letter PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 SB - IM CON - J Clin Oncol. 2004 May 15;22(10):1823-9. PMID: 15067026 MH - Breast Neoplasms/prevention & control/*surgery MH - *Decision Making MH - Female MH - Genetic Counseling MH - Humans MH - *Mastectomy MH - Patient Education as Topic EDAT- 2005/02/19 09:00 MHDA- 2005/03/12 09:00 CRDT- 2005/02/19 09:00 AID - 23/6/1330 [pii] AID - 10.1200/JCO.2005.05.173 [doi] PST - ppublish SO - J Clin Oncol. 2005 Feb 20;23(6):1330-1; author reply 1331-2. PMID- 15657522 OWN - NLM STAT- MEDLINE DA - 20050119 DCOM- 20050630 LR - 20091119 IS - 1340-6868 (Print) IS - 1340-6868 (Linking) VI - 12 IP - 1 DP - 2005 TI - General aspects and specific issues of informed consent on breast cancer treatments. PG - 39-44 AB - Informed consent (IC) is the process by which a patient can make choices about his/her health care; therefore it is considered to be a voluntary authorization given by the patient to the physician. To ensure the patient's right to self-determination, what can the physicians do? When treating breast cancer, there are several specific issues that must be clarified by the IC. We have selected and evaluated the basic elements of IC and mentioned the basic concepts of IC in details. First of all, complete information must be disclosed to the patient (physician's responsibility for medical accountability). The information to be disclosed is summarized in the following three elements: 1) The nature of the treatment/procedure, 2) The relevant risks/benefits, and 3) Reasonable alternatives to the proposed intervention (alternative treatments/procedures). However, the physician is not obliged to persuade the patient to accept the proposed intervention. IC information should be documented in detail on the patient's chart without delay. These issues include IC regarding surgical procedures (mastectomy or breast conservation treatment), IC regarding clinical studies (description of randomized controlled trials), IC regarding genetic diagnosis (ethical issues), and the like. IC means informed decision-making, close relationships between physicians and patients are needed. FAU - Takasugi, Miyuki AU - Takasugi M AD - Department of Surgical Oncology Divisions, National Cancer Center Hospital, 5-1-1, Chuo-ku, Tokyo, 104-0045, Japan. FAU - Iwamoto, Eriko AU - Iwamoto E FAU - Akashi-Tanaka, Sadako AU - Akashi-Tanaka S FAU - Kinoshita, Takayuki AU - Kinoshita T FAU - Fukutomi, Takashi AU - Fukutomi T FAU - Kubouchi, Kohichi AU - Kubouchi K LA - eng PT - Journal Article PL - Japan TA - Breast Cancer JT - Breast cancer (Tokyo, Japan) JID - 100888201 SB - E SB - IM MH - Breast Neoplasms/*therapy MH - Clinical Trials as Topic MH - Communication MH - Genetic Testing MH - Humans MH - *Informed Consent MH - Japan MH - Patient Education as Topic MH - Physician's Role MH - *Physician-Patient Relations MH - Sentinel Lymph Node Biopsy OID - KIE: 126036 OID - NRCBL: VF 8.3.1 OTO - KIE OT - Professional Patient Relationship GN - KIE: 8 refs. GN - KIE: KIE Bib: informed consent EDAT- 2005/01/20 09:00 MHDA- 2005/07/01 09:00 CRDT- 2005/01/20 09:00 PST - ppublish SO - Breast Cancer. 2005;12(1):39-44. PMID- 15633083 OWN - NLM STAT- MEDLINE DA - 20050105 DCOM- 20050311 LR - 20151119 IS - 0722-1819 (Print) IS - 0722-1819 (Linking) VI - 36 IP - 6 DP - 2004 Dec TI - [Breast cancer and quality of life--improvement by contralateral breast reconstruction and symmetrical mammaplasty?]. PG - 384-91 AB - We present the results of a retrospective study on 71 patients who underwent breast reconstruction after uni- or bilateral breast cancer. Quality of life (QoL) was evaluated dependent on whether contralateral mammaplasties to obtain symmetry had been performed or not. We used three standardized questionnaires ("SF-36" and the EORTC-questionnaires "QLQ-C30" and "QLQ-BR23") and compared four groups of patients: Group 1: no contralateral breast cancer, but contralateral symmetrical mammaplasty (n = 31). Group 2: no contralateral breast cancer, no contralateral mammaplasty (n = 22). Group 3: contralateral breast cancer, contralateral symmetrical mammaplasty (n = 9). Group 4: contralateral breast cancer, no contralateral mammaplasty (n = 9). Patients with contralateral mammaplasty for symmetry presented statistically higher levels of QoL than patients who only underwent a surgical reconstruction of the carcinomatous breast without any contralateral mammaplasty. More detailed, group 1 manifested higher levels in 17 out of 31 QoL categories than group 2. Group 3, when compared to group 4, showed higher levels in 15 QoL categories. These objective data demonstrate that the outward appearance of the female breast as a symmetrical created organ plays a pivotal role considering QoL. There is significant need to integrate breast symmetry into our preoperative plastic-surgical planning and conversations with patients. FAU - Kiene, M AU - Kiene M AD - Klinik fur Hand-, Brust- und Plastische Chirurgie (Chefarzt: PD Dr. J. Hoch), Klinikum Neustadt, Neustadt. marekkiene@web.de FAU - Hoch, J AU - Hoch J LA - ger PT - Comparative Study PT - English Abstract PT - Journal Article TT - Mammakarzinom und Lebensqualitat--Gewinn durch Rekonstruktion und Angleichung der Gegenseite? PL - Germany TA - Handchir Mikrochir Plast Chir JT - Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V... JID - 8302815 SB - IM MH - Aged MH - Breast Neoplasms/*surgery MH - Data Interpretation, Statistical MH - Female MH - Follow-Up Studies MH - Humans MH - *Mammaplasty/psychology MH - Middle Aged MH - *Quality of Life MH - Retrospective Studies MH - Surveys and Questionnaires MH - Time Factors EDAT- 2005/01/06 09:00 MHDA- 2005/03/12 09:00 CRDT- 2005/01/06 09:00 AID - 10.1055/s-2004-817951 [doi] PST - ppublish SO - Handchir Mikrochir Plast Chir. 2004 Dec;36(6):384-91. PMID- 15569200 OWN - NLM STAT- MEDLINE DA - 20041130 DCOM- 20050214 LR - 20041130 IS - 1075-122X (Print) IS - 1075-122X (Linking) VI - 10 IP - 6 DP - 2004 Nov-Dec TI - Surgical treatment planning in newly diagnosed breast cancer patients at high risk for BRCA-1 or BRCA-2 mutation. PG - 473-4 FAU - Chung, Maureen A AU - Chung MA FAU - Cady, Blake AU - Cady B LA - eng PT - Comment PT - Editorial PL - United States TA - Breast J JT - The breast journal JID - 9505539 SB - IM CON - Breast J. 2004 Nov-Dec;10(6):475-80. PMID: 15569201 MH - Breast Neoplasms/diagnosis/*genetics/*surgery MH - *Decision Support Techniques MH - Female MH - Genes, BRCA1 MH - Genes, BRCA2 MH - Genetic Predisposition to Disease MH - Humans MH - Mastectomy/*methods MH - Mutation EDAT- 2004/12/01 09:00 MHDA- 2005/02/16 09:00 CRDT- 2004/12/01 09:00 AID - TBJ21666 [pii] AID - 10.1111/j.1075-122X.2004.21666.x [doi] PST - ppublish SO - Breast J. 2004 Nov-Dec;10(6):473-4. PMID- 15386771 OWN - NLM STAT- MEDLINE DA - 20050411 DCOM- 20050823 LR - 20071115 IS - 1057-9249 (Print) IS - 1057-9249 (Linking) VI - 14 IP - 4 DP - 2005 Apr TI - Knowledge of risk management strategies, and information and risk management preferences of women at increased risk for ovarian cancer. PG - 249-61 AB - Little research is available on the level of knowledge about ovarian cancer risk management options in women at increased risk for this disease. The study objectives were to evaluate this together with the information and ovarian cancer risk management preferences of high-risk women. One hundred and twenty-nine women were assessed after their attendance at one of six familial cancer clinics in relation to knowledge of surveillance and/or preventative strategies for reduction of ovarian cancer risk, preferences for particular strategies, and information preferences. Screening was selected by 57 (44%) women as the preferred risk management option. One hundred and five women (82%) indicated a wish for as much information as possible about ovarian cancer, including both good and bad outcomes and 114 (89%) reported a preference for sharing treatment decisions with their health professional. Participants' knowledge about ovarian cancer risk management options was significantly associated with educational levels (Z = -3.2, p=0.001) and whether or not ovarian cancer was included in the family history (Z = -2.3, p = 0.018). Findings from this present study indicate that women at increased risk of ovarian cancer who attend familial cancer clinics want as much information as possible about this disease and they want to be involved in the decision-making process. Women who reported a lower level of education (no post-school qualifications) may be most likely to benefit from additional educational strategies designed to supplement genetic counseling to improve their knowledge levels. CI - Copyright 2004 John Wiley & Sons, Ltd. FAU - Tiller, K AU - Tiller K AD - Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia. tillerk@sesahs.nsw.gov.au FAU - Meiser, B AU - Meiser B FAU - Gould, L AU - Gould L FAU - Tucker, K AU - Tucker K FAU - Dudding, T AU - Dudding T FAU - Franklin, J AU - Franklin J FAU - Friedlander, M AU - Friedlander M FAU - Andrews, L AU - Andrews L LA - eng PT - Clinical Trial PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PL - England TA - Psychooncology JT - Psycho-oncology JID - 9214524 RN - 0 (Contraceptives, Oral) SB - IM MH - Adult MH - Aged MH - Breast Neoplasms/genetics/prevention & control/psychology MH - *Choice Behavior MH - Colorectal Neoplasms, Hereditary Nonpolyposis/genetics/prevention & control/psychology MH - Contraceptives, Oral/administration & dosage MH - Decision Support Techniques MH - Female MH - Genes, Dominant MH - Genetic Predisposition to Disease/genetics/*psychology MH - Health Knowledge, Attitudes, Practice MH - Heterozygote Detection MH - Humans MH - Mass Screening/psychology MH - Middle Aged MH - Neoplasms, Glandular and Epithelial/genetics/prevention & control/*psychology MH - Neoplastic Syndromes, Hereditary/genetics/prevention & control/psychology MH - New South Wales MH - Oncology Service, Hospital/utilization MH - Ovarian Neoplasms/genetics/prevention & control/*psychology MH - Ovariectomy/psychology MH - Patient Acceptance of Health Care/psychology MH - *Patient Education as Topic MH - Patient Participation/*psychology MH - Risk Assessment MH - Risk Reduction Behavior MH - Victoria EDAT- 2004/09/24 05:00 MHDA- 2005/08/24 09:00 CRDT- 2004/09/24 05:00 AID - 10.1002/pon.840 [doi] PST - ppublish SO - Psychooncology. 2005 Apr;14(4):249-61. PMID- 15310772 OWN - NLM STAT- MEDLINE DA - 20040816 DCOM- 20040902 LR - 20091119 IS - 0732-183X (Print) IS - 0732-183X (Linking) VI - 22 IP - 16 DP - 2004 Aug 15 TI - Randomized trial of a shared decision-making intervention consisting of trade-offs and individualized treatment information for BRCA1/2 mutation carriers. PG - 3293-301 AB - PURPOSE: To evaluate a shared decision-making intervention (SDMI) for BRCA1/2 mutation carriers who have to make a choice between screening and prophylactic surgery for breasts and/or ovaries. PATIENTS AND METHODS: The SDMI consisted of two value assessment sessions, using the time trade-off method, followed by individualized treatment information based on (quality-adjusted) life expectancy. After the baseline assessment (2 weeks after a positive DNA test result), women were randomly assigned to the SDMI group (n = 44), receiving the SDMI 2 months after the test result, or to the control group (n = 44). The short- and long-term effects, 3 and 9 months after the test result, were assessed using questionnaires. Data were collected on well-being, treatment choice, and decision-related outcomes. RESULTS: In the short term, the SDMI had no effect. In the long term, with respect to well-being, patients in the SDMI group had less intrusive thoughts (P =.05) and better general health (P =.01) and tended to be less depressed (P =.07). With respect to decision-related outcomes for the breasts, the SDMI group held stronger preferences (P =.02) and agreed more strongly to having weighed the pros and cons (P =.01). No effect was found on treatment choice. In the long term, interaction effects between the SDMI and cancer history were found. The SDMI showed an overall beneficial effect for unaffected women, whereas affected women tended to experience detrimental effects. CONCLUSION: We conclude that the SDMI improved decision making in unaffected BRCA1/2 mutation carriers. Supporting decision making in a systematic way using trade-offs is beneficial for these women. FAU - van Roosmalen, M S AU - van Roosmalen MS AD - Department of Radiotherapy (341), University Medical Center Nijmegen, PO Box 9101, 6500 HB Nijmegen, the Netherlands. m.vanroosmalen@rther.umcn.nl FAU - Stalmeier, P F M AU - Stalmeier PF FAU - Verhoef, L C G AU - Verhoef LC FAU - Hoekstra-Weebers, J E H M AU - Hoekstra-Weebers JE FAU - Oosterwijk, J C AU - Oosterwijk JC FAU - Hoogerbrugge, N AU - Hoogerbrugge N FAU - Moog, U AU - Moog U FAU - van Daal, W A J AU - van Daal WA LA - eng PT - Clinical Trial PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 SB - IM MH - Adult MH - Aged MH - Breast Neoplasms/*genetics/psychology/*surgery MH - DNA Mutational Analysis MH - *Decision Making MH - *Decision Support Techniques MH - Female MH - *Genes, BRCA1 MH - *Genes, BRCA2 MH - *Genetic Predisposition to Disease MH - *Genetic Testing MH - Humans MH - Life Expectancy MH - Mastectomy MH - Middle Aged MH - Ovarian Neoplasms/*genetics/*surgery MH - Patient Education as Topic MH - *Patient Participation MH - Patient Satisfaction MH - Quality of Life EDAT- 2004/08/18 05:00 MHDA- 2004/09/03 05:00 CRDT- 2004/08/18 05:00 AID - 10.1200/JCO.2004.05.066 [doi] AID - 22/16/3293 [pii] PST - ppublish SO - J Clin Oncol. 2004 Aug 15;22(16):3293-301. PMID- 15304229 OWN - NLM STAT- MEDLINE DA - 20040812 DCOM- 20041214 LR - 20071115 IS - 1462-3889 (Print) IS - 1462-3889 (Linking) VI - 8 IP - 3 DP - 2004 Sep TI - The information needs of women who have undergone breast reconstruction. Part I: decision-making and sources of information. PG - 211-23 AB - Women diagnosed with breast cancer treated by mastectomy can choose breast reconstruction. The information needs of women undergoing this procedure have only been addressed in the research literature to a limited extent. A qualitative approach was used to explore the experiences of women who had undergone breast reconstruction with a specific focus on their views on how they considered their information needs could best be met. A purposeful sample of eight women was recruited to participate in two focus groups, each lasting 2 hours. Framework analysis was used to develop an index of key themes and sub-themes which transformed the data into a structured record which facilitated systematic analysis. This paper will present the emergent key themes regarding decision-making about mastectomy and reconstructive surgery and the sources of information perceived to be relevant when preparing for breast reconstruction. Sources of information perceived by the participants as being helpful included the surgeon, the breast care clinical nurse specialist, photographs, contact with other patients, written information, the internet, a tape of the consultation and information videotapes. The breast care clinical nurse specialist played an important role in facilitating the process of receiving information. This study provides useful insight into how health care professionals can inform and prepare women for breast reconstruction. FAU - Wolf, Lisa AU - Wolf L AD - Clinical Nurse Specialist, Breast Care, Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK. Lisa.Wolf@rmh.nthames.nhs.uk LA - eng PT - Journal Article PL - Scotland TA - Eur J Oncol Nurs JT - European journal of oncology nursing : the official journal of European Oncology Nursing Society JID - 100885136 SB - IM SB - N MH - Adult MH - Breast Neoplasms/*psychology/*surgery MH - *Decision Making MH - Female MH - Focus Groups MH - Humans MH - Mammaplasty/*psychology MH - Mastectomy/psychology MH - Middle Aged MH - Needs Assessment MH - Nursing Assessment MH - Patient Education as Topic/*methods EDAT- 2004/08/12 05:00 MHDA- 2004/12/16 09:00 CRDT- 2004/08/12 05:00 AID - 10.1016/j.ejon.2003.12.012 [doi] AID - S1462388904000365 [pii] PST - ppublish SO - Eur J Oncol Nurs. 2004 Sep;8(3):211-23. PMID- 15280348 OWN - NLM STAT- MEDLINE DA - 20040728 DCOM- 20040802 LR - 20161017 IS - 1538-3598 (Electronic) IS - 0098-7484 (Linking) VI - 292 IP - 4 DP - 2004 Jul 28 TI - Decision aids from genetics to treatment of breast cancer: long-term clinical utility or temporary solution? PG - 496-8 FAU - Eng, Charis AU - Eng C FAU - Iglehart, Dirk AU - Iglehart D LA - eng PT - Comment PT - Editorial PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. PT - Research Support, U.S. Gov't, P.H.S. PL - United States TA - JAMA JT - JAMA JID - 7501160 SB - AIM SB - IM CON - JAMA. 2004 Jul 28;292(4):442-52. PMID: 15280342 CON - JAMA. 2004 Jul 28;292(4):435-41. PMID: 15280341 MH - Breast Neoplasms/*genetics/*surgery MH - Decision Making, Computer-Assisted MH - *Decision Support Techniques MH - Female MH - Genetic Testing MH - Humans MH - Mastectomy MH - *Patient Education as Topic MH - Patient Participation EDAT- 2004/07/29 05:00 MHDA- 2004/08/03 05:00 CRDT- 2004/07/29 05:00 AID - 10.1001/jama.292.4.496 [doi] AID - 292/4/496 [pii] PST - ppublish SO - JAMA. 2004 Jul 28;292(4):496-8. PMID- 15280341 OWN - NLM STAT- MEDLINE DA - 20040728 DCOM- 20040802 LR - 20161017 IS - 1538-3598 (Electronic) IS - 0098-7484 (Linking) VI - 292 IP - 4 DP - 2004 Jul 28 TI - Effect of a decision aid on knowledge and treatment decision making for breast cancer surgery: a randomized trial. PG - 435-41 AB - CONTEXT: The long-term results of randomized trials have demonstrated equivalent survival rates for mastectomy and breast-conserving therapy for the treatment of early stage breast cancer. Consequently, the choice of treatment should be based on a patient's preferences. OBJECTIVE: To evaluate the impact of a decision aid regarding the different surgical treatment options on patient decision making. DESIGN AND SETTING: A cluster randomized trial for which general surgeons in the communities of central-west, and eastern Ontario, Canada, were randomly assigned to use the decision aid or not in the surgical consultation. Patients received the decision aid or not based on the surgeon seen. PARTICIPANTS: Twenty surgeons participated in the study. Of the 208 eligible women with newly diagnosed clinical stage I or II breast cancer seen by study surgeons, 201 agreed to be evaluated: 94 were assigned to the decision board and 107 to usual practice. Patients were recruited from November 1999 to April 2002. INTERVENTION: The decision board is a decision aid designed to help physicians inform their patients about different treatment options and to enable patients to express a preference for treatment. MAIN OUTCOME MEASURES: Patient knowledge about the surgical treatment of breast cancer; decisional conflict; satisfaction with decision making; and the treatment decision following the consultation. RESULTS: Patients in the decision board group had higher knowledge scores about their treatment options (66.9 vs 58.7; P<.001), had less decisional conflict (1.40 vs 1.62, P =.02), and were more satisfied with decision making (4.50 vs 4.32, P =.05) following the consultation. Patients who used the decision board were more likely to choose BCT (94% vs 76%, P =.03). CONCLUSIONS: The decision board was helpful in improving communication and enabling women to make a choice regarding treatment. Such instruments should be considered by surgeons when communicating the different surgical options to women with breast cancer. FAU - Whelan, Timothy AU - Whelan T AD - Department of Medicine, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada. tim.whelan@hrcc.on.ca FAU - Levine, Mark AU - Levine M FAU - Willan, Andrew AU - Willan A FAU - Gafni, Amiram AU - Gafni A FAU - Sanders, Ken AU - Sanders K FAU - Mirsky, Doug AU - Mirsky D FAU - Chambers, Shelley AU - Chambers S FAU - O'Brien, Mary Ann AU - O'Brien MA FAU - Reid, Susan AU - Reid S FAU - Dubois, Sacha AU - Dubois S LA - eng PT - Clinical Trial PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PL - United States TA - JAMA JT - JAMA JID - 7501160 SB - AIM SB - IM CIN - Can J Surg. 2006 Dec;49(6):431-3. PMID: 17234074 CIN - JAMA. 2004 Jul 28;292(4):496-8. PMID: 15280348 MH - Breast Neoplasms/*surgery MH - Decision Making MH - *Decision Support Techniques MH - Female MH - General Surgery MH - Health Knowledge, Attitudes, Practice MH - Humans MH - *Mastectomy MH - Mastectomy, Segmental MH - Middle Aged MH - Patient Education as Topic MH - Patient Participation MH - Patient Satisfaction MH - Physician-Patient Relations MH - Referral and Consultation EDAT- 2004/07/29 05:00 MHDA- 2004/08/03 05:00 CRDT- 2004/07/29 05:00 AID - 10.1001/jama.292.4.435 [doi] AID - 292/4/435 [pii] PST - ppublish SO - JAMA. 2004 Jul 28;292(4):435-41. PMID- 15150557 OWN - NLM STAT- MEDLINE DA - 20040527 DCOM- 20040715 LR - 20140609 IS - 0007-0920 (Print) IS - 0007-0920 (Linking) VI - 90 IP - 11 DP - 2004 Jun 01 TI - Predictors of patients' choices for breast-conserving therapy or mastectomy: a prospective study. PG - 2123-30 AB - A study was undertaken to describe the treatment preferences and choices of patients with breast cancer, and to identify predictors of undergoing breast-conserving therapy (BCT) or mastectomy (MT). Consecutive patients with stage I/II breast cancer were eligible. Information about predictor variables, including socio-demographics, quality of life, patients' concerns, decision style, decisional conflict and perceived preference of the surgeon was collected at baseline, before decision making and surgery. Patients received standard information (n=88) or a decision aid (n=92) as a supplement to support decision making. A total of 180 patients participated in the study. In all, 72% decided to have BCT (n=123); 28% chose MT (n=49). Multivariate analysis showed that what patients perceived to be their surgeons' preference and the patients' concerns regarding breast loss and local tumour recurrence were the strongest predictors of treatment preference. Treatment preferences in itself were highly predictive of the treatment decision. The decision aid did not influence treatment choice. The results of this study demonstrate that patients' concerns and their perceptions of the treatment preferences of the physicians are important factors in patients' decision making. Adequate information and communication are essential to base treatment decisions on realistic concerns, and the treatment preferences of patients. FAU - Molenaar, S AU - Molenaar S AD - Academic Medical Center, Department of Medical Psychology (J4-401), PO Box 22 660, 1100 DD Amsterdam, The Netherlands. J.Molenaar@amc.uva.nl FAU - Oort, F AU - Oort F FAU - Sprangers, M AU - Sprangers M FAU - Rutgers, E AU - Rutgers E FAU - Luiten, E AU - Luiten E FAU - Mulder, J AU - Mulder J FAU - de Haes, H AU - de Haes H LA - eng PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't PL - England TA - Br J Cancer JT - British journal of cancer JID - 0370635 SB - IM MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/*surgery MH - Cross-Sectional Studies MH - *Decision Making MH - Decision Support Techniques MH - Demography MH - Female MH - Forecasting MH - Humans MH - *Mastectomy MH - *Mastectomy, Segmental MH - Middle Aged MH - *Patient Satisfaction MH - Physician-Patient Relations MH - Quality of Life MH - Risk Factors MH - Social Class PMC - PMC2409497 OID - NLM: PMC2409497 EDAT- 2004/05/20 05:00 MHDA- 2004/07/16 05:00 CRDT- 2004/05/20 05:00 AID - 10.1038/sj.bjc.6601835 [doi] AID - 6601835 [pii] PST - ppublish SO - Br J Cancer. 2004 Jun 1;90(11):2123-30. PMID- 15135682 OWN - NLM STAT- MEDLINE DA - 20040511 DCOM- 20040610 LR - 20161124 IS - 0002-9610 (Print) IS - 0002-9610 (Linking) VI - 187 IP - 5 DP - 2004 May TI - Criteria for establishing the adequacy of a sentinel lymphadenectomy. PG - 639-42; discussion 642 AB - BACKGROUND: Criteria are needed that could be used to terminate a sentinel lymphadenectomy for breast cancer prior to removing every sentinel lymph node, without increasing false negative rates. METHODS: Quantitative information on the radioactivity and color of sentinel lymph nodes removed from 541 breast cancer patients was correlated with pathologic information to determine when a sentinel lymphadenectomy could be terminated based on characteristics of the initially removed nodes. RESULTS: Tumor was found in the first two sentinel lymph nodes removed in 127 of 129 node-positive patients. In 65% of patients who were able to be evaluated, the most radioactive lymph node was a positive lymph node. When any axillary lymph node was blue, then the first tumor-containing sentinel lymph node was also blue. CONCLUSIONS: Removal of the most radioactive lymph node does not insure accurate assessment of the axilla. Removal of two sentinel lymph nodes accurately staged 98.4% of node-positive patients and 99.6% of the entire study population. FAU - Duncan, Mona AU - Duncan M AD - Department of General, Vascular, and Thoracic Surgery, Virginia Mason Medical Center, C6-GSUR, PO Box 900, 1100 Ninth Ave., Seattle, WA 98111, USA. FAU - Cech, Amy AU - Cech A FAU - Wechter, Debra AU - Wechter D FAU - Moonka, Ravi AU - Moonka R LA - eng PT - Comparative Study PT - Journal Article PT - Validation Studies PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 RN - 0 (Radiopharmaceuticals) RN - 0 (Rosaniline Dyes) RN - 39N9K8S2A4 (iso-sulfan blue) RN - 556Q0P6PB1 (Technetium Tc 99m Sulfur Colloid) SB - AIM SB - IM MH - Axilla MH - Biopsy/standards MH - *Breast Neoplasms/diagnostic imaging/pathology/surgery MH - Decision Support Techniques MH - Evidence-Based Medicine MH - False Negative Reactions MH - Humans MH - Mastectomy MH - Neoplasm Staging/methods/standards/statistics & numerical data MH - Practice Guidelines as Topic/*standards MH - Radionuclide Imaging MH - Radiopharmaceuticals MH - Rosaniline Dyes MH - Sensitivity and Specificity MH - *Sentinel Lymph Node Biopsy/methods/standards/statistics & numerical data MH - Technetium Tc 99m Sulfur Colloid MH - Washington EDAT- 2004/05/12 05:00 MHDA- 2004/06/21 10:00 CRDT- 2004/05/12 05:00 PHST- 2003/12/11 [received] PHST- 2004/01/18 [revised] AID - 10.1016/j.amjsurg.2004.01.017 [doi] AID - S0002961004000753 [pii] PST - ppublish SO - Am J Surg. 2004 May;187(5):639-42; discussion 642. PMID- 20574492 OWN - NLM STAT- PubMed-not-MEDLINE DA - 20100624 DCOM- 20110714 LR - 20170220 IS - 1536-0067 (Electronic) IS - 1535-2188 (Linking) VI - 18 IP - 2 DP - 2004 May TI - Patient education and decision making in breast reconstruction. PG - 139-47 LID - 10.1055/s-2004-829048 [doi] AB - A well-informed patient who actively participates in decision making is an essential ingredient of successful outcome in breast reconstruction. The plastic surgeon must be prepared to answer all the patient's questions in a clear and concise manner. All women considering breast reconstruction need to understand the rationale for reconstruction and have realistic expectations for what can be accomplished. They need to consider the optimal timing and the advantages and disadvantages of each technical option. The patient education process can be enhanced by the thoughtful inclusion of growing set of educational tools and decision aids. This article reviews each of these issues and suggests a way to organize and present the essential material in a way that has proven effective with women in our practice. FAU - Heller, Lior AU - Heller L AD - Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX. FAU - Miller, Michael J AU - Miller MJ LA - eng PT - Journal Article PL - United States TA - Semin Plast Surg JT - Seminars in plastic surgery JID - 101131275 PMC - PMC2884726 OID - NLM: PMC2884726 OTO - NOTNLM OT - Breast reconstruction OT - patient decision-making aid OT - patient education EDAT- 2004/05/01 00:00 MHDA- 2004/05/01 00:01 CRDT- 2010/06/25 06:00 AID - 10.1055/s-2004-829048 [doi] PST - ppublish SO - Semin Plast Surg. 2004 May;18(2):139-47. doi: 10.1055/s-2004-829048. PMID- 15106493 OWN - NLM STAT- MEDLINE DA - 20040426 DCOM- 20040701 LR - 20081103 IS - 1431-7621 (Print) IS - 1431-7621 (Linking) VI - 98 IP - 2 DP - 2004 Mar TI - [Shared decision-making in primary breast cancer]. PG - 127-33 AB - Following an overall view of the emotional situation of primary breast cancer patients and of studies exploring shared decision making in this setting we present the results of qualitative analyses about breaking bad news situations and interviews with this group of patients and describe both methods for implementing shared decision making in the treatment of primary breast cancer and an evaluation study. The main result was that most patients showed a lack of information about breast cancer and its therapy, which led to uncertainty. Another source of uncertainty was the lack of preoperative punch biopsy. Due to the so-called "diagnostic shock" patients felt under pressure to make a quick decision over their treatment. This perceived pressure can be effectively countered by a shared decision making approach. To investigate the options in breast cancer therapy, decision aids for diagnostic and therapeutic options have been developed focusing on the following treatment modalities: 1. breast conserving therapy and radiation versus radical mastectomy 2. chemotherapy plus endocrine therapy versus endocrine therapy alone 3. preoperative versus postoperative chemotherapy. The decision instruments in question were tested in N = 35 breast cancer patients and N = 36 nurses as a control group. The results of a questionnaire survey among both these groups revealed a very positive appraisal of the decision aids. Implementation in daily routine was favoured. FAU - Vodermaier, Andrea AU - Vodermaier A AD - Ludwig-Maximilians-Universitat Munchen, Klinik und Poliklinik fur Frauenheilkunde und Geburtshilfe-Grosshadern, Munchen. Vodermaier@med.uni-muenchen.de FAU - Caspari, Cornelia AU - Caspari C FAU - Kohm, Janna AU - Kohm J FAU - Bauerfeind, Ingo AU - Bauerfeind I FAU - Kahlert, Steffen AU - Kahlert S FAU - Untch, Michael AU - Untch M LA - ger PT - English Abstract PT - Journal Article TT - Partizipative Entscheidungsfindung beim primaren Mammakarzinom. PL - Germany TA - Z Arztl Fortbild Qualitatssich JT - Zeitschrift fur arztliche Fortbildung und Qualitatssicherung JID - 9707934 SB - IM MH - Breast Neoplasms/diagnosis/*psychology/therapy MH - *Emotions MH - Female MH - Humans MH - Patient Participation/*psychology MH - Physician-Patient Relations MH - Truth Disclosure EDAT- 2004/04/27 05:00 MHDA- 2004/07/02 05:00 CRDT- 2004/04/27 05:00 PST - ppublish SO - Z Arztl Fortbild Qualitatssich. 2004 Mar;98(2):127-33. PMID- 15075148 OWN - NLM STAT- MEDLINE DA - 20040412 DCOM- 20040813 LR - 20161124 IS - 0300-5771 (Print) IS - 0300-5771 (Linking) VI - 33 IP - 1 DP - 2004 Feb TI - Commentary: screening mammography: a decision analysis. PG - 68; discussion 69-73 FAU - Berry, Donald AU - Berry D AD - Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Box 447, Houston, TX 77030-4009, USA. dberry@mdanderson.org LA - eng PT - Journal Article PT - Comment PL - England TA - Int J Epidemiol JT - International journal of epidemiology JID - 7802871 SB - IM CON - Int J Epidemiol. 2004 Feb;33(1):43-55. PMID: 15075144 MH - Breast Neoplasms/*diagnostic imaging/mortality MH - Decision Making MH - Decision Support Techniques MH - Diagnostic Errors MH - Female MH - Humans MH - *Mammography/adverse effects MH - Mass Screening/adverse effects/*methods MH - Patient Education as Topic MH - Randomized Controlled Trials as Topic MH - Risk Factors EDAT- 2004/04/13 05:00 MHDA- 2004/08/17 10:00 CRDT- 2004/04/13 05:00 AID - 10.1093/ije/dyh034 [doi] AID - 33/1/68 [pii] PST - ppublish SO - Int J Epidemiol. 2004 Feb;33(1):68; discussion 69-73. PMID- 15055844 OWN - NLM STAT- MEDLINE DA - 20040401 DCOM- 20040416 LR - 20061115 IS - 0003-1348 (Print) IS - 0003-1348 (Linking) VI - 70 IP - 3 DP - 2004 Mar TI - Intraoperative frozen section of sentinel nodes: a formal decision analysis. PG - 215-20; discussion 220-1 AB - In the absence of data from randomized trials, a formal decision analysis was undertaken to quantify the relative value of the patients' quality of life with regard to performing intraoperative frozen section (FS) versus permanent section (PS) analysis of the sentinel lymph node (SLN) for breast cancer. Assumptions for this analysis were based on data from 203 nodal basins where the prevalence of nodal metastasis was 26.1 per cent; the FS sensitivity was 68 per cent and FS false-positive rate was 0.7 per cent. DATA 4.0 was used to model the decision analysis. The two branches of the tree represent the two surgical options of either FS analysis intraoperatively, accompanied by immediate axillary dissection for positive nodes versus PS analysis followed by reoperative axillary dissection. The expected utility (EU) with the FS strategy is 0.9736; the EU for PS is 0.9732, suggesting no definite preference for either procedure. Overall, the toss-up is very robust. The decision to choose FS versus PS should be based on individual patient risk and preference because the decision analysis indicated that these two options are equivalent with respect to patient quality of life. FAU - Chao, Celia AU - Chao C AD - Department of Surgery, University of Texas Medical Branch, Galveston 77555-0527, USA. FAU - Abell, Troy AU - Abell T FAU - Martin, Robert C G 2nd AU - Martin RC 2nd FAU - McMasters, Kelly M AU - McMasters KM LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 SB - IM MH - Adult MH - Aged MH - Biopsy, Needle MH - Breast Neoplasms/mortality/*pathology/*surgery MH - Decision Support Techniques MH - Disease-Free Survival MH - Female MH - *Frozen Sections MH - Humans MH - Immunohistochemistry MH - Intraoperative Care/methods MH - Lymph Nodes/*pathology MH - Mastectomy/methods MH - Middle Aged MH - Neoplasm Staging MH - Probability MH - Prognosis MH - *Quality of Life MH - Retrospective Studies MH - Risk Assessment MH - Sampling Studies MH - Sensitivity and Specificity MH - *Sentinel Lymph Node Biopsy MH - Survival Analysis MH - Treatment Outcome EDAT- 2004/04/02 05:00 MHDA- 2004/04/17 05:00 CRDT- 2004/04/02 05:00 PST - ppublish SO - Am Surg. 2004 Mar;70(3):215-20; discussion 220-1. PMID- 15015707 OWN - NLM STAT- MEDLINE DA - 20040312 DCOM- 20040423 LR - 20070718 IS - 1068-9265 (Print) IS - 1068-9265 (Linking) VI - 11 IP - 1 Suppl DP - 2004 Jan TI - Applying the neoadjuvant paradigm to ductal carcinoma in situ. PG - 28S-36S AB - Local treatment options for ductal carcinoma in situ (DCIS) are virtually identical to those for early invasive breast cancer, despite the fact that the survival from this condition is much higher. Our ability to more appropriately tailor therapy for DCIS is hampered by a lack of understanding of the natural history of DCIS, our limited ability to predict the rate of progression to invasive cancer and the response to therapy, and the absence of tools to follow patients who have not had invasive treatments. Neoadjuvant therapy, which has been proven to be both safe and effective in tailoring treatments for invasive cancer, could be ideally suited to DCIS. However, neoadjuvant therapy requires that doctors and patients delay surgical treatment that has known benefits. In order to successfully introduce this approach into clinical practice, risk assessment and decision support tools will be needed to help physicians and patients feel comfortable that they are not being exposed to unnecessary or excessive risk. In addition, we need better imaging to track extent and progression of disease. Among the possible benefits of the neoadjuvant approach, we may discover that many lesions are responsive and some even reversible, leaving us with treatments that might be tailored to biology and with important clues for breast cancer prevention in high-risk women. FAU - Esserman, Laura AU - Esserman L AD - Department of Surgery, University of California San Francisco Medical Center, San Francisco, California 94115, USA. laura.esserman@ucsfmedctr.org FAU - Sepucha, Karen AU - Sepucha K FAU - Ozanne, Elissa AU - Ozanne E FAU - Hwang, E Shelley AU - Hwang ES LA - eng PT - Journal Article PL - United States TA - Ann Surg Oncol JT - Annals of surgical oncology JID - 9420840 RN - 0 (Cyclooxygenase Inhibitors) SB - IM MH - Breast Neoplasms/epidemiology/*therapy MH - Carcinoma, Intraductal, Noninfiltrating/epidemiology/*therapy MH - Chemotherapy, Adjuvant MH - Cyclooxygenase Inhibitors/therapeutic use MH - Decision Support Techniques MH - Disease Progression MH - Female MH - Humans MH - Magnetic Resonance Imaging MH - Mastectomy, Segmental MH - *Neoadjuvant Therapy MH - Radiotherapy, Adjuvant MH - Risk Assessment MH - Sensitivity and Specificity EDAT- 2004/03/16 05:00 MHDA- 2004/04/24 05:00 CRDT- 2004/03/16 05:00 PST - ppublish SO - Ann Surg Oncol. 2004 Jan;11(1 Suppl):28S-36S. PMID- 14981106 OWN - NLM STAT- MEDLINE DA - 20040315 DCOM- 20040408 LR - 20041117 IS - 0732-183X (Print) IS - 0732-183X (Linking) VI - 22 IP - 6 DP - 2004 Mar 15 TI - Hormone replacement therapy and life expectancy after prophylactic oophorectomy in women with BRCA1/2 mutations: a decision analysis. PG - 1045-54 AB - PURPOSE: The decision about prophylactic oophorectomy is difficult for many premenopausal women with BRCA1/2 mutations because of concerns and controversy about the use of hormone replacement therapy (HRT) after oophorectomy. PATIENTS AND METHODS: A Markov decision analytic model used the most current epidemiologic data to assess the expected outcomes of prophylactic oophorectomy with or without HRT (to age 50 years or for life) in cohorts of women with BRCA1/2 mutations. Sensitivity analyses were conducted to assess the impact of alternative assumptions about effects of HRT, effects of prophylactic oophorectomy, and risks of cancer associated with BRCA1/2 mutations. RESULTS: In our model, prophylactic oophorectomy lengthened life expectancy in women with BRCA1/2 mutations, irrespective of whether HRT was used after oophorectomy. This gain ranged from 3.34 to 4.65 years, depending on age at oophorectomy. Use of HRT after oophorectomy was associated with relatively small changes in life expectancy (+0.17 to -0.34 years) when HRT was stopped at age 50, but larger decrements in life expectancy if HRT was continued for life (-0.79 to -1.09 years). HRT was associated with a gain in life expectancy of between 0.39 and 0.79 years for mutation carriers undergoing both prophylactic mastectomy and oophorectomy. CONCLUSION: On the basis of the results of this decision analysis, we recommend that women with BRCA1/2 mutations undergo prophylactic oophorectomy after completion of childbearing, decide about short-term HRT after oophorectomy based largely on quality-of-life issues rather than life expectancy, and, if using HRT, consider discontinuing treatment at the time of expected natural menopause, approximately age 50 years. FAU - Armstrong, Katrina AU - Armstrong K AD - Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA. karmstro@mail.med.upenn.edu FAU - Schwartz, J Sanford AU - Schwartz JS FAU - Randall, Thomas AU - Randall T FAU - Rubin, Stephen C AU - Rubin SC FAU - Weber, Barbara AU - Weber B LA - eng PT - Journal Article DEP - 20040223 PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 SB - IM CIN - J Clin Oncol. 2004 Mar 15;22(6):978-80. PMID: 14981100 MH - Adult MH - Age Factors MH - Cohort Studies MH - *Decision Support Techniques MH - *Estrogen Replacement Therapy/adverse effects MH - Female MH - Genes, BRCA1 MH - Genes, BRCA2 MH - Genetic Predisposition to Disease MH - Humans MH - *Life Expectancy MH - Markov Chains MH - Middle Aged MH - Mutation MH - Ovarian Neoplasms/genetics/*prevention & control MH - *Ovariectomy MH - *Postoperative Care MH - Risk MH - Treatment Outcome EDAT- 2004/02/26 05:00 MHDA- 2004/04/09 05:00 CRDT- 2004/02/26 05:00 AID - 10.1200/JCO.2004.06.090 [doi] AID - JCO.2004.06.090 [pii] PST - ppublish SO - J Clin Oncol. 2004 Mar 15;22(6):1045-54. Epub 2004 Feb 23. PMID- 14735173 OWN - NLM STAT- MEDLINE DA - 20040121 DCOM- 20040304 LR - 20140610 IS - 0007-0920 (Print) IS - 0007-0920 (Linking) VI - 90 IP - 2 DP - 2004 Jan 26 TI - Randomised trial of a decision aid and its timing for women being tested for a BRCA1/2 mutation. PG - 333-42 AB - The aim of the study was to evaluate the impact of a decision aid (DA) and its timing in women being tested for a BRCA1/2 mutation. Women with and without a previous history of cancer were included after blood sampling for genetic testing. The DA consisted of a brochure and video providing information on screening and prophylactic surgery. To evaluate the impact of the DA, women were randomised to the DA group (n=184), receiving the DA 2 weeks after blood sampling, or to the control group (n=184). To evaluate the impact of timing, mutation carriers who had received the DA before the test result (n=47) were compared to mutation carriers who received the DA after the test result (n=42). Data were collected on well-being, treatment choice, decision and information related outcomes. The impact of the DA was measured 4 weeks after blood sampling. The impact of timing was measured 2 weeks after a positive test result. The DA had no impact on well-being. Regarding decision related outcomes, the DA group more frequently considered prophylactic surgery (P=0.02) corroborated with higher valuations (P=0.04). No differences were found for the other decision related outcomes. Regarding information related outcomes, the DA group felt better informed (P=0.00), was more satisfied with the information (P=0.00), and showed more accurate risk perceptions. Timing of the DA had no effect on any of the outcomes. No interactions were found between the DA and history of cancer. In conclusion, women being tested for a BRCA1/2 mutation benefit from the DA on information related outcomes. Because timing had no effect, the DA is considered useful either before or after the test result. FAU - van Roosmalen, M S AU - van Roosmalen MS AD - Joint Center for Radiation Oncology Arnhem-Nijmegen (RADIAN), University Medical Center Nijmegen, Nijmegen, The Netherlands. m.vanroosmalen@rther.umcn.nl FAU - Stalmeier, P F M AU - Stalmeier PF FAU - Verhoef, L C G AU - Verhoef LC FAU - Hoekstra-Weebers, J E H M AU - Hoekstra-Weebers JE FAU - Oosterwijk, J C AU - Oosterwijk JC FAU - Hoogerbrugge, N AU - Hoogerbrugge N FAU - Moog, U AU - Moog U FAU - van Daal, W A J AU - van Daal WA LA - eng PT - Clinical Trial PT - Journal Article PT - Randomized Controlled Trial PL - England TA - Br J Cancer JT - British journal of cancer JID - 0370635 SB - IM MH - Adult MH - Attitude to Health MH - Breast Neoplasms/*genetics/pathology/surgery MH - DNA Mutational Analysis MH - *Decision Making MH - *Decision Support Techniques MH - Female MH - *Genes, BRCA1 MH - *Genes, BRCA2 MH - *Genetic Counseling MH - *Genetic Predisposition to Disease MH - *Genetic Testing MH - Humans MH - Mastectomy MH - Middle Aged MH - Pamphlets MH - *Patient Education as Topic MH - Prognosis MH - Risk Factors MH - Time Factors MH - Video Recording PMC - PMC2410151 OID - NLM: PMC2410151 EDAT- 2004/01/22 05:00 MHDA- 2004/03/05 05:00 CRDT- 2004/01/22 05:00 AID - 10.1038/sj.bjc.6601525 [doi] AID - 6601525 [pii] PST - ppublish SO - Br J Cancer. 2004 Jan 26;90(2):333-42. PMID- 14725910 OWN - NLM STAT- MEDLINE DA - 20040116 DCOM- 20040227 LR - 20061115 IS - 1278-3218 (Print) IS - 1278-3218 (Linking) VI - 7 IP - 6 DP - 2003 Dec TI - [Re-irradiation after salvage mastectomy for local recurrence after a conservative treatment: a retrospective analysis of twenty patients (Nancy: 1988-2001)]. PG - 369-79 AB - PURPOSE: To retrospectively assess the efficacy of post-mastectomy re-irradiation for local relapse of breast cancer. PATIENTS AND METHODS: Twenty patients, initially treated by conservative surgery and radiotherapy (50 Gy in 25 fractions over 5 weeks) were treated from 1998 to 2001 for a local relapse by salvage mastectomy and re-irradiation (either electron or photon beams). Mean age was 53 years (31-71). Reasons for re-irradiation were that the local relapses were inflammatory (4 pts), multifocal (5 pts), cutaneous (5 pts), involved the nipple (3 pts) or because the surgical margins (either muscle or skin) were involved (3 pts). The median dose of re-irradiation was 45 Gy (33-65) in 15 fractions over 33 days. Mean follow-up was 48 months (5-97). RESULTS: Fifteen patients remained free of a second local recurrence and 10 were still alive, without metastasis. Neither the dose of re-irradiation nor the irradiated surfaces were prognostic factors of local control (P = 0.877 and P = 0.424). Five patients developed radiation-induced pneumonitis without functional respiratory impairment. The incidence of pneumonitis seemed to be related to the biological dose of re-irradiation (P = 0.037). Other late complications occurred such as pigmentation changes (12 pts), telangiectasia (8 pts), chondritis (2 pts), parietal fibrosis (7 pts), rib fractures (4 pts), severe pain (11 pts) and lymphedema (2 pts). The increase in biological equivalent dose was highly statistically linked with the occurrence of disabling pain (P = 0.0123). CONCLUSION: Parietal re-irradiation achieves good and lasting local control with an acceptable rate of acute complications but with a risk of disabling late sequelae such as severe pain. FAU - Racadot, S AU - Racadot S AD - Service de radiotherapie, centre Alexis-Vautrin, avenue de Bourgogne, 54511 Vandoeuvre-les-Nancy, France. sracadot@wanadoo.fr FAU - Marchal, C AU - Marchal C FAU - Charra-Brunaud, C AU - Charra-Brunaud C FAU - Verhaeghe, J-L AU - Verhaeghe JL FAU - Peiffert, D AU - Peiffert D FAU - Bey, P AU - Bey P LA - fre PT - Comparative Study PT - English Abstract PT - Journal Article TT - Re-irradiation parietale apres mastectomie de rattrapage pour recidive d'un cancer du sein apres traitement conservateur : etude retrospective sur 20 patientes (Nancy : 1988-2001). PL - France TA - Cancer Radiother JT - Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique JID - 9711272 SB - IM MH - Adult MH - Aged MH - Brachytherapy MH - Breast/pathology MH - Breast Neoplasms/drug therapy/mortality/pathology/*radiotherapy/surgery MH - Carcinoma, Ductal, Breast/drug therapy/mortality/pathology/*radiotherapy MH - Carcinoma, Lobular/drug therapy/mortality/pathology/*radiotherapy/surgery MH - Chemotherapy, Adjuvant MH - Chi-Square Distribution MH - Combined Modality Therapy MH - Data Interpretation, Statistical MH - Female MH - Follow-Up Studies MH - Humans MH - Lymphatic Metastasis MH - *Mastectomy MH - Middle Aged MH - Neoplasm Metastasis MH - Neoplasm Recurrence, Local/drug therapy/mortality/pathology/*radiotherapy/surgery MH - Radiotherapy/adverse effects MH - Radiotherapy Dosage MH - Retrospective Studies MH - *Salvage Therapy MH - Time Factors EDAT- 2004/01/17 05:00 MHDA- 2004/02/28 05:00 CRDT- 2004/01/17 05:00 AID - S1278321803001161 [pii] PST - ppublish SO - Cancer Radiother. 2003 Dec;7(6):369-79. PMID- 14581440 OWN - NLM STAT- MEDLINE DA - 20031203 DCOM- 20040105 LR - 20151119 IS - 0732-183X (Print) IS - 0732-183X (Linking) VI - 21 IP - 23 DP - 2003 Dec 01 TI - Adjuvant chemotherapy for breast cancer: how presentation of recurrence risk influences decision-making. PG - 4299-305 AB - PURPOSE: The purpose of this study was to examine the impact of four methods of communicating survival benefits on chemotherapy decisions. We hypothesized that the four methods of communicating mathematically equivalent risk information would lead to different chemotherapy decisions. METHODS: Each participant received two hypothetical scenarios regarding their mother (a postmenopausal woman with an invasive, lymph node-negative, hormone receptor-positive breast cancer) and was asked to decide whether they would encourage their mother to take chemotherapy in addition to surgery and tamoxifen. In the part 1, participants received one of four methods of describing the chemotherapy survival benefit: (1) relative risk reduction, (2) absolute risk reduction, (3) absolute survival benefit, or (4) number needed to treat. In part 2, each participant received all four methods. Following each decision, participants were asked to rate their confidence and confusion regarding their decision. RESULTS: Participants included 203 preclinical medical students. In part 1, participants who received relative risk reduction information were significantly more likely to endorse chemotherapy. In part 2, there were no treatment decision differences when participants received all four methods of communicating survival benefits of chemotherapy. However, receiving all four methods led to significantly higher ratings of confusion. In deciding on endorsing chemotherapy, participants understood the information best when presented with data in the absolute survival benefit format. CONCLUSION: These results support the hypothesis that the method used to present information about chemotherapy influences treatment decisions. Absolute survival benefit is the most easily understood method of conveying the information regarding benefit of treatment. FAU - Chao, Celia AU - Chao C AD - Department of Surgery, University of Texas Medical Branch, 301 University Blvd, Route 0527, Galveston, TX 77555-0527, USA. cechao@utmb.edu FAU - Studts, Jamie L AU - Studts JL FAU - Abell, Troy AU - Abell T FAU - Hadley, Terence AU - Hadley T FAU - Roetzer, Lynne AU - Roetzer L FAU - Dineen, Sean AU - Dineen S FAU - Lorenz, Doug AU - Lorenz D FAU - YoussefAgha, Ahmed AU - YoussefAgha A FAU - McMasters, Kelly M AU - McMasters KM LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20031027 PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 RN - 0 (Antineoplastic Agents) RN - 0 (Receptors, Estrogen) RN - 094ZI81Y45 (Tamoxifen) SB - IM CIN - J Clin Oncol. 2003 Dec 1;21(23):4263-4. PMID: 14581445 MH - Adult MH - Antineoplastic Agents/therapeutic use MH - Breast Neoplasms/*drug therapy/*mortality MH - Chemotherapy, Adjuvant MH - *Decision Making MH - *Decision Support Techniques MH - Female MH - Humans MH - Lymph Nodes/pathology MH - Male MH - Mastectomy/methods MH - Middle Aged MH - Neoplasm Invasiveness MH - Neoplasm Recurrence, Local/*drug therapy MH - Prognosis MH - Receptors, Estrogen/analysis MH - Risk Assessment MH - Risk Factors MH - *Risk Reduction Behavior MH - Surveys and Questionnaires MH - Survival Rate MH - Tamoxifen/therapeutic use MH - Treatment Outcome EDAT- 2003/10/29 05:00 MHDA- 2004/01/06 05:00 CRDT- 2003/10/29 05:00 AID - 10.1200/JCO.2003.06.025 [doi] AID - JCO.2003.06.025 [pii] PST - ppublish SO - J Clin Oncol. 2003 Dec 1;21(23):4299-305. Epub 2003 Oct 27. PMID- 14528554 OWN - NLM STAT- MEDLINE DA - 20031007 DCOM- 20031027 LR - 20151119 IS - 0738-3991 (Print) IS - 0738-3991 (Linking) VI - 37 IP - 3 DP - 1999 Jul TI - Offering a choice between two adjuvant chemotherapy regimens: a pilot study to develop a decision aid for women with breast cancer. PG - 283-91 AB - BACKGROUND: The primary objective of this study was to develop a decision aid which would encourage and assist patients to become involved in treatment decision making, and help clinicians to objectively educate patients about the benefits and risks of adjuvant chemotherapy for breast cancer. A secondary objective was to investigate the factors influencing this treatment decision-making process for women when choosing between adriamycin and cyclophosphamide (AC) versus cyclophosphamide, methotrexate and 5-fluorouracil (CMF) chemotherapy. METHODS: An educational visual instrument called a Decision Board was developed consisting of written and graphical material. The Decision Board displays general information about chemotherapy and detailed information about each chemotherapy regimen, including the schedule and side effects, and was presented to patients with a scripted standardized oral explanation. The instrument was evaluated in 46 premenopausal women newly diagnosed with node-positive breast cancer. Following presentation of the board, the patients were given a take home version to review and asked to return 1-2 weeks later with a decision. During the second visit each patient was asked to complete a questionnaire regarding demographics, learning and comprehension, treatment preference, and factors influencing their decision. RESULTS: Recall of information was acceptable (> or = 80%). The Decision Board was found helpful by all, but the level of difficulty with decision making was variable. Out of 46 women, 23 women chose AC, 21 chose CMF, and two chose no treatment. The major factors affecting treatment preference were related to the impact on quality of life, the length of therapy, and the side effects, in particular, vomiting and alopecia. CONCLUSIONS: The Decision Board appears to be a valuable educational tool that enables patients to become well-informed and directly involved in their treatment decisions. FAU - Irwin, E AU - Irwin E AD - McMaster University, School of Nursing, OCTRF Hamilton Regional Cancer Centre, Hamilton, Ontario, Canada. FAU - Arnold, A AU - Arnold A FAU - Whelan, T J AU - Whelan TJ FAU - Reyno, L M AU - Reyno LM FAU - Cranton, P AU - Cranton P LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Adult MH - Antineoplastic Combined Chemotherapy Protocols/therapeutic use MH - Attitude to Health MH - Audiovisual Aids/standards MH - Breast Neoplasms/drug therapy/*psychology MH - Chemotherapy, Adjuvant/adverse effects/*psychology MH - *Choice Behavior MH - *Decision Support Techniques MH - Female MH - Humans MH - Male MH - Mastectomy MH - Middle Aged MH - Patient Education as Topic/*methods MH - Pilot Projects MH - Premenopause/psychology MH - Quality of Life MH - Surveys and Questionnaires MH - Treatment Outcome MH - Women/*education/*psychology EDAT- 2003/10/08 05:00 MHDA- 2003/10/28 05:00 CRDT- 2003/10/08 05:00 PST - ppublish SO - Patient Educ Couns. 1999 Jul;37(3):283-91. PMID- 12942517 OWN - NLM STAT- MEDLINE DA - 20030827 DCOM- 20040108 LR - 20061115 IS - 0738-1085 (Print) IS - 0738-1085 (Linking) VI - 23 IP - 4 DP - 2003 TI - Cost-utility analysis comparing free and pedicled TRAM flap for breast reconstruction. PG - 287-95 AB - The purpose of this study was to compare the free TRAM to the unipedicled TRAM flap in postmastectomy reconstruction, using a cost-utility analysis. A decision analytic model was used for this study. Medical costs associated with the two techniques were estimated from the Ontario Ministry of Health Schedule of Benefits (1998). Hospital costs were obtained from St. Joseph's Healthcare, a university hospital in Hamilton, Ontario. Utilities were obtained from 33 "experts" across Canada and then converted into quality-adjusted life-years (QALYs). The probabilities of various health states associated with unipedicled and free TRAM flaps were obtained by reviewing several key articles. The free TRAM flap was more costly than the unipedicled TRAM flap, but it provided more QALYs. The baseline incremental cost-utility ratio (ICUR) was $5,113.73/QALY, favoring adoption of the free TRAM flap. This study showed that the free TRAM flap is a cost-effective procedure for postmastectomy reconstruction in the Canadian healthcare system. CI - Copyright 2003 Wiley-Liss, Inc. MICROSURGERY 23:287-295 2003 FAU - Thoma, Achilleas AU - Thoma A AD - Division of Plastic and Reconstructive Surgery, Department of Surgery, St. Joseph's Healthcare, Surgical Outcomes Research Centre and McMaster University, Hamilton, Ontario, Canada. athoma@mcmaster.ca FAU - Khuthaila, Dana AU - Khuthaila D FAU - Rockwell, Gloria AU - Rockwell G FAU - Veltri, Karen AU - Veltri K LA - eng PT - Comparative Study PT - Journal Article PL - United States TA - Microsurgery JT - Microsurgery JID - 8309230 SB - IM MH - Cost-Benefit Analysis MH - Costs and Cost Analysis MH - *Decision Support Techniques MH - Female MH - Hospital Costs/statistics & numerical data MH - Humans MH - Mammaplasty/*economics/methods MH - National Health Programs/economics MH - Ontario MH - Quality-Adjusted Life Years MH - *Surgical Flaps/economics EDAT- 2003/08/28 05:00 MHDA- 2004/01/09 05:00 CRDT- 2003/08/28 05:00 AID - 10.1002/micr.10138 [doi] PST - ppublish SO - Microsurgery. 2003;23(4):287-95. PMID- 12919237 OWN - NLM STAT- MEDLINE DA - 20030815 DCOM- 20031020 LR - 20161025 IS - 0002-8614 (Print) IS - 0002-8614 (Linking) VI - 51 IP - 9 DP - 2003 Sep TI - Effect of nurse case management on the treatment of older women with breast cancer. PG - 1252-9 AB - OBJECTIVES: To evaluate the effect of nurse case management on the treatment of older women with breast cancer. DESIGN: Randomized prospective trial. SETTING: Sixty surgeons practicing at 13 community and two public hospitals in southeast Texas. PARTICIPANTS: Three hundred thirty-five women (166 control and 169 intervention) aged 65 and older newly diagnosed with breast cancer. INTERVENTION: Women seeing surgeons randomized to the intervention group received the services of a nurse case manager for 12 months after the diagnosis of breast cancer. MEASUREMENTS: The primary outcome was the type and use of cancer-specific therapies received in the first 6 months after diagnosis. Secondary outcomes were patient satisfaction and arm function on the affected side 2 months after diagnosis. RESULTS: More women in the intervention group received breast-conserving surgery (28.6% vs 18.7%; P=.031) and radiation therapy (36.0% vs 19.0%; P=.003). Of women undergoing breast-conserving surgery, greater percentages in the case management group received adjuvant radiation (78.3% vs 44.8%; P=.001) and axillary dissection (71.4% vs 44.8%; P=.057). Women in the case management group were also more likely to receive more breast reconstruction surgery (9.3% vs 2.6%, P=.054), and women in the case management group with advanced cancer were more likely to receive chemotherapy (72.7% vs 30.0%, P=.057). Two months after surgery, higher percentages of women in the case manager group had normal arm function (93% vs 84%; P=.037) and were more likely to state that they had a real choice in their treatment (82.2% vs 69.9%, P=.020). Women with indicators of poor social support were more likely to benefit from nurse case management. CONCLUSION: Nurse case management results in more appropriate management of older women with breast cancer. FAU - Goodwin, James S AU - Goodwin JS AD - Department of Internal Medicine, School of Medicine, The University of Texas Medical Branch, Galveston, Texas 77555, USA. jsgoodwi@utmb.edu FAU - Satish, Shiva AU - Satish S FAU - Anderson, Elizabeth T AU - Anderson ET FAU - Nattinger, Ann B AU - Nattinger AB FAU - Freeman, Jean L AU - Freeman JL LA - eng GR - P30 AG024832/AG/NIA NIH HHS/United States PT - Clinical Trial PT - Comparative Study PT - Journal Article PT - Randomized Controlled Trial PL - United States TA - J Am Geriatr Soc JT - Journal of the American Geriatrics Society JID - 7503062 SB - IM CIN - Evid Based Nurs. 2004 Apr;7(2):58. PMID: 15106640 MH - Age Factors MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/nursing/psychology/surgery/*therapy MH - *Case Management MH - Data Interpretation, Statistical MH - Female MH - Geriatric Assessment MH - *Health Services Accessibility MH - Humans MH - Male MH - Middle Aged MH - *Nurse's Role MH - Patient Satisfaction MH - Physician's Role MH - Prospective Studies MH - Psychiatric Status Rating Scales MH - *Social Support MH - Socioeconomic Factors MH - Time Factors MH - Treatment Outcome EDAT- 2003/08/16 05:00 MHDA- 2003/10/21 05:00 CRDT- 2003/08/16 05:00 AID - 51409 [pii] PST - ppublish SO - J Am Geriatr Soc. 2003 Sep;51(9):1252-9. PMID- 12880217 OWN - NLM STAT- MEDLINE DA - 20030725 DCOM- 20030915 LR - 20151119 IS - 1541-6577 (Print) IS - 1541-6577 (Linking) VI - 17 IP - 2 DP - 2003 Summer TI - Australian women's prediagnostic decision-making styles, relating to treatment choices for early breast cancer treatment. PG - 117-36 AB - Women diagnosed with early breast cancer are now asked by their doctors to choose from a range of options for their preferred medical treatment plan. Little information is known about women's treatment decision-making and therefore nurses do not have evidence to guide this decision support. The aim of this descriptive survey was to investigate the prediagnostic decision-making behavior of a sample (N = 377) of Australian women, regarding their treatment choices for early breast cancer. The data were collected using the Pre-Decision Portfolio Questionnaire (PDPQ) by Pierce (1996), which includes the Michigan Assessment of Decision Styles (MADS). Of 366 participating women, 19.9% strongly agreed to all three items of the MADS factor Deferring Responsibility; 0.3% strongly agreed to all four factors of Avoidance; 32.7% strongly agreed on all four items of Information Seeking; and 63.4% strongly agreed to all five items of Deliberation. Women showed a variety of preferred decision styles, depending on age, education, occupation and employment status. Only 36% of women indicated it was critically important to "get the treatment over as soon as possible;" 55% to "participate in selecting treatment;" and 53% to "read a lot of information:" The understanding of factors that are important to women when they are making decisions for medical treatment is a mandatory step in designing customized evidence-based decision support, which can be delivered by nurses to help women during this distressing experience. FAU - Budden, Lea M AU - Budden LM AD - School of Nursing Sciences, James Cook University Townsville, Queensland, Australia. Lea.Budden@jcu.edu.au FAU - Pierce, Penny F AU - Pierce PF FAU - Hayes, Barbara A AU - Hayes BA FAU - Buettner, Petra G AU - Buettner PG LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Res Theory Nurs Pract JT - Research and theory for nursing practice JID - 101146940 SB - IM SB - N MH - Adult MH - Age Factors MH - Aged MH - Avoidance Learning MH - Breast Neoplasms/diagnosis/*psychology/*therapy MH - *Choice Behavior MH - *Decision Making MH - Educational Status MH - Employment/psychology MH - Female MH - Humans MH - Internal-External Control MH - Linear Models MH - Middle Aged MH - Nurse's Role MH - Nursing Methodology Research MH - Patient Education as Topic MH - Patient Participation/methods/*psychology MH - Problem Solving MH - Queensland MH - Socioeconomic Factors MH - Surveys and Questionnaires MH - Women/education/*psychology EDAT- 2003/07/26 05:00 MHDA- 2003/09/16 05:00 CRDT- 2003/07/26 05:00 PST - ppublish SO - Res Theory Nurs Pract. 2003 Summer;17(2):117-36. PMID- 12865955 OWN - NLM STAT- MEDLINE DA - 20030716 DCOM- 20031030 LR - 20161124 IS - 0044-409X (Print) IS - 0044-409X (Linking) VI - 128 IP - 6 DP - 2003 Jun TI - [Prospective multicenter study for quality management of breast cancer surgery]. PG - 493-9 AB - Over the last 10 years a dramatic decrease became apparent in primary treatment of breast cancer in general surgical departments. A prospective 1-year observational study involving 84 surgical departments was carried out to describe the current therapeutic situation. A total of 1,416 patients undergoing primary surgical treatment for mammary carcinoma were recorded, and their data evaluated. 68.9% of the carcinomas were treated in departments with an annual case load for this disease of more than 20 operations, with 50% of them being operated on in 8 departments with a case load of 40-100 procedures per year. 94.4% of the carcinomas were confirmed histologically, and in 91% of the patients surgery was performed in curative intention. The rate of breast-preserving procedures was 40%, and breast amputations accounted for 60%. An analysis of the data allowed an evaluation of this specific patient group in the surgical departments. Deficits in terms of management quality are identified. FAU - Leinung, S AU - Leinung S AD - Chirurgische Klinik II der Universitat Leipzig. leinungs@medizin.uni-leipzig.de FAU - Schonfelder, M AU - Schonfelder M FAU - Winzer, K-J AU - Winzer KJ FAU - Schuster, E AU - Schuster E FAU - Gastinger, I AU - Gastinger I FAU - Lippert, H AU - Lippert H FAU - Wurl, P AU - Wurl P CN - Studiengruppe "Mammakarzinom" der Ostdeutschen Arbeitsgruppe fur Leistungserfassung und Qualitatssicherung und das An-Institut fur Qualitatssicherung in der operativen Medizin der Otto-von-Guericke-Universitat Magdeburg LA - ger PT - Comparative Study PT - Journal Article PT - Multicenter Study TT - Prospektive Multizenterstudie zur Qualitatssicherung der Chirurgie des Mammakarzinoms. PL - Germany TA - Zentralbl Chir JT - Zentralblatt fur Chirurgie JID - 0413645 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/diagnosis/diagnostic imaging/*surgery MH - Combined Modality Therapy MH - Data Interpretation, Statistical MH - Female MH - Follow-Up Studies MH - Humans MH - Lymph Node Excision MH - Mammography MH - Mastectomy MH - Middle Aged MH - Neoadjuvant Therapy MH - Neoplasm Metastasis MH - Postoperative Care MH - Prospective Studies MH - *Quality Assurance, Health Care MH - Risk Factors MH - Time Factors MH - Tomography, X-Ray Computed MH - Ultrasonography, Mammary EDAT- 2003/07/17 05:00 MHDA- 2003/10/31 05:00 CRDT- 2003/07/17 05:00 AID - 10.1055/s-2003-40623 [doi] PST - ppublish SO - Zentralbl Chir. 2003 Jun;128(6):493-9. PMID- 12825857 OWN - NLM STAT- MEDLINE DA - 20030626 DCOM- 20031104 LR - 20071115 IS - 0167-6806 (Print) IS - 0167-6806 (Linking) VI - 79 IP - 2 DP - 2003 May TI - Treatment of early stage breast cancer: do surgeons and patients agree regarding whether treatment alternatives were discussed? PG - 225-31 AB - BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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. FAU - Keating, Nancy L AU - Keating NL AD - Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. keating@hcp.med.harvard.edu FAU - Weeks, Jane C AU - Weeks JC FAU - Borbas, Catherine AU - Borbas C FAU - Guadagnoli, Edward AU - Guadagnoli E LA - eng GR - CA57755/CA/NCI NIH HHS/United States GR - CA59408/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. PL - Netherlands TA - Breast Cancer Res Treat JT - Breast cancer research and treatment JID - 8111104 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/*pathology/psychology/*surgery MH - Communication MH - Data Collection MH - *Decision Making MH - Female MH - Humans MH - Logistic Models MH - Middle Aged MH - Neoplasm Staging MH - Patient Education as Topic MH - Patient Participation/*statistics & numerical data MH - Patient Satisfaction/*statistics & numerical data MH - *Physician-Patient Relations EDAT- 2003/06/27 05:00 MHDA- 2003/11/05 05:00 CRDT- 2003/06/27 05:00 PST - ppublish SO - Breast Cancer Res Treat. 2003 May;79(2):225-31. PMID- 12723313 OWN - NLM STAT- MEDLINE DA - 20030501 DCOM- 20030609 LR - 20131121 IS - 1661-8157 (Print) IS - 1661-8157 (Linking) VI - 92 IP - 14 DP - 2003 Apr 02 TI - [Correlation of risk factors with the efficacy of applied therapies by breast conserving procedure in breast cancer]. PG - 639-48 AB - 1007 cases of female breast cancer patients treated with breast conserving surgery and subsequently irradiation with a median dose of 66 (50-80) Gy including boost with tangential high voltage photon beams. 34.6% (348/1007) received no further therapies, 53.4% (538/1007) Tamoxifen, 26% (262/1007) an adjuvant chemotherapy +/- Tamoxifen. All tumors were classified on the basis of the pathologic-anatomical spreading: 70.7% (712/1007) pT1a-c, 27.4% (276/1007) pT2. 1.9% (19/1007) pT3-4 due to the refusal of mastectomy or an error in the preoperative diagnosis. 32.5% (327/1007) showed proven axillary metastases, of which 26.3% (86/327) > or = 4 LN+. Median age 56 (23-92) years. The local relapse rate after a median follow-up of 70 (12-264) months amounted to 5.9% (59/1007). Distant metastases were registered in 11.5% (116/1007). A total of 8.8% (89/1007) died as consequence of breast cancer, 3.2% (32/1007) of other causes. In 82.6% (816/988) of the pT1/pT2 tumors the resection area had been described. In 29.8% (156/524) in the resected parts there were found rests of tumors. The LRFS falls from 94% to 82% and by remained R1 (26/524) to 47%. Correlation likewise the DMFS, which sanks from 81% to 68% respectively to 63%. We expect a second wave of metastases like the situation by local relapses. Often the R1-resection was connected with other histological high risk factors as multifocality/-centricity, necrosis or vascular invasion. If one divides the patient case sample into a first group with special risk factors (< or = 40 years of age, > or = 4 positive axillary lymph nodes, vascular invasion), and a second which exhibited none of these components, the first group had a 23-26% lower disease free survival rate. Amazing is the fact that, subsequent to a lumpectomy and irradiation, the use or non use of Tamoxifen and/or cytostatics was without proven statistical significance. The evaluation was conceived and implemented more than 20 years ago, and documentation was continuously collected ever since. We're aware of the lack of randomization, but there are less the randomized studies than rather its transformations respectively the daily routine who will decide about life and death. However, evaluations of this data by medical oncologists would, on the one hand, make it possible to better assess the importance of the available data and our results, and, on the other hand, clarify the clinical value of partially and/or completely applied medical treatments. FAU - Schwegler, N AU - Schwegler N AD - Kantonsspital Aarau. FAU - Puric, E AU - Puric E LA - ger PT - Comparative Study PT - English Abstract PT - Journal Article TT - Korrelation von Risikofakoren mit angewandten Therapien bei brusterhaltend behandelten Mammakarzinomen. PL - Switzerland TA - Praxis (Bern 1994) JT - Praxis JID - 101468093 RN - 0 (Antineoplastic Agents, Hormonal) RN - 094ZI81Y45 (Tamoxifen) SB - IM MH - Adult MH - Age Factors MH - Aged MH - Aged, 80 and over MH - Antineoplastic Agents, Hormonal/therapeutic use MH - Breast/pathology MH - Breast Neoplasms/drug therapy/pathology/radiotherapy/*surgery MH - Chemotherapy, Adjuvant MH - Combined Modality Therapy MH - Data Interpretation, Statistical MH - Disease-Free Survival MH - Female MH - Follow-Up Studies MH - Humans MH - Lymphatic Metastasis MH - *Mastectomy, Segmental MH - Middle Aged MH - Neoplasm Metastasis MH - Neoplasm Recurrence, Local MH - Postoperative Care MH - Radiotherapy Dosage MH - Risk Factors MH - Tamoxifen/therapeutic use MH - Time Factors EDAT- 2003/05/02 05:00 MHDA- 2003/06/10 05:00 CRDT- 2003/05/02 05:00 AID - 10.1024/0369-8394.92.14.639 [doi] PST - ppublish SO - Praxis (Bern 1994). 2003 Apr 2;92(14):639-48. PMID- 12697850 OWN - NLM STAT- MEDLINE DA - 20030416 DCOM- 20030507 LR - 20151119 IS - 0027-8874 (Print) IS - 0027-8874 (Linking) VI - 95 IP - 8 DP - 2003 Apr 16 TI - Helping patients make informed choices: a randomized trial of a decision aid for adjuvant chemotherapy in lymph node-negative breast cancer. PG - 581-7 AB - BACKGROUND: In recent years, patients have indicated a desire for more information about their disease and to be involved in making decisions about their care. We developed an aid called the "Decision Board" to help clinicians inform patients with lymph node-negative breast cancer of the risks and benefits of adjuvant chemotherapy. We determined whether adding the Decision Board to the medical consultation improved patient knowledge and satisfaction compared with the medical consultation alone. METHODS: Between October 1995 and March 2000, 176 women with lymph node-negative breast cancer who were candidates for adjuvant chemotherapy were randomly assigned to receive the Decision Board plus the medical consultation (83 patients) or the medical consultation alone (93 patients). One week after the consultation, patients completed a questionnaire assessing their knowledge about breast cancer and chemotherapy. Satisfaction with decision making was assessed 1 week and 3, 6, and 12 months after randomization, and differences between groups were analyzed by a repeated measures analysis of variance. All statistical tests were two-sided. RESULTS: Patients in the Decision Board arm were better informed about breast cancer and adjuvant chemotherapy than patients in the control arm (mean knowledge score = 80.2 [on a scale of 0-100], 95% confidence interval [CI] = 77.1 to 83.3, and 71.7, 95% CI = 69.0 to 74.4, respectively; P<.001). Over the entire study period, satisfaction with decision making was higher for patients in the Decision Board arm than for patients in the control arm (P =.032). There was no statistically significant difference between the two groups in the number of patients who chose adjuvant chemotherapy (77% and 70% for patients in the Decision Board arm and those in the control arm, respectively; P =.303). CONCLUSION: When making decisions regarding adjuvant chemotherapy, patients with early breast cancer who had been exposed to the Decision Board had better knowledge of the disease and treatment options and greater satisfaction with their decision making than those who received the standard consultation. FAU - Whelan, Timothy AU - Whelan T AD - Cancer Care Ontario (CCO), Hamilton Regional Cancer Centre, and Supportive Cancer Care Research Unit, McMaster University, Hamilton, Ontario, Canada. tim.whelan@hrcc.on.ca FAU - Sawka, Carol AU - Sawka C FAU - Levine, Mark AU - Levine M FAU - Gafni, Amiram AU - Gafni A FAU - Reyno, Leonard AU - Reyno L FAU - Willan, Andrew AU - Willan A FAU - Julian, Jim AU - Julian J FAU - Dent, Susan AU - Dent S FAU - Abu-Zahra, Hakam AU - Abu-Zahra H FAU - Chouinard, Edmond AU - Chouinard E FAU - Tozer, Richard AU - Tozer R FAU - Pritchard, Kathleen AU - Pritchard K FAU - Bodendorfer, Ilona AU - Bodendorfer I LA - eng PT - Clinical Trial PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PL - United States TA - J Natl Cancer Inst JT - Journal of the National Cancer Institute JID - 7503089 RN - 0 (Antineoplastic Agents) SB - IM CIN - J Natl Cancer Inst. 2003 Apr 16;95(8):570-1. PMID: 12697842 MH - Adult MH - Aged MH - Antineoplastic Agents/*administration & dosage MH - Breast Neoplasms/drug therapy/pathology/surgery/*therapy MH - Chemotherapy, Adjuvant MH - Decision Making MH - *Decision Support Techniques MH - Female MH - Follow-Up Studies MH - Humans MH - Lymphatic Metastasis MH - Mastectomy/methods MH - Middle Aged MH - Neoplasm Recurrence, Local MH - *Patient Participation MH - *Patient Satisfaction MH - Surveys and Questionnaires MH - Treatment Outcome EDAT- 2003/04/17 05:00 MHDA- 2003/05/08 05:00 CRDT- 2003/04/17 05:00 PST - ppublish SO - J Natl Cancer Inst. 2003 Apr 16;95(8):581-7. PMID- 12690474 OWN - NLM STAT- MEDLINE DA - 20030411 DCOM- 20030916 LR - 20161020 IS - 1435-2443 (Print) IS - 1435-2443 (Linking) VI - 388 IP - 1 DP - 2003 Mar TI - Preventive mastectomy in patients at breast cancer risk due to genetic alterations in the BRCA1 and BRCA2 gene. PG - 3-8 AB - BACKGROUND: The availability of genetic testing for inherited mutations in the BRCA1 and BRCA2 gene provides potentially valuable information to women at high risk of breast and ovarian cancer. METHODS AND FOCUS: We review the literature on the value of prophylactic surgical strategies in patients with hereditary predisposition to develop breast cancer and discuss the surgical options available in high-risk cancer patients, decision analyses, and possible complications. RESULTS: Preventive surgical interventions to reduce cancer risk in high-risk patients are often strongly recommended. A patient's life-time risk to develop breast cancer in the presence of BRCA1 and BRCA2 mutations is 50-90%. Despite the reduction in the risk of developing breast cancer, prophylactic mastectomy often leads to significant physical and psychological sequelae. FAU - Taucher, Susanne AU - Taucher S AD - Department of Surgery, Medical School, Vienna University, Waehringer Guertel 18-20, 1090 Vienna, Austria. susanne.taucher@univie.ac.at FAU - Gnant, Michael AU - Gnant M FAU - Jakesz, Raimund AU - Jakesz R LA - eng PT - Journal Article DEP - 20030221 PL - Germany TA - Langenbecks Arch Surg JT - Langenbeck's archives of surgery JID - 9808285 SB - IM MH - Breast Neoplasms/*genetics/prevention & control MH - Decision Support Techniques MH - Female MH - *Genes, BRCA1 MH - *Genes, BRCA2 MH - Humans MH - *Mastectomy MH - Ovariectomy EDAT- 2003/04/12 05:00 MHDA- 2003/09/17 05:00 CRDT- 2003/04/12 05:00 PHST- 2002/11/04 [received] PHST- 2003/01/17 [accepted] AID - 10.1007/s00423-003-0355-9 [doi] PST - ppublish SO - Langenbecks Arch Surg. 2003 Mar;388(1):3-8. Epub 2003 Feb 21. PMID- 12641345 OWN - NLM STAT- MEDLINE DA - 20030318 DCOM- 20030328 LR - 20071115 IS - 0003-1348 (Print) IS - 0003-1348 (Linking) VI - 69 IP - 2 DP - 2003 Feb TI - A study of the patient factors affecting reconstruction after mastectomy for breast carcinoma. PG - 95-7 AB - Breast shape may be retained after surgery for breast cancer with either wide local excision (WLE) and radiotherapy or mastectomy (M) and immediate reconstruction (M+R). We determined the proportions of patients who would be suitable for these options, would accept them, and if they declined M+R their reasons for doing so. Over a 10-month period 177 women were assessed at a combined breast clinic by general and plastic surgeons and by radiation oncologists. A prospective record was made of the patient demographic data, the clinical decisions (and their reasons), and the patient choices (and their reasons). A transverse rectus abdominis myocutaneous flap was the commonest method of reconstruction. One hundred thirty-five (76%) were judged to be suitable for locoregional surgery. Of these M+R was offered to 83 patients, whereas 53 were not considered because of combinations of cosmetic considerations (31), risk factors (25), old age (13), and oncological factors (nine). Fifty-one of the 83 (61%) offered M+R declined it because they preferred a simpler procedure (34), regarded breast appearance as unimportant (15), preferred breast conservation (five), did not have a partner (three), felt that they were too old (two), or had religious reasons (two). Ultimately 69 (51%) underwent M, 34 (25%) WLE, and 32 (24%) M+R. There was no correlation between acceptance or not of M+R and age, race, employment, education level, or marital status. We conclude that many patients were suitable for M+R, but fewer than half accepted it; this decision was unrelated to age, race, employment, or marital status. FAU - Panieri, Eugenio AU - Panieri E AD - Department of Surgery, Groote Schuur Hospital and University of Cape Town, Faculty of Health Sciences, Cape Town, South Africa. FAU - Lazarus, Dirk AU - Lazarus D FAU - Dent, David M AU - Dent DM FAU - Hudson, Don A AU - Hudson DA FAU - Murray, Elizabeth AU - Murray E FAU - Werner, I Dudley AU - Werner ID LA - eng PT - Journal Article PL - United States TA - Am Surg JT - The American surgeon JID - 0370522 SB - IM MH - Age Factors MH - Aged MH - Breast Neoplasms/psychology/*surgery MH - *Choice Behavior MH - Comorbidity MH - Counseling MH - Educational Status MH - Employment MH - Esthetics MH - Ethnic Groups MH - Female MH - Humans MH - Mammaplasty/methods/*psychology/*statistics & numerical data MH - Marital Status MH - Mastectomy MH - Middle Aged MH - Motivation MH - Patient Acceptance of Health Care/*psychology/*statistics & numerical data MH - Patient Education as Topic MH - *Patient Selection MH - Prospective Studies MH - Risk Factors MH - South Africa MH - Surgical Flaps EDAT- 2003/03/19 04:00 MHDA- 2003/03/29 05:00 CRDT- 2003/03/19 04:00 PST - ppublish SO - Am Surg. 2003 Feb;69(2):95-7. PMID- 12613483 OWN - NLM STAT- MEDLINE DA - 20030303 DCOM- 20030314 LR - 20161209 IS - 0755-4982 (Print) IS - 0755-4982 (Linking) VI - 32 IP - 4 DP - 2003 Feb 01 TI - [Preventive oophorectomy in women exhibiting BRCA mutations]. PG - 149-50 FAU - Roseau, Emmanuel AU - Roseau E LA - fre PT - Comparative Study PT - Journal Article TT - Ovariectomie preventive chez les femmmes avec mutations BRCA. PL - France TA - Presse Med JT - Presse medicale (Paris, France : 1983) JID - 8302490 SB - IM MH - Adult MH - Breast Neoplasms/diagnostic imaging/epidemiology/genetics/*prevention & control MH - Cohort Studies MH - Data Interpretation, Statistical MH - Female MH - Follow-Up Studies MH - *Genes, BRCA1 MH - *Genes, BRCA2 MH - Humans MH - Mammography MH - Mastectomy MH - Middle Aged MH - Multicenter Studies as Topic MH - *Mutation MH - Ovarian Neoplasms/epidemiology/genetics/*prevention & control MH - *Ovariectomy MH - Prospective Studies MH - Retrospective Studies MH - Risk MH - Risk Factors MH - Time Factors EDAT- 2003/03/05 04:00 MHDA- 2003/03/15 04:00 CRDT- 2003/03/05 04:00 PST - ppublish SO - Presse Med. 2003 Feb 1;32(4):149-50. PMID- 12603376 OWN - NLM STAT- MEDLINE DA - 20030226 DCOM- 20030707 LR - 20071115 IS - 1075-122X (Print) IS - 1075-122X (Linking) VI - 9 IP - 2 DP - 2003 Mar-Apr TI - Why most women with breast cancer still undergo mastectomy. PG - 69-70 FAU - Masood, Shahla AU - Masood S LA - eng PT - Editorial PL - United States TA - Breast J JT - The breast journal JID - 9505539 SB - IM MH - Adult MH - Anecdotes as Topic MH - Attitude to Health MH - Breast Neoplasms/*psychology/*surgery MH - *Decision Making MH - Female MH - Humans MH - Mastectomy/*psychology MH - Middle Aged MH - *Patient Education as Topic/methods MH - Physician's Role MH - Physician-Patient Relations MH - Quality of Life MH - *Self Concept MH - United States EDAT- 2003/02/27 04:00 MHDA- 2003/07/08 05:00 CRDT- 2003/02/27 04:00 AID - 09201 [pii] PST - ppublish SO - Breast J. 2003 Mar-Apr;9(2):69-70. PMID- 12532709 OWN - NLM STAT- MEDLINE DA - 20030120 DCOM- 20030212 LR - 20061115 IS - 1010-660X (Print) IS - 1010-660X (Linking) VI - 38 IP - 10 DP - 2002 TI - [Efficiency of rehabilitation methods in the treatment of arm lymphedema after breast cancer surgery]. PG - 1003-8 AB - In this article we analyze influence of rehabilitation methods in treatment of arm lymphedema. In Kaunas oncological hospital were examined 60 women after surgery for breast cancer. The work objective was to evaluate efficiency of rehabilitation methods in treatment of arm lymphedema and in evaluate movement amplitude of shoulder joint. Two groups of women depending on rehabilitation start were evaluated. The same methods of rehabilitation were applied to both groups: physical therapy, electrostimulation, massage, lymphodrainage with apparate. Our study indicated that women, who were treated at early period of rehabilitation (3 months), showed statistically significantly (p < 0.01) better results in increase of movement amplitude of shoulder joint. However, results of treatment of arm lymphedema, comparing with women who started rehabilitation after 12 months, were equally successful--results were not statistically significantly better (p > 0.05). FAU - Petruseviciene, Daiva AU - Petruseviciene D AD - Kauno medicinos universiteto Reabilitacijos klinika, Eiveniu 2, 3007 Kaunas. FAU - Krisciunas, Aleksandras AU - Krisciunas A FAU - Sameniene, Jurate AU - Sameniene J LA - lit PT - Comparative Study PT - English Abstract PT - Journal Article TT - Pacienciu po kruties vezio operacijos reabilitacijos priemoniu efektyvumas rankos limfoedemai gydyti. PL - Netherlands TA - Medicina (Kaunas) JT - Medicina (Kaunas, Lithuania) JID - 9425208 SB - IM MH - *Arm MH - Breast Neoplasms/*surgery MH - Data Interpretation, Statistical MH - Female MH - Humans MH - Lymph Node Excision MH - Lymphedema/etiology/*rehabilitation MH - Mastectomy/*adverse effects MH - Physical Therapy Modalities MH - Time Factors EDAT- 2003/01/21 04:00 MHDA- 2003/02/14 04:00 CRDT- 2003/01/21 04:00 AID - 0210-07l [pii] PST - ppublish SO - Medicina (Kaunas). 2002;38(10):1003-8. PMID- 12515987 OWN - NLM STAT- MEDLINE DA - 20030107 DCOM- 20030416 LR - 20071115 IS - 1538-0688 (Electronic) IS - 0190-535X (Linking) VI - 30 IP - 1 DP - 2003 Jan-Feb TI - Improving the quality of decision making in breast cancer: consultation planning template and consultation recording template. PG - 99-106 AB - PURPOSE/OBJECTIVES: To describe two templates that can be used to improve the quality of breast cancer treatment decisions. DATA SOURCES: Case study, survey of current users, three clinical trials. FINDINGS: Clinical applications of the Consultation Planning Template and Consultation Recording Template vary across organizations. Clinical trials have demonstrated that the templates can improve the quality of decisions, the quality of communication between patients and providers, and satisfaction. CONCLUSIONS: The templates can be adapted to different clinical settings and can improve the quality of treatment decisions. IMPLICATIONS FOR NURSING: Nurses often provide the majority of education and coaching for patients making decisions. As patients' demands for involvement in decision making increase, nurses need practical tools to help patients participate. The templates are practical tools that nurses can use to help patients make better decisions. FAU - Sepucha, Karen R AU - Sepucha KR AD - Harvard Medical School, Boston, MA, USA. ksepucha@partners.org FAU - Belkora, Jeffrey K AU - Belkora JK FAU - Aviv, Caryn AU - Aviv C FAU - Mutchnik, Stephanie AU - Mutchnik S FAU - Esserman, Laura J AU - Esserman LJ LA - eng PT - Case Reports PT - Evaluation Studies PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, Non-P.H.S. PL - United States TA - Oncol Nurs Forum JT - Oncology nursing forum JID - 7809033 SB - IM SB - N MH - Adult MH - Benchmarking MH - Breast Neoplasms/diagnosis/*nursing/psychology/therapy MH - Carcinoma, Ductal, Breast/diagnosis/nursing/psychology/therapy MH - Choice Behavior MH - Female MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - Mastectomy/psychology MH - Patient Education as Topic/*methods MH - Patient Participation/*methods MH - Process Assessment (Health Care) MH - Prognosis MH - Quality of Life EDAT- 2003/01/08 04:00 MHDA- 2003/04/17 05:00 CRDT- 2003/01/08 04:00 AID - 10.1188/03.ONF.99-106 [doi] PST - ppublish SO - Oncol Nurs Forum. 2003 Jan-Feb;30(1):99-106. PMID- 12464832 OWN - NLM STAT- MEDLINE DA - 20021204 DCOM- 20030110 LR - 20151119 IS - 0162-220X (Print) IS - 0162-220X (Linking) VI - 25 IP - 6 DP - 2002 Dec TI - Feasibility of using a computer-assisted intervention to enhance the way women with breast cancer communicate with their physicians. PG - 417-24 AB - This study was conducted to evaluate the feasibility of using a computer intervention to enhance communication between healthcare professionals and women with breast cancer. Additional aims were to measure the extent to which women achieved their preferred decisional roles and satisfaction with the clinical medical appointment. This two-arm randomized clinical trial design included a convenience sample of 749 women with breast cancer attending 3 urban Canadian outpatient oncology clinics. Most women were older than 50 years and had a high school diploma or greater (57%). Women in the control group completed measures of decision preference before their clinic appointments. Women in the intervention group were encouraged to use the information and decision preference profiles generated by the computer program at their clinic appointments. Levels of involvement in decision making and satisfaction were measured after the clinic appointments. Results showed that although the majority of women in both groups did assume their preferred roles in decision making, a significantly higher proportion of women in the intervention group reported playing a more passive role than originally planned. Both groups reported high satisfaction levels. Future research is required to study how this computer intervention could be used by clinicians to provide information and decision support to these women. FAU - Davison, B Joyce AU - Davison BJ AD - Prostate Center at Vancouver General Hospital, British Columbia, Canada. jdavison@vanhosp.bc.ca FAU - Degner, Lesley F AU - Degner LF LA - eng PT - Clinical Trial PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PL - United States TA - Cancer Nurs JT - Cancer nursing JID - 7805358 SB - IM SB - N MH - Adaptation, Psychological MH - Breast Neoplasms/*psychology MH - *Communication MH - Computer-Assisted Instruction/*methods MH - Decision Making MH - Electronic Mail/*organization & administration MH - Feasibility Studies MH - Female MH - Humans MH - Internal-External Control MH - Manitoba MH - Middle Aged MH - Needs Assessment MH - Patient Education as Topic/*methods MH - Patient Participation MH - Patient Satisfaction MH - *Physician-Patient Relations MH - Surveys and Questionnaires MH - Telemedicine/*methods EDAT- 2002/12/05 04:00 MHDA- 2003/01/11 04:00 CRDT- 2002/12/05 04:00 AID - 00002820-200212000-00001 [pii] PST - ppublish SO - Cancer Nurs. 2002 Dec;25(6):417-24. PMID- 12460220 OWN - NLM STAT- MEDLINE DA - 20021203 DCOM- 20030317 LR - 20170219 IS - 1369-6513 (Print) IS - 1369-6513 (Linking) VI - 5 IP - 4 DP - 2002 Dec TI - "Well, have I got cancer or haven't I?" The psycho-social issues for women diagnosed with ductal carcinoma in situ. PG - 310-8 AB - OBJECTIVES: To explore women's experience of being diagnosed with ductal carcinoma in situ (DCIS) in relation to the following: response to the diagnosis; understanding about the diagnosis; satisfaction with information; satisfaction with the level of involvement in treatment decision-making and satisfaction with support services. DESIGN: An explorative descriptive qualitative design was used to facilitate an in-depth exploration of women's experiences. SETTING AND PARTICIPANTS: Five focus group interviews were conducted in New South Wales (NSW), Australia, involving 26 women diagnosed with DCIS. RESULTS: DCIS is a non-invasive breast disease, that in most cases will not recur if treated, and cannot of itself metastasize to other parts of the body. However, this study found that women were confused about whether or not they had cancer that could result in death. Women's confusion was compounded by the use of the term "carcinoma" and by the recommendation of treatments such as mastectomy. Women's confusion was not alleviated by appropriate information, with most women reporting dissatisfaction with the information they received specifically about DCIS. CONCLUSIONS: This study identifies that a diagnosis of DCIS has a significant psychological impact on women. The communication challenges highlighted in this study are not only relevant to DCIS but to any other disease in which the natural history is uncertain and the evidence about treatment effectiveness is still emerging. Further research is needed in areas such as DCIS to explore the difficulties experienced in doctor-patient communication and their impact on patient outcomes, and how to optimize doctor-patient communication. FAU - De Morgan, Simone AU - De Morgan S AD - NHMRC National Breast Cancer Centre, Sydney, Australia. simoned@nbcc.org.au FAU - Redman, Sally AU - Redman S FAU - White, Kate J AU - White KJ FAU - Cakir, Burcu AU - Cakir B FAU - Boyages, John AU - Boyages J LA - eng PT - Journal Article PL - England TA - Health Expect JT - Health expectations : an international journal of public participation in health care and health policy JID - 9815926 SB - IM MH - Adult MH - Aged MH - Australia MH - Breast Neoplasms/*diagnosis/psychology/therapy MH - Carcinoma, Intraductal, Noninfiltrating/*diagnosis/psychology/therapy MH - Decision Making MH - Female MH - Focus Groups MH - Health Services Research MH - Humans MH - Information Services MH - Middle Aged MH - National Health Programs MH - *Patient Education as Topic MH - *Patient Satisfaction MH - Physician-Patient Relations MH - *Social Support PMC - PMC5142722 EDAT- 2002/12/04 04:00 MHDA- 2003/03/18 04:00 CRDT- 2002/12/04 04:00 AID - 199 [pii] PST - ppublish SO - Health Expect. 2002 Dec;5(4):310-8. PMID- 12239750 OWN - NLM STAT- MEDLINE DA - 20020920 DCOM- 20021203 LR - 20091111 IS - 0009-4773 (Print) IS - 0009-4773 (Linking) VI - 54 IP - 4 DP - 2002 Jul-Aug TI - The oestrogen-progesterone receptor ratio: an indicator of breast cancer evolution. PG - 423-8 AB - Two groups of patients were chosen from among 4,025 subjects examined in a breast screening program, one consisting of patients with stage I and the other of patients with stage IV breast cancer, characterized by neoplastic recurrence. In this comparison p53, HER and grading are of no direct help. We investigated receptor status at the time of the first operation and after complete surgical excision of the recurrence. The following variables were determined: oestrogen and progesterone receptor measures (ER, PR) in f.mol/ml, the 4 receptor phenotypes, the oestrogen-progesterone ratio and histological tumour grading in relation to oestrogen receptor positivity or negativity. Surgery consisted in quadrantectomy or total mastectomy, with axillary dissection or complete surgical excision of the recurrence. Adjuvant therapy was administered. The results show a different receptor percentage in recurrence compared to early breast cancer, which though not significant, indicates a reduced presence of ER+ PR+, ER- PR-, and an increase in the ER+PR- phenotype. Recurrence occurs more frequently when the lesion at the first operation is more advanced and if radiotherapy has not been included in the treatment. Histological grading shows a greater number of undifferentiated cells and a reduction in ER+ in recurrence, thus indicating a reduced target for the most widely used hormone treatments. The oestrogen-progesterone ratio is significantly increased (P < 0.01) in recurrence compared to stage I cancers. The cause of recurrence is a neoplastic embolism, often documented histologically. Recurrence does not necessarily mean a poor prognosis, because there is a survival rate after two years of 77% of the cases treated. These results obtained with widely used methods show the aggressiveness of some breast tumours, which can evolve and have a very poor prognosis even with the most complete therapy. FAU - Cherubini, Mariano AU - Cherubini M AD - Unita Operativa di Clinica Chirurgica, Dipartimento di Scienze Chirurgiche Generali, Anestesiologiche e Medicina Intensiva, Universita degli Studi di Trieste. FAU - Baxa, Pietro AU - Baxa P FAU - Guarino, Gerardo AU - Guarino G LA - eng PT - Comparative Study PT - Journal Article PL - Italy TA - Chir Ital JT - Chirurgia italiana JID - 0151753 RN - 0 (Receptors, Estrogen) RN - 0 (Receptors, Progesterone) SB - IM MH - Breast Neoplasms/*chemistry/mortality/radiotherapy/*surgery MH - Data Interpretation, Statistical MH - Female MH - Humans MH - Lymph Node Excision MH - Mastectomy MH - Mastectomy, Segmental MH - Neoplasm Recurrence, Local/surgery MH - Phenotype MH - Prognosis MH - Receptors, Estrogen/*analysis/genetics MH - Receptors, Progesterone/*analysis/genetics MH - Survival Analysis EDAT- 2002/09/21 10:00 MHDA- 2002/12/04 04:00 CRDT- 2002/09/21 10:00 PST - ppublish SO - Chir Ital. 2002 Jul-Aug;54(4):423-8. PMID- 12216083 OWN - NLM STAT- MEDLINE DA - 20020906 DCOM- 20020927 LR - 20071114 IS - 0008-543X (Print) IS - 0008-543X (Linking) VI - 95 IP - 6 DP - 2002 Sep 15 TI - Factors that influence surgical choices in women with breast carcinoma. PG - 1185-90 AB - BACKGROUND: In the absence of medical contraindications, survival after undergoing breast-conserving therapy (BCT), mastectomy (M), and mastectomy with immediate reconstruction (MIR) is equal. The authors studied demographic factors to identify the variables that differed significantly among women making different surgical choices. METHODS: Women with ductal carcinoma in situ or clinical Stage I or II breast carcinoma with no contraindications for BCT or MIR who were treated between 1995 and 1998 were identified from a prospectively collected data base. Demographic and tumor factors were compared using the Fisher exact test. RESULTS: There were 578 women with 586 tumors who did not have contraindications for BCT or MIR. Among this group, 85.2% of women chose BCT, 9.2% of women chose M, and 5.6% of women chose MIR. Women undergoing M alone were older and were more likely to have Stage II carcinoma compared with women undergoing BCT. Patients undergoing M or MIR were more likely to have had a prior breast biopsy compared with patients who chose BCT. Marital status and employment approached significance (P = 0.06); however, a family history of breast carcinoma was not a predictor of treatment choice. CONCLUSIONS: The current findings suggest a need for patient education strategies that emphasize the lack of influence of age and prior breast biopsy on the use of BCT. Differences in demographic variables may reflect true variations in patient preference among groups, emphasizing the need to address the spectrum of treatment options with patients. CI - Copyright 2002 American Cancer Society. FAU - Staradub, Valerie L AU - Staradub VL AD - Division of Surgical Oncology, Department of Surgery, Northwestern University Medical School, Chicago, Illinois, USA. vstaradu@nmff.org FAU - Hsieh, Yi-Ching AU - Hsieh YC FAU - Clauson, Jennifer AU - Clauson J FAU - Langerman, Alexander AU - Langerman A FAU - Rademaker, Alfred W AU - Rademaker AW FAU - Morrow, Monica AU - Morrow M LA - eng GR - P50CA89018/CA/NCI NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. PL - United States TA - Cancer JT - Cancer JID - 0374236 SB - AIM SB - IM MH - Age Factors MH - Breast Neoplasms/*surgery MH - Carcinoma, Ductal, Breast/surgery MH - *Choice Behavior MH - Employment MH - Female MH - Humans MH - Marital Status MH - Mastectomy/*psychology MH - Mastectomy, Segmental/psychology MH - Middle Aged MH - Prospective Studies MH - Women/*psychology EDAT- 2002/09/07 10:00 MHDA- 2002/09/28 04:00 CRDT- 2002/09/07 10:00 AID - 10.1002/cncr.10824 [doi] PST - ppublish SO - Cancer. 2002 Sep 15;95(6):1185-90. PMID- 12039934 OWN - NLM STAT- MEDLINE DA - 20020531 DCOM- 20020620 LR - 20161102 IS - 0732-183X (Print) IS - 0732-183X (Linking) VI - 20 IP - 11 DP - 2002 Jun 01 TI - Decision-analytic model and cost-effectiveness evaluation of postmastectomy radiation therapy in high-risk premenopausal breast cancer patients. PG - 2713-25 AB - PURPOSE: To present a decision model that describes the clinical and economic outcomes of node-positive breast cancer with and without postmastectomy radiation therapy (PMRT). METHODS: A Markov process was constructed to project the natural history of breast cancer following mastectomy in premenopausal node-positive women. Biannual hazards of local and distant recurrence without PMRT were derived from a large meta-analysis of adjuvant systemic therapy trials for breast cancer. The addition of PMRT reduced the risk of disease relapse by an odds ratio of 0.69. Costs of PMRT ($11,600) and recurrent breast cancer ($4,250 to 16,200/year) were estimated from available literature. The model projected number of recurrences, relapse-free and overall survival, and costs to 15 years, using a discount rate of 3%. Cost-effectiveness ratios were calculated per incremental year of life and quality-adjusted year of life gained. One- and two-way sensitivity analyses were performed to determine the sensitivity of results to clinical and economic assumptions. RESULTS: The model projected 15-year relapse-free survival of 52% and 43% with and without PMRT, respectively. Overall survival was increased from 48% to 55% with PMRT, resulting in an incremental 0.29 years of life gained per subject. PMRT increased 15-year costs from $40,800 to $48,100. Cost per year of life gained was $24,900, or $22,600 when survival was adjusted for quality of life. Results of the model were relatively sensitive to radiation therapy cost and breast cancer relapse risk. CONCLUSION: This analysis suggests that PMRT offers substantial clinical benefits achieved in a cost-effective manner, with an average cost per year of life gained of $24,900. Results of the model were robust under a wide range of clinical and economic parameters. FAU - Lee, Jason H AU - Lee JH AD - Department of Radiation Oncology, Division of General Internal Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA. jasonlee@massmed.org FAU - Glick, Henry A AU - Glick HA FAU - Hayman, James A AU - Hayman JA FAU - Solin, Lawrence J AU - Solin LJ LA - eng PT - Journal Article PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 SB - IM MH - Aftercare/*economics MH - Breast Neoplasms/*economics/mortality/pathology/*radiotherapy/surgery MH - Cost-Benefit Analysis MH - *Decision Support Techniques MH - Disease-Free Survival MH - Female MH - Humans MH - Lymphatic Metastasis MH - Markov Chains MH - Mastectomy MH - Middle Aged MH - *Models, Econometric MH - Premenopause MH - Quality-Adjusted Life Years MH - Radiotherapy, Adjuvant/economics MH - Reproducibility of Results MH - Sensitivity and Specificity MH - Survival Rate MH - *Value of Life EDAT- 2002/06/01 10:00 MHDA- 2002/06/21 10:01 CRDT- 2002/06/01 10:00 AID - 10.1200/JCO.2002.07.008 [doi] PST - ppublish SO - J Clin Oncol. 2002 Jun 1;20(11):2713-25. PMID- 12011131 OWN - NLM STAT- MEDLINE DA - 20020515 DCOM- 20020605 LR - 20161102 IS - 0732-183X (Print) IS - 0732-183X (Linking) VI - 20 IP - 10 DP - 2002 May 15 TI - Effect of prevention strategies on survival and quality-adjusted survival of women with BRCA1/2 mutations: an updated decision analysis. PG - 2520-9 AB - PURPOSE: This study updates findings regarding the effects of prophylactic surgery, chemoprevention, and surveillance on the survival and quality-adjusted survival of women who test positive for BRCA1/2 mutations. MATERIALS AND METHODS: Markov modeling of outcomes was performed in a simulated cohort of 30-year-old women who tested positive for BRCA1/2 mutations. The model incorporated breast and ovarian cancer incidence rates from the literature and mortality rates from the Surveillance, Epidemiology, and End Results Program. Quality adjustment of survival estimates were obtained from a survey of women aged 33 to 50 years. Sensitivity analyses were performed of varied assumptions regarding timing and effects of preventive measures on cancer incidence and adverse effects. RESULTS: A 30-year-old woman could prolong her survival beyond that associated with surveillance alone by use of preventive measures: 1.8 years with tamoxifen, 2.6 years with prophylactic oophorectomy, 4.6 years with both tamoxifen and prophylactic oophorectomy, 3.5 years with prophylactic mastectomy, and 4.9 years with both surgeries. She could prolong her quality-adjusted survival by 2.8 years with tamoxifen, 4.4 years with prophylactic oophorectomy, 6.3 years with tamoxifen and oophorectomy, and 2.6 years with mastectomy, or with both surgeries. The benefits of all of these strategies would decrease if they were initiated at later ages. CONCLUSION: Women who test positive for BRCA1/2 mutations may derive greater survival and quality adjusted survival benefits than previously reported from chemoprevention, prophylactic surgery, or a combination. Observational studies and clinical trials are needed to verify the results of this analysis of the long-term benefits of preventive strategies among BRCA1/2-positive women. FAU - Grann, Victor R AU - Grann VR AD - Herbert Irving Comprehensive Cancer Center, Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 W 168th Street, New York, NY 10032, USA. FAU - Jacobson, Judith S AU - Jacobson JS FAU - Thomason, Dustin AU - Thomason D FAU - Hershman, Dawn AU - Hershman D FAU - Heitjan, Daniel F AU - Heitjan DF FAU - Neugut, Alfred I AU - Neugut AI LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 RN - 0 (Anticarcinogenic Agents) RN - 0 (BRCA1 Protein) RN - 0 (BRCA2 Protein) RN - 094ZI81Y45 (Tamoxifen) SB - IM MH - Adult MH - Age Factors MH - Aged MH - Aged, 80 and over MH - Anticarcinogenic Agents/*therapeutic use MH - BRCA1 Protein/*genetics MH - BRCA2 Protein/*genetics MH - Breast Neoplasms/genetics/*prevention & control/therapy MH - Combined Modality Therapy MH - Disease-Free Survival MH - Female MH - Humans MH - Markov Chains MH - Mastectomy MH - Middle Aged MH - Mutation MH - Ovarian Neoplasms/genetics/*prevention & control/therapy MH - Ovariectomy MH - Probability MH - Quality of Life MH - Quality-Adjusted Life Years MH - Risk Factors MH - Tamoxifen/*therapeutic use EDAT- 2002/05/16 10:00 MHDA- 2002/06/06 10:01 CRDT- 2002/05/16 10:00 AID - 10.1200/JCO.2002.10.101 [doi] PST - ppublish SO - J Clin Oncol. 2002 May 15;20(10):2520-9. PMID- 11956270 OWN - NLM STAT- MEDLINE DA - 20020416 DCOM- 20020430 LR - 20161102 IS - 0732-183X (Print) IS - 0732-183X (Linking) VI - 20 IP - 8 DP - 2002 Apr 15 TI - Decision analysis of prophylactic surgery or screening for BRCA1 mutation carriers: a more prominent role for oophorectomy. PG - 2092-100 AB - PURPOSE: BRCA1 mutation carriers have a high risk of developing breast and ovarian cancer. Carriers may opt for prophylactic surgery and screening. Recent data suggesting that prophylactic oophorectomy reduces breast cancer risk have been incorporated in a decision analysis. METHODS: A Markov model was developed to compare LE and QALE following four strategies: (1) prophylactic mastectomy and prophylactic oophorectomy (PMPO), (2) screening for breast cancer and prophylactic oophorectomy (BSPO), (3) prophylactic mastectomy and screening for ovarian cancer (PMOS), and (4) screening for breast and ovarian cancer (BSOS). The analysis was performed for a high (85% breast cancer, 63% ovarian cancer) and medium (56% breast cancer, 16% ovarian cancer) risk level. Utilities for the health states after prophylactic surgery were obtained from mutation carriers. Other model parameter values were obtained from the literature. Sensitivity analyses were performed. RESULTS: When compared with BSOS, the average gain in LE for 30-year-old carriers in the high (medium) risk group was 11.7 (6.6) years for PMPO, 9.5 (5.3) years for BSPO, and 4.9 (4.4) years for PMOS. For 30-year-old carriers, BSPO had a QALE advantage when PO was performed before age 40. In the medium-risk group, there was a stronger advantage for BSPO when QALE was considered. CONCLUSION: PMPO is the most effective strategy to prolong life. However, if patient preferences were taken into account, BSPO tends to be a better strategy in most women at medium risk or in young women at high risk when PO was performed before age 40. FAU - van Roosmalen, Marielle S AU - van Roosmalen MS AD - Joint Center for Radiation Oncology Arnhem-Nijmegen (RADIAN), University Medical Center Nijmegen, The Netherlands. m.vanroosmalen@rther.azn.nl FAU - Verhoef, Lia C G AU - Verhoef LC FAU - Stalmeier, Peep F M AU - Stalmeier PF FAU - Hoogerbrugge, Nicoline AU - Hoogerbrugge N FAU - van Daal, Willem A J AU - van Daal WA LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 SB - IM MH - Adult MH - Breast Neoplasms/*genetics/*prevention & control MH - *Decision Support Techniques MH - Female MH - *Genes, BRCA1 MH - Genes, BRCA2 MH - Genetic Testing MH - Humans MH - Markov Chains MH - *Mastectomy MH - Mutation MH - Ovarian Neoplasms/*genetics/*prevention & control MH - *Ovariectomy MH - Quality-Adjusted Life Years EDAT- 2002/04/17 10:00 MHDA- 2002/05/01 10:01 CRDT- 2002/04/17 10:00 AID - 10.1200/jco.2002.08.035 [doi] PST - ppublish SO - J Clin Oncol. 2002 Apr 15;20(8):2092-100. PMID- 11920455 OWN - NLM STAT- MEDLINE DA - 20020328 DCOM- 20020415 LR - 20151119 IS - 0008-543X (Print) IS - 0008-543X (Linking) VI - 94 IP - 4 DP - 2002 Feb 15 TI - Results of the Lynn Sage Second-Opinion Program for local therapy in patients with breast carcinoma. Changes in management and determinants of where care is delivered. PG - 889-94 AB - BACKGROUND: The treatment options of breast conservation therapy (BCT) and immediate reconstruction for patients with carcinoma of the breast have not been adopted widely. The objectives of this study were to determine how often a second opinion on the local therapy of breast carcinoma changed patient management and to identify factors predictive of remaining at the second-opinion site for therapy. METHODS: Two hundred thirty-one patients with intraductal carcinoma or Stage I and II breast carcinoma were reviewed retrospectively. At the time of the second opinion, patients completed a questionnaire regarding their initial surgical opinion and the reason for seeking consultation. RESULTS: Only 46% of patients had a complete discussion of treatment options prior to the second opinion. The second opinion changed management in 54 patients (20.3%). The most common finding was eligibility for BCT in patients who were offered only mastectomy. Definitive local therapy occurred at the second-opinion site in 65.8% of patients. The only predictors of remaining at the second-opinion site were insurance type (P = 0.008) and the patient's perception that options were not discussed at the initial opinion (P < 0.001). CONCLUSIONS: Second opinions provide useful information to patients and may change the management of their disease. They result in significant patient capture for an institution. CI - Copyright 2002 American Cancer Society.DOI 10.1002/cncr.10318 FAU - Clauson, Jennifer AU - Clauson J AD - Lynn Sage Breast Program, Northwestern University, Chicago, Illinois, USA. FAU - Hsieh, Y C AU - Hsieh YC FAU - Acharya, Simbi AU - Acharya S FAU - Rademaker, Alfred W AU - Rademaker AW FAU - Morrow, Monica AU - Morrow M LA - eng GR - P50-CA89018/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. PL - United States TA - Cancer JT - Cancer JID - 0374236 SB - AIM SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/*therapy MH - Carcinoma, Intraductal, Noninfiltrating/*therapy MH - *Decision Making MH - Female MH - Humans MH - Middle Aged MH - *Patient Care Planning MH - Patient Education as Topic MH - *Referral and Consultation MH - Retrospective Studies EDAT- 2002/03/29 10:00 MHDA- 2002/04/16 10:01 CRDT- 2002/03/29 10:00 AID - 10.1002/cncr.10318 [pii] PST - ppublish SO - Cancer. 2002 Feb 15;94(4):889-94. PMID- 11904473 OWN - NLM STAT- MEDLINE DA - 20020320 DCOM- 20020529 LR - 20131121 IS - 1018-8843 (Print) IS - 1018-8843 (Linking) VI - 41 IP - 3 DP - 2001 TI - [Chemotherapy-associated myelosuppression in gynecological oncology]. PG - 166-73 AB - INTRODUCTION AND OBJECTIVE: A clinically important myelosuppression due to adjuvant chemotherapy is seen more frequently as dosage is intensified and new drugs are used. The assessment of the cytopenia expected is frequently hampered by a lack of directly comparable data. The aim of this study was to compare - in our own patient population - the chemotherapy-associated myelosuppression of four chemotherapeutic regimens used in gynecological oncology. METHODS: 79 patients with primary breast cancer and 26 patients with epithelial ovarian carcinoma underwent cytostatic treatment, and the associated myelosuppression was evaluated by the determination of cytopenia and the need for supportive therapy. The chemotherapy regimens investigated were CMF (cyclophosphamide 600 mg/m(2), methotrexate 40 mg/m(2), 5-fluorouracil 600 mg/m(2), 6xq3w), EC/CMF (epirubicin 90 mg/m(2), cyclophosphamide 600 mg/m(2), 4xq3w, followed by CMF, 3xq3w), DE (docetaxel 75 mg/m(2), epirubicin 90 mg/m(2), 6xq3w) and CC (cyclophosphamide 600 mg/m(2), carboplatin AUC 6, 6xq3w). RESULTS: The EC/CMF and DE regimens were used significantly more frequently for more advanced tumor stages, but there were no differences concerning tumor-dependent prechemotherapeutic myelosuppression. Hemopoiesis was most impaired in the CC group with a mean drop of serum hemoglobin of 1.5 g/dl to the end of the cytostatic treatment; correspondingly, most transfusions of concentrated erythrocytes were needed in this group. The strongest suppression of leukopoiesis was found in the DE group, with a mean drop in leukocyte counts of 6.2 x 10(3)/microliter per cycle; in this group, a mean of 7.6 ready-made syringes with 263 microgram Lenogastrim was used to stimulate leukopoiesis. The severest drop in the mean thrombocyte count, i.e. 171.7 x 10(3)/microliter, was found in the CC group. CONCLUSIONS: The CC regimen impairs thrombo- and erythropoiesis most, whereas the DE regimen causes marked leukopenia. The regimen with the smallest myelosuppression was CMF. No severe cytopenia-associated complications were detected in any of the cases investigated. FAU - Janni, W AU - Janni W AD - 1. Frauenklinik, Klinikum der Ludwig-Maximilians-Universitat, Munchen, Deutschland. janni@fk-i.med.uni-muenchen.de FAU - Rjosk, D AU - Rjosk D FAU - Strobl, B AU - Strobl B FAU - Bergauer, F AU - Bergauer F FAU - Linka, F AU - Linka F FAU - Dimpfl, T AU - Dimpfl T FAU - Schindlbeck, C AU - Schindlbeck C FAU - Rack, B AU - Rack B FAU - Kaestner, R AU - Kaestner R FAU - Sommer, H AU - Sommer H LA - ger PT - Comparative Study PT - English Abstract PT - Journal Article PT - Research Support, Non-U.S. Gov't TT - Chemotherapieassoziierte Myelosuppression in der gynakologischen Onkologie. PL - Switzerland TA - Gynakol Geburtshilfliche Rundsch JT - Gynakologisch-geburtshilfliche Rundschau JID - 9212667 RN - 0 (Cobalt Radioisotopes) RN - 6PLQ3CP4P3 (Etoposide) RN - 8N3DW7272P (Cyclophosphamide) RN - Q20Q21Q62J (Cisplatin) RN - U3P01618RT (Fluorouracil) RN - YL5FZ2Y5U1 (Methotrexate) RN - CMF regimen RN - CP protocol RN - EC regimen RN - VP-P protocol SB - IM MH - Adult MH - Aged MH - Antineoplastic Combined Chemotherapy Protocols/*adverse effects MH - Bone Marrow/*drug effects MH - Breast Neoplasms/*drug therapy/radiotherapy/surgery MH - Chemotherapy, Adjuvant MH - Cisplatin/*adverse effects MH - Cobalt Radioisotopes/therapeutic use MH - Combined Modality Therapy MH - Cyclophosphamide/*adverse effects MH - Data Interpretation, Statistical MH - Etoposide/*adverse effects MH - Female MH - Fluorouracil/*adverse effects MH - Hematopoiesis/drug effects MH - Humans MH - Leukopoiesis/drug effects MH - Lymph Node Excision MH - Lymphatic Metastasis MH - Mastectomy, Segmental MH - Methotrexate/*adverse effects MH - Middle Aged MH - Ovarian Neoplasms/*drug therapy/surgery MH - Platelet Count MH - Radioisotope Teletherapy MH - Radiotherapy Dosage EDAT- 2002/03/21 10:00 MHDA- 2002/05/30 10:01 CRDT- 2002/03/21 10:00 AID - 49471 [pii] AID - 49471 [doi] PST - ppublish SO - Gynakol Geburtshilfliche Rundsch. 2001;41(3):166-73. PMID- 11803105 OWN - NLM STAT- MEDLINE DA - 20020122 DCOM- 20020606 LR - 20151119 IS - 0301-2115 (Print) IS - 0301-2115 (Linking) VI - 101 IP - 1 DP - 2002 Feb 10 TI - Breast feeding after reduction mammaplasty performed during adolescence. PG - 79-82 AB - UNLABELLED: Reduction mammaplasty (RM) can be performed during adolescence if the functional capacity of the breast is preserved. Future breast feeding must be carefully considered in the therapeutic decision making process. PURPOSE OF THE STUDY: Breast feeding after reduction mammaplasty performed during adolescence was assessed to determine surgical factors influencing outcome and patient reception of information concerning breast feeding. METHODS: A questionnaire was sent to 109 women who had undergone reduction mammaplasty between 1981 and 1997 when they were 15-17 years old to ascertain their reasons for having surgery, their satisfaction, and their attitude towards breast feeding. RESULTS: Sixty-five questionnaires (60%) could be analyzed. Mean delay since surgery was 8.1 years. Seventeen women (26%) had delivered 25 infants (mean 1.5). Mean delay after surgery to first delivery was 7.68 years. Five women (29%) nursed their first infant for a mean 11.3 days. None of the women interrupted breast feeding for a reason related to a nipple anomaly or difficult sucking. Twelve women (71%) did not nurse their first infant, because of the prior breast surgery for six of them. Among the 48 nulliparous women, 24 (50%) stated they would nurse their future infant. Although information on breast feeding was systematically delivered, 41 women (63%) stated they had not been informed. There was no statistical relationship between breast feeding and degree of satisfaction, patient-assessed scar quality, or nipple disorders. CONCLUSION: Adolescents who undergo reduction mammaplasty can nurse their future infants with a complication rate similar to that in the general population. Special attention must be given to delivery of information on breast feeding. FAU - Aillet, S AU - Aillet S AD - Service de Chirurgie Plastique, Reconstructrice et Esthetique, Hopital Sud, Universite de Rennes, 35056 Rennes Cedex, France. FAU - Watier, E AU - Watier E FAU - Chevrier, S AU - Chevrier S FAU - Pailheret, J-P AU - Pailheret JP FAU - Grall, J-Y AU - Grall JY LA - eng PT - Journal Article PL - Ireland TA - Eur J Obstet Gynecol Reprod Biol JT - European journal of obstetrics, gynecology, and reproductive biology JID - 0375672 SB - IM MH - Adult MH - *Breast Feeding MH - Female MH - Humans MH - *Mammaplasty MH - Patient Education as Topic MH - Patient Satisfaction MH - Surveys and Questionnaires EDAT- 2002/01/23 10:00 MHDA- 2002/06/12 10:01 CRDT- 2002/01/23 10:00 AID - S0301211501005176 [pii] PST - ppublish SO - Eur J Obstet Gynecol Reprod Biol. 2002 Feb 10;101(1):79-82. PMID- 11794205 OWN - NLM STAT- MEDLINE DA - 20011105 DCOM- 20020116 LR - 20041117 IS - 0028-4793 (Print) IS - 0028-4793 (Linking) VI - 345 IP - 20 DP - 2001 Nov 15 TI - Prophylactic mastectomy in carriers of BRCA mutations. PG - 1499; author reply 1499-500 FAU - Riggs, T AU - Riggs T LA - eng PT - Letter PL - United States TA - N Engl J Med JT - The New England journal of medicine JID - 0255562 SB - AIM SB - IM MH - Breast Neoplasms/genetics/*prevention & control MH - Data Interpretation, Statistical MH - Female MH - Genes, BRCA1 MH - Genes, BRCA2 MH - Humans MH - *Mastectomy MH - Mutation MH - Risk MH - Sensitivity and Specificity EDAT- 2002/01/17 10:00 MHDA- 2002/01/17 10:01 CRDT- 2002/01/17 10:00 PST - ppublish SO - N Engl J Med. 2001 Nov 15;345(20):1499; author reply 1499-500. PMID- 11773308 OWN - NLM STAT- MEDLINE DA - 20020104 DCOM- 20020626 LR - 20071115 IS - 1052-6773 (Print) IS - 1052-6773 (Linking) IP - 30 DP - 2001 TI - Decision-making process--communicating risk/benefits: is there an ideal technique? PG - 143-5 FAU - Levine, M AU - Levine M AD - Cancer Care Ontario-Hamilton Regional Cancer Centre, Department of Medicine, McMaster University, 1200 Main St. W., Hamilton, Ontario L8N 3Z5, Canada. mlevine@mcmaster.ca FAU - Whelan, T AU - Whelan T LA - eng PT - Journal Article PT - Review PL - United States TA - J Natl Cancer Inst Monogr JT - Journal of the National Cancer Institute. Monographs JID - 9011255 SB - IM MH - Breast Neoplasms/*psychology/radiotherapy/surgery/*therapy MH - Chemotherapy, Adjuvant/psychology MH - Decision Making MH - Humans MH - Mastectomy/psychology MH - Mastectomy, Segmental/psychology MH - Patient Education as Topic/*methods MH - Risk Assessment/methods RF - 15 EDAT- 2002/01/05 10:00 MHDA- 2002/06/27 10:01 CRDT- 2002/01/05 10:00 PST - ppublish SO - J Natl Cancer Inst Monogr. 2001;(30):143-5. PMID- 11721686 OWN - NLM STAT- MEDLINE DA - 20011126 DCOM- 20020104 LR - 20071115 IS - 1521-2076 (Electronic) IS - 1521-2076 (Linking) VI - 6 IP - 5 DP - 2001 Oct TI - Presenting all the choices: teaching women about breast prosthetics. PG - 4 AB - It is imperative that women facing breast cancer surgery have all their options for regaining body symmetry presented to them in a nonbiased manner. Today, women are more likely to receive information about breast reconstruction than about external breast prostheses. This may largely be due to the wealth of information available about reconstruction and the comfort level of the medical community in recommending this procedure. Breast prosthetic science is not taught in medical or nursing education programs, and few articles exist on the subject. FAU - Kiefer, C G AU - Kiefer CG AD - Academy of Certified Case Managers. LA - eng PT - Journal Article PL - United States TA - Medscape Womens Health JT - Medscape women's health JID - 100844142 SB - K MH - Body Image MH - Breast Implantation MH - Breast Neoplasms/psychology/*surgery MH - Clothing MH - Communication MH - Decision Making MH - Esthetics MH - Female MH - Humans MH - *Mammaplasty MH - Mastectomy/*psychology MH - *Patient Education as Topic MH - Patient Participation MH - Physician-Patient Relations MH - Prostheses and Implants/*trends MH - Prosthesis Design MH - Prosthesis Fitting EDAT- 2001/11/28 10:00 MHDA- 2002/01/10 10:01 CRDT- 2001/11/28 10:00 PST - ppublish SO - Medscape Womens Health. 2001 Oct;6(5):4. PMID- 11679382 OWN - NLM STAT- MEDLINE DA - 20011026 DCOM- 20011204 LR - 20081120 IS - 0959-8138 (Print) IS - 0959-535X (Linking) VI - 323 IP - 7319 DP - 2001 Oct 27 TI - Row over breast cancer screening shows that scientists bring "some subjectivity into their work. PG - 956 FAU - Mayor, S AU - Mayor S LA - eng PT - News PL - England TA - BMJ JT - BMJ (Clinical research ed.) JID - 8900488 SB - AIM SB - IM MH - Breast Neoplasms/*diagnosis/surgery MH - *Data Interpretation, Statistical MH - Female MH - Humans MH - Mammography MH - Mass Screening/*statistics & numerical data MH - Mastectomy/statistics & numerical data MH - *Meta-Analysis as Topic MH - Randomized Controlled Trials as Topic PMC - PMC1121506 OID - NLM: PMC1121506 EDAT- 2001/10/27 10:00 MHDA- 2002/01/05 10:01 CRDT- 2001/10/27 10:00 PST - ppublish SO - BMJ. 2001 Oct 27;323(7319):956. PMID- 11567173 OWN - NLM STAT- MEDLINE DA - 20010921 DCOM- 20011018 LR - 20151119 IS - 0025-7079 (Print) IS - 0025-7079 (Linking) VI - 39 IP - 10 DP - 2001 Oct TI - Identifying a cohort of patients with early-stage breast cancer: a comparison of hospital discharge and primary data. PG - 1105-17 AB - BACKGROUND: Hospital discharge data are a potential source of information for quality of care; however, they lack detailed clinical data. OBJECTIVES: To assess the usefulness of hospital discharge data for describing patterns of care. RESEARCH DESIGN: Cohort study comparing hospital discharge data with data collected from medical records and patients. PATIENTS: Women diagnosed with early-stage breast cancer in Massachusetts and Minnesota (1993-1995). MEASURES: The percentage of patients in the primary data set who did not match a record in the discharge data set, and the percentage of patients in the discharge data set who did not match a record in the primary data set. Odds ratios for appearing in one data set, but not the other according to patient and hospital characteristics. RESULTS: For patients in the primary data set, 26.9% from Massachusetts and 13.2% from Minnesota did not match a record in the discharge data set. In both states, factors associated with failure to match to the discharge data included receipt of breast conserving surgery, shorter length of stay, and treatment hospital. For patients in the discharge data set, 43.4% in Massachusetts and 30.3% in Minnesota did not match a patient in the primary data set. In both states, factors associated with failure to match to the primary data included treatment hospital and the presence of positive lymph nodes. CONCLUSIONS: Hospital discharge data were fairly sensitive when linked to patients with early-stage breast cancer who were identified through hospital records. The discharge data lacked specificity, however. If discharge data are used to characterize patterns care for inpatients with early stage disease, estimates are likely to be inaccurate due to the inclusion of unsuitable patients in the denominator used to calculate procedure rates. FAU - Jonkman, J N AU - Jonkman JN AD - Department of Mathematics and Statistics, Mississippi State University, Mississippi State, MS, USA. FAU - Normand, S L AU - Normand SL FAU - Wolf, R AU - Wolf R FAU - Borbas, C AU - Borbas C FAU - Guadagnoli, E AU - Guadagnoli E LA - eng GR - R01 CA75545/CA/NCI NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, U.S. Gov't, P.H.S. PL - United States TA - Med Care JT - Medical care JID - 0230027 SB - IM MH - Adult MH - Aged MH - Breast Neoplasms/pathology/*surgery MH - Cohort Studies MH - Data Interpretation, Statistical MH - Female MH - Humans MH - Logistic Models MH - Massachusetts/epidemiology MH - Mastectomy, Segmental/*utilization MH - *Medical Record Linkage MH - Middle Aged MH - Minnesota/epidemiology MH - Neoplasm Staging MH - *Patient Discharge MH - Practice Patterns, Physicians'/*statistics & numerical data MH - *Primary Health Care MH - Utilization Review/methods/statistics & numerical data EDAT- 2001/09/22 10:00 MHDA- 2001/10/19 10:01 CRDT- 2001/09/22 10:00 PST - ppublish SO - Med Care. 2001 Oct;39(10):1105-17. PMID- 11555031 OWN - NLM STAT- MEDLINE DA - 20010913 DCOM- 20011101 LR - 20071115 IS - 0309-2402 (Print) IS - 0309-2402 (Linking) VI - 35 IP - 6 DP - 2001 Sep TI - Factors influencing women's decisions for choice of surgery for Stage I and Stage II breast cancer in Western Australia. PG - 836-47 AB - BACKGROUND: Internal and external factors have been reported to influence decision-making by women for breast cancer surgery. AIM OF THE STUDY: The aim of the study was to describe the factors those women with Stage I or Stage II breast cancer, perceived to be important when selecting either modified radical mastectomy or breast conserving treatment. DESIGN/METHOD: A descriptive correlational study was conducted. A consecutive sample of women with a diagnosis of breast cancer during a 6-month period was selected from the Health Department of Western Australia Cancer Registry. RESULTS: Women who had breast conserving treatment rated the surgeon's preference as a more important factor in decision-making than women who had modified radical mastectomy. The lack of difference in long-term survival between the types of surgery was also a more important influence on decision-making for the breast conserving treatment group compared with women who had received modified radical mastectomy. Women in rural areas tended to choose modified radical mastectomy rather than breast conserving treatment. The surgeon, family and general practitioner were important sources of information. A significant association was found between women's involvement in decision-making and their use of a general practitioner as an information source. Many women wanted the decision about surgery to be entirely their own; the breast conserving treatment group preferred a more active role in decision-making compared with those who chose modified radical mastectomy. Most women had participated in the decision-making process as much as they wished, had enough time in which to make their decisions and had received sufficient information. A correlation between adequacy of information and sufficient time for decision-making was found. CONCLUSION: Findings may be useful to nurses and other health professionals who endeavour to provide adequate information and support to women during their initial treatment decision-making experience. FAU - Mastaglia, B AU - Mastaglia B AD - School of Nursing and Public Health, Edith Cowan University, Churchlands, Western Australia, Australia. B.Mastaglia@ecu.edu.au FAU - Kristjanson, L J AU - Kristjanson LJ LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - J Adv Nurs JT - Journal of advanced nursing JID - 7609811 SB - IM SB - N MH - Adult MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/nursing/*pathology/*surgery MH - *Decision Making MH - Female MH - Humans MH - Life Change Events MH - *Mastectomy, Modified Radical MH - *Mastectomy, Segmental MH - Middle Aged MH - Neoplasm Staging MH - Nursing Research MH - Patient Education as Topic MH - Professional-Patient Relations MH - Western Australia EDAT- 2001/09/14 10:00 MHDA- 2001/11/03 10:01 CRDT- 2001/09/14 10:00 AID - jan1921 [pii] PST - ppublish SO - J Adv Nurs. 2001 Sep;35(6):836-47. PMID- 11523293 OWN - NLM STAT- MEDLINE DA - 20010828 DCOM- 20010920 LR - 20170214 IS - 1077-5587 (Print) IS - 1077-5587 (Linking) VI - 58 IP - 3 DP - 2001 Sep TI - Medicare fees and small area variations in breast-conserving surgery among elderly women. PG - 334-60 AB - This study used data from Medicare files, the American Hospital Association's Annual Survey of Hospitals, and the 1990 census to investigate whether Medicare fees for breast-conserving surgery (BCS) and mastectomy (MST) affected the rate of BCS across 799 3-digit ZIP code areas in 1994. The full model, which was based on the conceptual framework of the supply of and demand for different treatments, explained 51 percent of the variation in BCS rates. Medicare fees were statistically significant and had the hypothesized effects: a 10 percent higher BCS fee was associated with a 7 to 10 percent higher BCS rate, while a 10 percent higher MST fee was associated with a 2 to 3 percent lower proportion receiving BCS. Other significant economic variables were proximity to a radiation therapy hospital, a teaching hospital or a cancer center, and the percentage of elderly women with incomes below the poverty rate, which were negatively related to the BCS rate. Variations in age, race, and metropolitan populations had small or insignificant effects. The single most important was the percentage of cases with one or more comorbidities. FAU - Hadley, J AU - Hadley J AD - Georgetown University, USA. FAU - Mitchell, J M AU - Mitchell JM FAU - Mandelblatt, J AU - Mandelblatt J LA - eng GR - HS08395/HS/AHRQ HHS/United States PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. PT - Research Support, U.S. Gov't, P.H.S. PL - United States TA - Med Care Res Rev JT - Medical care research and review : MCRR JID - 9506850 SB - IM MH - Aged MH - Breast Neoplasms/*surgery MH - Data Interpretation, Statistical MH - Female MH - Humans MH - Mastectomy/*economics/*utilization MH - Mastectomy, Segmental/*economics/*utilization MH - Medicare/*economics MH - Small-Area Analysis MH - United States EDAT- 2001/08/29 10:00 MHDA- 2001/09/21 10:01 CRDT- 2001/08/29 10:00 AID - 10.1177/107755870105800303 [doi] PST - ppublish SO - Med Care Res Rev. 2001 Sep;58(3):334-60. PMID- 11471952 OWN - NLM STAT- MEDLINE DA - 20010726 DCOM- 20011207 LR - 20071115 IS - 0094-1298 (Print) IS - 0094-1298 (Linking) VI - 28 IP - 3 DP - 2001 Jul TI - A surgical perspective from two decades of breast augmentation: toward state of the art in 2001. PG - 425-34, v AB - This article summarizes the author's perspective of two decades of breast augmentation based on clinical experience using virtually every type of implant, incision location, pocket location, dissection technique and instrumentation available from 1977 to 2001. Based on this experience, the author focuses on patient education, the importance of patient choice, patient evaluation and preoperative planning, surgical techniques, patient recovery, and factors to limit reoperations. FAU - Tebbetts, J B AU - Tebbetts JB AD - jbt@plastic-surgery.com LA - eng PT - Journal Article PL - United States TA - Clin Plast Surg JT - Clinics in plastic surgery JID - 0424767 SB - IM MH - Breast/*surgery MH - Breast Implants MH - Choice Behavior MH - Female MH - Humans MH - Mammaplasty/*methods MH - Patient Education as Topic MH - Patient Selection MH - Preoperative Care EDAT- 2001/07/27 10:00 MHDA- 2002/01/05 10:01 CRDT- 2001/07/27 10:00 PST - ppublish SO - Clin Plast Surg. 2001 Jul;28(3):425-34, v. PMID- 11443605 OWN - NLM STAT- MEDLINE DA - 20010709 DCOM- 20010726 LR - 20131121 IS - 0008-543X (Print) IS - 0008-543X (Linking) VI - 92 IP - 1 DP - 2001 Jul 01 TI - A comparison of four treatment strategies for ductal carcinoma in situ using decision analysis. PG - 23-9 AB - BACKGROUND: The goals of the current study were to compare four treatment approaches in the management of ductal carcinoma in situ (DCIS), to determine the conditions where mastectomy may be preferred to breast-conserving therapy (BCT), and to determine conditions where the addition of tamoxifen produces better results than BCT alone. METHODS: A decision analysis model was used to compare four treatment approaches after local excision for DCIS: mastectomy, irradiation, irradiation plus adjuvant tamoxifen, or observation. The model weighed the potential benefits of each treatment approach (reduction of ipsilateral and/or contralateral breast carcinoma) against the potential risks of treatment-related toxicities. In addition, the model adjusted for the potential detrimental impact of local recurrence or treatment-related toxicity on health-related quality of life (HRQOL). Base-case estimates were obtained from published randomized trial data. One-way and two-way sensitivity analyses were performed. RESULTS: According to the model, the optimal treatment for DCIS was strongly dependent on the individual's risk of local recurrence and the patient's attitudes toward mastectomy. Mastectomy was preferred in patients whose estimated 10-year risk of local recurrence was > 15%, provided that mastectomy resulted in a very low reduction in quality of life (i.e., utility estimate > 0.97). Conditions where the addition of tamoxifen was preferred to breast-conserving therapy alone included the following: estimated 10-year risk of local recurrence > 38%, estimated 10-year risk of developing a contralateral breast carcinoma > 6%, or a significant decrement in HRQOL associated with the development of an invasive local recurrence or salvage mastectomy (utility estimates < 0.85). CONCLUSION: Based on this quality-adjusted model, BCT appeared to be the preferred treatment for DCIS. The most important determinants of optimal management for DCIS included the risk of local recurrence and the utility of mastectomy. Formal evaluation of utilities in the context of DCIS and more accurate determination of the risk of recurrence are required. CI - Copyright 2001 American Cancer Society. FAU - Bordeleau, L AU - Bordeleau L AD - Toronto-Sunnybrook Regional Cancer Center, University of Toronto, Ontario, Canada. FAU - Rakovitch, E AU - Rakovitch E FAU - Naimark, D M AU - Naimark DM FAU - Pritchard, K I AU - Pritchard KI FAU - Ackerman, I AU - Ackerman I FAU - Sawka, C A AU - Sawka CA LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Cancer JT - Cancer JID - 0374236 RN - 0 (Antineoplastic Agents, Hormonal) RN - 094ZI81Y45 (Tamoxifen) SB - AIM SB - IM MH - Antineoplastic Agents, Hormonal/therapeutic use MH - Breast Neoplasms/drug therapy/*surgery MH - Carcinoma, Intraductal, Noninfiltrating/drug therapy/*surgery MH - Combined Modality Therapy MH - *Decision Making MH - Female MH - Humans MH - Mastectomy MH - Mastectomy, Segmental MH - Risk Assessment MH - Tamoxifen/therapeutic use EDAT- 2001/07/10 10:00 MHDA- 2001/07/28 10:01 CRDT- 2001/07/10 10:00 AID - 10.1002/1097-0142(20010701)92:1<23::AID-CNCR1287>3.0.CO;2-Y [pii] PST - ppublish SO - Cancer. 2001 Jul 1;92(1):23-9. PMID- 11427832 OWN - NLM STAT- MEDLINE DA - 20010627 DCOM- 20010927 LR - 20151119 IS - 0398-7620 (Print) IS - 0398-7620 (Linking) VI - 49 IP - 3 DP - 2001 Jun TI - [How to evaluate the quality of information transfer from physician to patient? Choice of psychometric tests for a decision tree in a Regional Cancer Centre]. PG - 299-313 AB - BACKGROUND: Decision boards are used to transfer information from physicians to patients to help them participate in the clinical decision-making process. We present the tests and results of the psychometric properties of a decision board in a sample of healthy volunteers. METHODS: In the Regional Cancer Centre located in Lyon, we developed a decision board for post-menopausal women with breast cancer after lumpectomy without any poor prognostic factors. Two treatment options were proposed, one involving chemotherapy and the other not. We tested for the following psychometric properties: comprehension, construct validity and reliability. Comprehension was evaluated using a questionnaire, in order to test whether the rates of correct answers were due to chance alone. The construct validity was assessed by changing the information provided (relapse and survival rates, characteristics of chemotherapy) and testing whether the proportion of healthy volunteers choosing an option changed in a predictable and significant way. The reliability was evaluated using the test-retest method. Two reliability statistics were computed: the Pearson correlation and the Intraclass Correlation Coefficient. RESULTS: In the sample of 40 healthy volunteers, 23 chose the option with chemotherapy and 17 the option without chemotherapy. Results show that the decision board was comprehensive, valid (the women changed their choices in a predictable way) and reliable (Pearson correlation and Intraclass Correlation Coefficient close to 1). CONCLUSION: The choice of the psychometrics properties tested and the statistical tests used are discussed. The psychometric properties of our tool are found to be satisfactory. FAU - Morelle, M AU - Morelle M AD - Groupe de Recherche en Economie de la Sante et Reseaux de Soins en Cancerologie (GRESAC)-Laboratoire d'Analyse des Systemes de Sante, UMR 5823 du CNRS, Centre Leon Berard, 28 rue Laennec, 69008 Lyon, France. FAU - Moumjid-Ferdjaoui, N AU - Moumjid-Ferdjaoui N FAU - Bremond, A AU - Bremond A FAU - Charavel, M AU - Charavel M FAU - Carrere, M O AU - Carrere MO LA - fre PT - English Abstract PT - Journal Article PT - Validation Studies TT - Comment evaluer la qualite du transfert de l'information du medecin au patient? Le choix des tests psychometriques d'un tableau de decision dans un Centre Regional de Lutte contre le Cancer. PL - France TA - Rev Epidemiol Sante Publique JT - Revue d'epidemiologie et de sante publique JID - 7608039 RN - 0 (Antineoplastic Agents) SB - IM MH - Aged MH - Antineoplastic Agents/therapeutic use MH - Breast Neoplasms/mortality/*psychology/*therapy MH - Case-Control Studies MH - Chemotherapy, Adjuvant MH - Choice Behavior MH - *Decision Trees MH - Female MH - France/epidemiology MH - Humans MH - Mastectomy, Segmental MH - Middle Aged MH - Patient Education as Topic/*methods/standards MH - Patient Participation/*psychology MH - Postmenopause/psychology MH - Predictive Value of Tests MH - Prognosis MH - Psychometrics MH - Regional Medical Programs MH - Surveys and Questionnaires MH - Survival Analysis EDAT- 2001/06/28 10:00 MHDA- 2001/09/28 10:01 CRDT- 2001/06/28 10:00 AID - MDOI-RESP-06-2001-49-3-0398-7620-101019-ART9 [pii] PST - ppublish SO - Rev Epidemiol Sante Publique. 2001 Jun;49(3):299-313. PMID- 11407276 OWN - NLM STAT- MEDLINE DA - 20010615 DCOM- 20010719 LR - 20151119 IS - 0028-2162 (Print) IS - 0028-2162 (Linking) VI - 145 IP - 21 DP - 2001 May 26 TI - [Interactive cd-rom on the choice between breast-sparing treatment and mastectomy: positive responses from patients and surgeons]. PG - 1004-8 AB - OBJECTIVE: To assess how breast cancer patients and surgeons rate an interactive decision aid, using CD-ROM technology, developed to support a choice between breast-conserving therapy and mastectomy. DESIGN: Questionnaire investigation. METHOD: Written questionnaires were presented to patients as soon as they had finished using the CD-ROM. They responded on a 5-point scale. Surgeons (n = 14) were sent a written questionnaire to investigate their experiences of using the CD-ROM program. RESULTS: The interactive CD-ROM was offered to 92 consecutive breast cancer patients. Responses were obtained from 86 (93%) of the patients. The remainder were inadvertently not given the questionnaire. All of the patients evaluated the program as positive. Most of the patients found the program to be 'interesting', 'clear', 'useful', 'encouraging', and 'reassuring'. A majority (n = 76) expressed the view that the amount of information received was 'just right'. The interactive, computer-based method was evaluated as 'agreeable' by 74 patients. Almost all of the patients (n = 82) recommended that the program be shown to other patients. All of the surgeons (n = 14) stated that their patients' evaluations of the program were positive. Moreover, most of the surgeons (n = 10) were of the opinion that the program 'considerably contributed' to the provision of information. With the exception of one surgeon (n = 13), they all held the view that the program can be offered to breast cancer patients facing a choice between breast-conservation or mastectomy on a standard basis. CONCLUSION: Interactive decision-making support by means of a CD-ROM for patients with breast cancer, received positive evaluations from both the patients and surgeons. FAU - Molenaar, S AU - Molenaar S AD - Academisch Medisch Centrum, afd. Medische Psychologie, Meibergdreef 9, 1105 AZ Amsterdam. j.molenaar@amc.uva.nl FAU - Sprangers, M A AU - Sprangers MA FAU - Rutgers, E J AU - Rutgers EJ FAU - Mulder, H J AU - Mulder HJ FAU - Luiten, E J AU - Luiten EJ FAU - de Haes, J C AU - de Haes JC LA - dut PT - Comparative Study PT - English Abstract PT - Journal Article PT - Research Support, Non-U.S. Gov't TT - Interactieve cd-rom over de keuze tussen borstsparende behandeling en amputatie: positieve reacties van patienten en chirurgen. PL - Netherlands TA - Ned Tijdschr Geneeskd JT - Nederlands tijdschrift voor geneeskunde JID - 0400770 SB - IM MH - Adult MH - Aged MH - Breast Neoplasms/*surgery MH - *CD-ROM MH - Decision Making MH - Female MH - Humans MH - Male MH - Mastectomy/psychology MH - Mastectomy, Segmental/methods/*psychology MH - Middle Aged MH - Netherlands MH - Patient Education as Topic/*methods MH - Patient Satisfaction/*statistics & numerical data MH - Physicians/*statistics & numerical data MH - Surveys and Questionnaires EDAT- 2001/06/16 10:00 MHDA- 2001/07/20 10:01 CRDT- 2001/06/16 10:00 PST - ppublish SO - Ned Tijdschr Geneeskd. 2001 May 26;145(21):1004-8. PMID- 11297648 OWN - NLM STAT- MEDLINE DA - 20010412 DCOM- 20010531 LR - 20140613 IS - 0143-005X (Print) IS - 0143-005X (Linking) VI - 55 IP - 5 DP - 2001 May TI - Prognostic factors in women with breast cancer: distribution by socioeconomic status and effect on differences in survival. PG - 308-15 AB - STUDY OBJECTIVE: To quantify and investigate differences in survival from breast cancer between women resident in affluent and deprived areas and define the contribution of underlying factors to this variation. DESIGN: Analysis of two datasets relating to breast cancer patients in Scotland: (1) population-based cancer registry data; (2) a subset of cancer registration records supplemented by abstraction of prognostic variables (stage, node status, tumour size, oestrogen receptor (ER) status, type of surgery, use of radiotherapy and use of adjuvant systemic therapy) from medical records. SETTING: Scotland. PATIENTS: (1) Cancer registration data on 21,751 women aged under 85 years diagnosed with primary breast cancer between 1978 and 1987; (2) national clinical audit data on 2035 women aged under 85 years diagnosed with primary breast cancer during 1987 for whom adequate medical records were available. MAIN RESULTS: Survival differences of 10% between affluent and deprived women were observed in both datasets, across all age groups. In the audit dataset, the distribution of ER status varied by deprivation group (65% ER positive in affluent group v 48% ER positive in deprived group; under 65 age group). Women aged under 65 with non-metastatic disease were more likely to have breast conservation than a mastectomy if they were affluent (45%) than deprived (32%); the affluent were more likely to receive endocrine therapy (65%) than the deprived (50%). However, these factors accounted for about 20% of the observed difference in survival between women resident in affluent and deprived areas. CONCLUSIONS: Deprived women with breast cancer have poorer outcomes than affluent women. This can only partly be explained by deprived women having more ER negative tumours than affluent women. Further research is required to identify other reasons for poorer outcomes in deprived women, with a view to reducing these survival differences. FAU - Thomson, C S AU - Thomson CS AD - Scottish Cancer Intelligence Unit, Information and Statistics Division, Trinity Park House, Edinburgh EH5 3SQ, UK. catherine.thomson@isd.csa.scot.nhs.uk FAU - Hole, D J AU - Hole DJ FAU - Twelves, C J AU - Twelves CJ FAU - Brewster, D H AU - Brewster DH FAU - Black, R J AU - Black RJ CN - Scottish Cancer Therapy Network LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - J Epidemiol Community Health JT - Journal of epidemiology and community health JID - 7909766 RN - 0 (Receptors, Estrogen) SB - IM MH - Adult MH - Age Distribution MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/chemistry/*mortality/therapy MH - Chi-Square Distribution MH - Data Interpretation, Statistical MH - Female MH - Humans MH - Middle Aged MH - Prognosis MH - Proportional Hazards Models MH - Receptors, Estrogen/analysis MH - Registries MH - Scotland/epidemiology MH - *Social Class MH - Survival Rate PMC - PMC1731899 OID - NLM: PMC1731899 EDAT- 2001/04/12 10:00 MHDA- 2001/06/02 10:01 CRDT- 2001/04/12 10:00 PST - ppublish SO - J Epidemiol Community Health. 2001 May;55(5):308-15. PMID- 11281859 OWN - NLM STAT- Publisher DA - 20010402 LR - 20170219 IS - 1369-7625 (Electronic) IS - 1369-6513 (Linking) VI - 1 IP - 1 DP - 1998 Jun TI - Development of a patient decision aid for choice of surgical treatment for breast cancer. PG - 23-36 AB - PURPOSE: A patient decision aid for the surgical treatment of early stage breast cancer was developed and evaluated. The rationale for its development was the knowledge that breast conserving therapy (lumpectomy followed by breast radiation) and mastectomy produce equivalent outcomes, and the current general agreement that the decision for the type of surgery should rest with the patient. METHODS: A decision aid was developed and evaluated in sequential pilot studies of 18 and 10 women with newly diagnosed breast cancer who were facing a decision for breast conserving therapy or mastectomy. Both qualitative (general reaction, self-reported anxiety, clarity, satisfaction) and quantitative (knowledge and decisional conflict) measures were assessed. RESULTS: The decision aid consists of an audiotape and workbook and takes 36 min to complete. Based on qualitative comments and satisfaction ratings, 17 of 18 women reported a positive reaction to the decision aid, and all 18 reported that it helped clarify information given by the surgeon. Women did not report an increase in anxiety and 17 of 18 women were either satisfied or very satisfied with the decision aid. CONCLUSION: This pilot study supports the hypothesis that this decision aid may be a helpful adjunct in the decision for surgical management of early stage breast cancer. We are currently conducting a randomized trial of the decision aid versus a simple educational pamphlet to evaluate its efficacy as measured by knowledge, decisional conflict, anxiety and post-decisional regret. FAU - Sawka, Carol A. AU - Sawka CA AD - Divisions of Medical Oncology/Hematology, Faculty of Medicine, University of Toronto, Toronto, Canada; Divisions of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada; Divisions of Surgical Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada; Toronto-Sunnybrook Regional Cancer Center, Toronto, Faculty of Medicine, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Science in Ontario, Toronto, Canada; Faculty of Health Sciences, University of Ottawa, Ottawa; York County Hospital, Newmarket, Canada. FAU - Goel, Vivek AU - Goel V FAU - Mahut, Catherine A. AU - Mahut CA FAU - Taylor, Glen A. AU - Taylor GA FAU - Thiel, Elaine C. AU - Thiel EC FAU - O'Connor, Annette M. AU - O'Connor AM FAU - Ackerman, Ida AU - Ackerman I FAU - Burt, Janet H. AU - Burt JH FAU - Gort, Elaine H. AU - Gort EH LA - eng PT - Journal Article PL - England TA - Health Expect JT - Health expectations : an international journal of public participation in health care and health policy JID - 9815926 PMC - PMC5081065 EDAT- 2001/04/03 10:00 MHDA- 2001/04/03 10:00 CRDT- 2001/04/03 10:00 AID - hex003 [pii] PST - ppublish SO - Health Expect. 1998 Jun;1(1):23-36. PMID- 11259883 OWN - NLM STAT- MEDLINE DA - 20010322 DCOM- 20010621 LR - 20071115 IS - 0933-3657 (Print) IS - 0933-3657 (Linking) VI - 22 IP - 1 DP - 2001 Apr TI - ONCODOC: a successful experiment of computer-supported guideline development and implementation in the treatment of breast cancer. PG - 43-64 AB - Originally published as textual documents, clinical practice guidelines have poorly penetrated medical practice because their editorial properties do not allow the reader to easily solve, at the point of care, a given medical problem. However, despite the proliferation of implemented clinical practice guidelines as decision support systems providing an easy access to patient-centered information, there is still little evidence of high physician compliance to guidelines recommendations. Apart from physicians' psychological reluctance, the incompleteness of guideline knowledge and the impreciseness of the terms used, another reason may be that, although suited to average patients, clinical practice guideline recommendations are not a substitute for the physician-controlled clinical judgement that should be applied to each actual individual patient. Therefore, computer-based approaches based on the automation of context-free operationalization of guideline knowledge, although providing uniform optimal strategies to problem-focused care delivery, may generate inappropriate inferences for a specific patient that the physician does not follow in practice. Rather than providing automated decision support, ONCODOC allows the clinician to control the operationalization of guideline knowledge through his hypertextual reading of a knowledge base encoded as a decision tree. In this way, he has the opportunity to interpret the information provided in the context of his patient, therefore, controlling his categorization to the closest matching formal patient. Experimented in life-size ONCODOC demonstrated good appropriation of the system by physicians with significantly high scores of compliance. We successfully tested the implemented strategy and the knowledge base in a second medical institution, giving then a noticeable example of reuse and sharing of encoded guideline knowledge across institutions. FAU - Seroussi, B AU - Seroussi B AD - Service d'Informatique Medicale, DSI/AP-HP & Departement de Biomatiques, Universite Paris 6, Paris, France. bs@biomath.jussieu.fr FAU - Bouaud, J AU - Bouaud J FAU - Antoine, E C AU - Antoine EC LA - eng PT - Journal Article PL - Netherlands TA - Artif Intell Med JT - Artificial intelligence in medicine JID - 8915031 SB - IM MH - *Artificial Intelligence MH - Breast Neoplasms/*therapy MH - Computers MH - *Decision Support Systems, Clinical MH - Female MH - Health Plan Implementation MH - Humans MH - *Physician's Role MH - *Practice Guidelines as Topic EDAT- 2001/03/22 10:00 MHDA- 2001/06/22 10:01 CRDT- 2001/03/22 10:00 AID - S0933-3657(00)00099-3 [pii] PST - ppublish SO - Artif Intell Med. 2001 Apr;22(1):43-64. PMID- 11250997 OWN - NLM STAT- MEDLINE DA - 20010319 DCOM- 20010412 LR - 20170210 IS - 0732-183X (Print) IS - 0732-183X (Linking) VI - 19 IP - 6 DP - 2001 Mar 15 TI - Decision support for patients with early-stage breast cancer: effects of an interactive breast cancer CDROM on treatment decision, satisfaction, and quality of life. PG - 1676-87 AB - PURPOSE: To investigate the effects of the Interactive Breast Cancer CDROM as a decision aid for breast cancer patients with a choice between breast conserving therapy (BCT) and mastectomy (MT). PATIENTS AND METHODS: Consecutive patients with stage I and II breast cancer were enrolled. A quasi-experimental, longitudinal, and pretest/posttest design was used. Follow-up was scheduled 3 and 9 months after discharge from the hospital. Control patients (n = 88) received standard care (oral information and brochures). The CDROM was provided to patients in the experimental condition (n = 92) as a supplement to standard procedures. Outcome variables were treatment decision, satisfaction, and quality of life (QoL). RESULTS: No effect on treatment decision was found. CDROM patients expressed more general satisfaction with information at 3 and 9 months (95% confidence interval for the difference (d) between the means (d: 4.1 to 12.5 and 5.7 to 14.2 respectively). CDROM patients were also more satisfied with their treatment decision at 3 and at 9 months (d: 0.1 to 0.4; 0.2 to 0.5). Moreover, at 9 months, CDROM patients were more satisfied with breast cancer-specific information (d: 0.9 to 16.5), the decision-making process (d: 0.1 to 0.4), and communication (d: 0.2 to 11.0). At 3 and 9 months, a positive effect was found on general health (d: 0.2 to 14.5 and 0.3 to 15.0). Moreover, at 9 months, CDROM patients reported better physical functioning (d: 5.1 to 19.8), less pain (d: -17.9 to -4.5), and fewer arm symptoms (d: -14.1 to -0.5). CONCLUSION: The Interactive Breast Cancer CDROM improved decision making in patients with early-stage breast cancer with a choice between BCT and MT, as evaluated in terms of patients' satisfaction and QoL. FAU - Molenaar, S AU - Molenaar S AD - Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands. J.Molenaar@AMC.UvA.NL FAU - Sprangers, M A AU - Sprangers MA FAU - Rutgers, E J AU - Rutgers EJ FAU - Luiten, E J AU - Luiten EJ FAU - Mulder, J AU - Mulder J FAU - Bossuyt, P M AU - Bossuyt PM FAU - van Everdingen, J J AU - van Everdingen JJ FAU - Oosterveld, P AU - Oosterveld P FAU - de Haes, H C AU - de Haes HC LA - eng PT - Clinical Trial PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 SB - IM MH - Aged MH - Body Image MH - Breast Neoplasms/psychology/*therapy MH - *CD-ROM MH - Decision Making MH - *Decision Making, Computer-Assisted MH - Female MH - Humans MH - Longitudinal Studies MH - Mastectomy MH - Mastectomy, Segmental MH - Middle Aged MH - Patient Satisfaction MH - Quality of Life EDAT- 2001/03/17 10:00 MHDA- 2001/04/17 10:01 CRDT- 2001/03/17 10:00 AID - 10.1200/JCO.2001.19.6.1676 [doi] PST - ppublish SO - J Clin Oncol. 2001 Mar 15;19(6):1676-87. PMID- 11206942 OWN - NLM STAT- MEDLINE DA - 20010206 DCOM- 20010510 LR - 20170214 IS - 0272-989X (Print) IS - 0272-989X (Linking) VI - 21 IP - 1 DP - 2001 Jan-Feb TI - Randomized trial of a patient decision aid for choice of surgical treatment for breast cancer. PG - 1-6 AB - A decision aid for the surgical treatment of early breast cancer was evaluated in a randomized controlled trial. The decision aid, a tape and workbook, includes explicit presentation of probabilities, photographs and graphics, and a values clarification exercise. Community surgeons were randomized to use the decision aid or a control pamphlet. Patients completed a questionnaire prior to using the decision aid, after reviewing it but prior to surgery, and 6 months after enrollment. There was no difference in anxiety, knowledge, or decisional regret across the 2 groups. There was a nonsignificant trend toward lower decisional conflict in the decision aid group. A subgroup of women who were initially leaning toward mastectomy or were unsure had lower decisional conflict. Although the decision aid had minimal impact on the main study outcomes, a subgroup may have benefited. Such subgroups should be identified, and appropriate decision support interventions should be developed and evaluated. FAU - Goel, V AU - Goel V AD - Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. vivek.goel@utoronto.ca FAU - Sawka, C A AU - Sawka CA FAU - Thiel, E C AU - Thiel EC FAU - Gort, E H AU - Gort EH FAU - O'Connor, A M AU - O'Connor AM LA - eng PT - Clinical Trial PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PL - United States TA - Med Decis Making JT - Medical decision making : an international journal of the Society for Medical Decision Making JID - 8109073 SB - IM MH - Breast Neoplasms/*surgery MH - *Decision Support Techniques MH - Female MH - Humans MH - Mastectomy MH - Middle Aged MH - *Patient Education as Topic MH - *Patient Participation EDAT- 2001/02/24 12:00 MHDA- 2001/05/22 10:01 CRDT- 2001/02/24 12:00 AID - 10.1177/0272989X0102100101 [doi] PST - ppublish SO - Med Decis Making. 2001 Jan-Feb;21(1):1-6. PMID- 11177139 OWN - NLM STAT- MEDLINE DA - 20010222 DCOM- 20010405 LR - 20071115 IS - 0004-0010 (Print) IS - 0004-0010 (Linking) VI - 136 IP - 2 DP - 2001 Feb TI - Physician sex and other factors associated with type of breast cancer surgery in older women. PG - 185-91 AB - HYPOTHESIS: Physician-related factors as well as patient characteristics may explain why women aged 65 years or older with early-stage breast cancer undergo lumpectomy less often than younger women, despite National Institutes of Health recommendations favoring lumpectomy over mastectomy. DESIGN: A descriptive and analytical retrospective computer-assisted telephone survey. SETTING: A population-based random sample of breast cancer survivors in Colorado, identified from the Colorado Central Cancer Registry. PATIENTS: Women aged 65 to 84 years when diagnosed as having stage I or II breast cancer, treated 1 to 6 years previously with mastectomy or lumpectomy, and without recurrence or second primary cancers. Among women contacted, 58% participated. Results of 198 interviews are reported. METHODS: Survey questions included patient decision-making participation and physician recommendations, sources and amount of treatment information provided by physicians, physician characteristics, and patient surgery preferences and demographic characteristics. A multivariate logistic regression model identified factors independently associated with lumpectomy. RESULTS: Lumpectomy was strongly associated with higher patient education, female physician sex, patient age 75 years or older, and amount of physician-provided information. The number of physician-provided information sources was associated with surgery explanations, and female physicians provided more sources of information. A physician decision or recommendation for surgery type was reported by 61% of women, of whom 93% underwent the recommended procedure. A subset of patients (13%) reported deferring the surgery decision to someone else. CONCLUSIONS: These results suggest that better-educated and better-informed older women are more likely to undergo lumpectomy, and that physicians may influence breast cancer patients' decisions about surgery type. FAU - Cyran, E M AU - Cyran EM AD - Division of General Internal Medicine, Campus Box B-212, University of Colorado Health Sciences Center, 4200 E Ninth Ave, Denver, CO 80262, USA. Lisa.Cyran@UCHSC.edu FAU - Crane, L A AU - Crane LA FAU - Palmer, L AU - Palmer L LA - eng GR - 5T32-PE10006/PE/BHP HRSA HHS/United States PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. PL - United States TA - Arch Surg JT - Archives of surgery (Chicago, Ill. : 1960) JID - 9716528 SB - AIM SB - IM MH - Age Factors MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/*surgery MH - Female MH - Humans MH - Interviews as Topic MH - Logistic Models MH - Male MH - *Mastectomy MH - *Mastectomy, Segmental MH - *Physicians, Women MH - Random Allocation MH - Registries/statistics & numerical data MH - Sex Factors MH - Truth Disclosure EDAT- 2001/02/15 11:00 MHDA- 2001/04/06 10:01 CRDT- 2001/02/15 11:00 AID - soa0080 [pii] PST - ppublish SO - Arch Surg. 2001 Feb;136(2):185-91. PMID- 11110334 OWN - NLM STAT- MEDLINE DA - 20010301 DCOM- 20010405 LR - 20161020 IS - 0884-2175 (Print) IS - 0090-0311 (Linking) VI - 29 IP - 6 DP - 2000 Nov-Dec TI - Pregnancy and breast cancer. PG - 634-40 AB - Pregnancy-associated breast cancer (PABC) and pregnancy subsequent to breast cancer are two areas of concern facing women of childbearing age. The current approach to the management of PABC is to treat the cancer with some modification because of the pregnancy. The clinical management of both PABC and pregnancy occurring after breast cancer in young survivors, with emphasis on issues in clinical decision making, clinical management, and client education and support, are addressed. FAU - Dow, K H AU - Dow KH AD - School of Nursing, College of Health and Public Affairs, University of Central Florida, Orlando, 32816, USA. LA - eng PT - Journal Article PT - Review PL - United States TA - J Obstet Gynecol Neonatal Nurs JT - Journal of obstetric, gynecologic, and neonatal nursing : JOGNN JID - 8503123 RN - 0 (Antineoplastic Agents) SB - IM SB - N MH - Amenorrhea/chemically induced MH - Antineoplastic Agents/adverse effects MH - Breast Neoplasms/*diagnosis/mortality/*therapy MH - Combined Modality Therapy MH - Female MH - Humans MH - Infertility, Female/chemically induced MH - Mastectomy MH - Maternal-Child Nursing MH - Patient Education as Topic MH - Patient Selection MH - Pregnancy MH - Pregnancy Complications, Neoplastic/*diagnosis/mortality/*therapy MH - Social Support MH - Survival Analysis MH - Time Factors RF - 28 EDAT- 2000/12/08 11:00 MHDA- 2001/04/06 10:01 CRDT- 2000/12/08 11:00 AID - S0884-2175(15)33854-5 [pii] PST - ppublish SO - J Obstet Gynecol Neonatal Nurs. 2000 Nov-Dec;29(6):634-40. PMID- 11005553 OWN - NLM STAT- MEDLINE DA - 20010102 DCOM- 20010111 LR - 20070718 IS - 1068-9265 (Print) IS - 1068-9265 (Linking) VI - 7 IP - 8 DP - 2000 Sep TI - Factors associated with local breast cancer recurrence after lumpectomy alone: postmenopausal patients. PG - 562-7 AB - BACKGROUND: We have been following a cohort of patients who underwent a lumpectomy without receiving adjuvant radiotherapy or adjuvant systemic therapy. We now report the experience of a postmenopausal subgroup. METHODS: The postmenopausal subgroup included 244 patients accrued between 1977 and 1986 and followed up. The end point was ipsilateral local breast cancer recurrence. The factors studied were the patient's age in years; tumor size (in mm); nodal status (N-, Nx, N+); estrogen and progesterone receptor status (< 10, - 10 fmol/mg protein); presence or absence of lymphovascular/perineural invasion; presence or absence, and type, of DCIS (none, non-comedo, comedo); percentage of DCIS; histological grade (1,2,3); and nuclear grade (1,2,3). Univariate analyses consisted of Kaplan-Meier plots and the Wilcoxon (Peto-Prentice) test statistic; the multivariate analyses were step-wise Cox and log-normal regressions. RESULTS: The median follow-up of those patients still alive was 9.1 years, and the overall relapse rate was 24% (59/244). The univariate results indicated that the characteristics of smaller tumor size, negative nodes, positive ER status, and no lymphovascular or perineural invasion were associated with significantly (P <.05) lower relapse. From the multivariate analyses, the factors lymphovascular or perineural invasion, age, and amount of DCIS were all significantly associated with local relapse with both Cox and log-normal regressions. Additionally, there was weak evidence of an association between ER (P = .08 in the Cox regression and in the log-normal) and nodal status (P = .09 in the log-normal regression) with local relapse. We also are able to define a low-risk subgroup (N-, age -65, no comedo, ER positive, no emboli) with a crude 10-year local recurrence rate of 9%. CONCLUSION: With longer follow-up, and for postmenopausal patients, there continues to be support for the theory that local relapse is affected by the factors lymphovascular or perineural invasion, age, amount of DCIS, ER, and nodal status. A low risk subgroup has been identified. FAU - McCready, D R AU - McCready DR AD - Department of Surgical Oncology, University Health Network, Princess Margaret Hospital, University of Toronto, Ontario, Canada. FAU - Chapman, J A AU - Chapman JA FAU - Hanna, W M AU - Hanna WM FAU - Kahn, H J AU - Kahn HJ FAU - Yap, K AU - Yap K FAU - Fish, E B AU - Fish EB FAU - Lickley, H L AU - Lickley HL LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Ann Surg Oncol JT - Annals of surgical oncology JID - 9420840 RN - 0 (Receptors, Estrogen) RN - 0 (Receptors, Progesterone) SB - IM CIN - Ann Surg Oncol. 2000 Sep;7(8):552-3. PMID: 11005551 MH - Breast Neoplasms/pathology/*surgery MH - Carcinoma in Situ/pathology/surgery MH - Carcinoma, Ductal, Breast/pathology/surgery MH - Combined Modality Therapy MH - Data Interpretation, Statistical MH - Female MH - Follow-Up Studies MH - Humans MH - Incidence MH - Lymphatic Metastasis MH - *Mastectomy, Segmental MH - Neoplasm Invasiveness MH - Neoplasm Recurrence, Local/*epidemiology MH - *Postmenopause MH - Receptors, Estrogen/analysis MH - Receptors, Progesterone/analysis EDAT- 2000/09/27 11:00 MHDA- 2001/02/28 10:01 CRDT- 2000/09/27 11:00 PST - ppublish SO - Ann Surg Oncol. 2000 Sep;7(8):562-7. PMID- 10929847 OWN - NLM STAT- MEDLINE DA - 20001129 DCOM- 20001129 LR - 20170214 IS - 0272-989X (Print) IS - 0272-989X (Linking) VI - 20 IP - 3 DP - 2000 Jul-Sep TI - Prophylactic mastectomy or screening in women suspected to have the BRCA1/2 mutation: a prospective pilot study of women's treatment choices and medical and decision-analytic recommendations. PG - 251-62 AB - BACKGROUND: Women suspected to have the BRCA1/2 mutation may choose between two management options: breast cancer screening and prophylactic mastectomy (PM). OBJECTIVES: To compare women's treatment choices with medical and decision-analytic recommendations and to explore variables related to the women's choices. METHODS: After provision of information, individual time-tradeoff values for the health outcome "living after PM" were assessed and incorporated into a decision-analytic model, which compared the management options PM and screening with respect to their effects on quality-adjusted life expectancy. RESULTS: Of the 54 women suspected to have the mutation, 51 completed the shared-decision-making procedure. Quality-adjusted life expectancy after PM management was longer for 67% of proven carriers and for 58% of women awaiting the DNA-test result. Twelve proven carriers made definitive treatment choices: eight (67%) chose PM and four (33%) chose screening. All carriers' treatment choices agreed with the normative decision-analytic recommendations. Four (33%) disagreed with the medical recommendations. Of the 36 women awaiting DNA-test results, 32 made hypothetical treatment choices. The agreement between these hypothetical treatment choices and the decision-analytic recommendations was good (78%). Combining data from all 48 women, being married (OR = 14.00, p = 0.006), having children (OR = 4.71, p = 0.02), low desire to participate (OR = 0.14, p = 0.004), high decisional stress (OR = 5.22, p = 0.01), a lower estimate of the "probability of cure for screen-detected breast cancer" (OR = 0.13, p = 0.004), and higher time-tradeoff values for PM (OR = 182, p < 0.0001) made a choice for PM more likely. CONCLUSIONS: The complete agreement between the decision-analytic recommendations and the carriers' choices suggests that women act in accordance with normative decision theory. The disagreement between the carriers' choices and the medical recommendations suggests that women's choices and physicians' recommendations were guided by different arguments. The strong association between time-tradeoff value and treatment choice suggests that the time-tradeoff is a valid method to assess preferences. FAU - Unic, I AU - Unic I AD - Joint Center for Radiation Oncology Arnhem-Nijmegen, University Medical Center Nijmegen, The Netherlands. FAU - Verhoef, L C AU - Verhoef LC FAU - Stalmeier, P F AU - Stalmeier PF FAU - van Daal, W A AU - van Daal WA LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Med Decis Making JT - Medical decision making : an international journal of the Society for Medical Decision Making JID - 8109073 RN - 0 (BRCA1 Protein) RN - 0 (BRCA2 Protein) RN - 0 (Neoplasm Proteins) RN - 0 (Transcription Factors) SB - IM MH - Adult MH - BRCA1 Protein/genetics MH - BRCA2 Protein MH - Breast Neoplasms/diagnosis/*genetics/psychology/surgery MH - *Decision Making MH - *Decision Support Techniques MH - Educational Status MH - Female MH - Heterozygote MH - Humans MH - Marital Status MH - *Mastectomy MH - Middle Aged MH - Neoplasm Proteins/genetics MH - Netherlands MH - *Patient Participation MH - Probability MH - Prospective Studies MH - *Quality-Adjusted Life Years MH - Time Factors MH - Transcription Factors/genetics EDAT- 2000/08/10 11:00 MHDA- 2001/02/28 10:01 CRDT- 2000/08/10 11:00 AID - 10.1177/0272989X0002000301 [doi] PST - ppublish SO - Med Decis Making. 2000 Jul-Sep;20(3):251-62. PMID- 10696733 OWN - NLM STAT- MEDLINE DA - 20000313 DCOM- 20000313 LR - 20151119 IS - 1081-4442 (Print) IS - 1081-4442 (Linking) VI - 6 IP - 1 DP - 2000 Jan-Feb TI - Prevention with tamoxifen or other hormones versus prophylactic surgery in BRCA1/2-positive women: a decision analysis. PG - 13-20 AB - PURPOSE: Recent randomized controlled trials have shown that tamoxifen and raloxifene may prevent invasive breast cancer. This decision analysis study compares the outcomes of chemoprevention with tamoxifen, raloxifene, or oral contraceptives with the outcomes of prophylactic surgery among women with high-risk BRCA1/2 mutations. PATIENTS AND METHODS: We used a simulated cohort of 30-year-old women who tested positive for BRCA1/2 mutations and constructed a Markov model with Monte Carlo simulations, incorporating cumulative breast and ovarian cancer incidence rates from the literature and survival figures from SEER data. We assumed that prophylactic surgery reduces ovarian cancer risk by 45% and breast cancer risk by 90%, that tamoxifen reduces invasive breast cancer risk by 49%, and that raloxifene has similar efficacy and safety in premenopausal and postmenopausal women. We used data obtained from high-risk women by a time trade-off questionnaire to calculate quality-adjusted life-years. We based our cost estimates for hospital and ambulatory care on Health Care Financing Administration payments, the SEER-HCFA database, and the Pharmacy Fundamental Reference. RESULTS: In our model, a 30-year-old BRCA1/2+ woman could prolong survival by 0.9 years (95% probability interval, 0.4-1.2 years) by having bilateral oophorectomy, 3.4 years (2.7-3.7 years) by having bilateral mastectomy, and 4.3 years (3.6-4.6 years) by having both procedures instead of surveillance alone. Chemoprevention with tamoxifen and raloxifene increased survival by 1.6 years (1.0-2.1 years) and 2.2 years (1.3-2.8 years), respectively. Chemoprevention yielded more quality-adjusted life-years than did prophylactic surgery, even when treatment was delayed to age 40 or 50 years. All these procedures were cost-effective or cost-saving compared with surveillance alone. DISCUSSION: Our model suggests that although surgery may yield more substantial survival and cost benefits, quality of life issues may make chemoprevention a more attractive option for young women at high genetic risk. FAU - Grann, V R AU - Grann VR AD - Herbert Irving Comprehensive Cancer Center, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA. FAU - Jacobson, J S AU - Jacobson JS FAU - Whang, W AU - Whang W FAU - Hershman, D AU - Hershman D FAU - Heitjan, D F AU - Heitjan DF FAU - Antman, K H AU - Antman KH FAU - Neugut, A I AU - Neugut AI LA - eng GR - P30 CA13696-26/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Research Support, U.S. Gov't, P.H.S. PL - United States TA - Cancer J Sci Am JT - The cancer journal from Scientific American JID - 9513568 RN - 0 (Anticarcinogenic Agents) RN - 0 (BRCA2 Protein) RN - 0 (Contraceptives, Oral) RN - 0 (Neoplasm Proteins) RN - 0 (Transcription Factors) RN - 094ZI81Y45 (Tamoxifen) RN - 4F86W47BR6 (Raloxifene Hydrochloride) SB - IM MH - Adult MH - Aged MH - Anticarcinogenic Agents/*therapeutic use MH - BRCA2 Protein MH - Breast Neoplasms/*epidemiology/*genetics/prevention & control MH - Cohort Studies MH - Contraceptives, Oral/therapeutic use MH - Disease-Free Survival MH - Female MH - *Genes, BRCA1 MH - Humans MH - Markov Chains MH - *Mastectomy MH - Middle Aged MH - Monte Carlo Method MH - *Mutation MH - Neoplasm Proteins/*genetics MH - Ovarian Neoplasms/*epidemiology/*genetics/prevention & control MH - *Ovariectomy MH - Quality of Life MH - Raloxifene Hydrochloride/therapeutic use MH - Risk Factors MH - Tamoxifen/*therapeutic use MH - Transcription Factors/*genetics EDAT- 2000/03/04 09:00 MHDA- 2000/03/18 09:00 CRDT- 2000/03/04 09:00 PST - ppublish SO - Cancer J Sci Am. 2000 Jan-Feb;6(1):13-20. PMID- 10665701 OWN - NLM STAT- MEDLINE DA - 20000216 DCOM- 20000216 LR - 20161017 IS - 0098-7484 (Print) IS - 0098-7484 (Linking) VI - 283 IP - 5 DP - 2000 Feb 02 TI - Life expectancy gains from cancer prevention strategies for women with breast cancer and BRCA1 or BRCA2 mutations. PG - 617-24 AB - CONTEXT: Women with BRCA1- or BRCA2-associated breast cancer are at increased risk for contralateral breast cancer and ovarian cancer and therefore may consider secondary cancer prevention strategies, such as prophylactic surgery and tamoxifen therapy. It is not proven to what extent these strategies reduce risk of second cancers in such patients. OBJECTIVE: To examine the effect of tamoxifen therapy, bilateral prophylactic oophorectomy (PO), prophylactic contralateral mastectomy (PCM), and combinations of these strategies on life expectancy for women with unilateral breast cancer and a BRCA1 or BRCA2 gene mutation. DESIGN AND SETTING: Decision analysis using a Markov model. Probabilities for developing contralateral breast cancer and ovarian cancer, dying from these cancers, dying from primary breast cancer, and the reduction in cancer incidence and mortality due to prophylactic surgeries and/or tamoxifen were estimated from published studies. PARTICIPANTS: Hypothetical breast cancer patients with BRCA1 or BRCA2 mutations facing decisions about secondary cancer prevention strategies. INTERVENTIONS: Seven strategies, including 5 years of tamoxifen use, PO, PCM, and combinations of these strategies, compared with careful surveillance. MAIN OUTCOME MEASURES: Total and incremental life expectancy (LE) with each intervention strategy. RESULTS: Depending on the assumed penetrance of the BRCA mutation, compared with surveillance alone, 30-year-old early-stage breast cancer patients with BRCA mutations gain in LE 0.4 to 1.3 years from tamoxifen therapy, 0.2 to 1.8 years from PO, and 0.6 to 2.1 years from PCM. The magnitude of these gains is least for women with low-penetrance mutations (assumed contralateral breast cancer risk of 24% and ovarian cancer risk of 6%) and greatest for those with high-penetrance mutations (assumed contralateral breast cancer risk of 65% and ovarian cancer risk of 40%.) Older age and poorer prognosis from primary breast cancer further attenuate these gains. CONCLUSIONS: Interventions to prevent second cancers, particularly PCM, may offer substantial LE gain for young women with BRCA-associated early-stage breast cancer. Estimates of LE gain may help women and their physicians consider the uncertainties, risks, and advantages of these interventions and lead to more informed choices about cancer prevention strategies. FAU - Schrag, D AU - Schrag D AD - Department of Adult Oncology, Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Mass, USA. FAU - Kuntz, K M AU - Kuntz KM FAU - Garber, J E AU - Garber JE FAU - Weeks, J C AU - Weeks JC LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - JAMA JT - JAMA JID - 7501160 RN - 0 (Antineoplastic Agents, Hormonal) RN - 0 (BRCA2 Protein) RN - 0 (Neoplasm Proteins) RN - 0 (Transcription Factors) RN - 094ZI81Y45 (Tamoxifen) SB - AIM SB - IM CIN - JAMA. 2000 Jun 21;283(23):3070-2. PMID: 10865296 CIN - JAMA. 2000 Jun 21;283(23):3070; author reply 3071-2. PMID: 10865295 MH - Adult MH - Antineoplastic Agents, Hormonal/*therapeutic use MH - BRCA2 Protein MH - Breast Neoplasms/genetics/*mortality/*prevention & control MH - Decision Support Techniques MH - Female MH - Genes, BRCA1 MH - Humans MH - *Life Expectancy MH - Markov Chains MH - *Mastectomy MH - Mutation MH - Neoplasm Proteins/genetics MH - Ovarian Neoplasms/genetics/*mortality/*prevention & control MH - *Ovariectomy MH - Prognosis MH - Risk MH - Tamoxifen/*therapeutic use MH - Transcription Factors/genetics EDAT- 2000/02/09 09:00 MHDA- 2000/02/19 09:00 CRDT- 2000/02/09 09:00 AID - joc90720 [pii] PST - ppublish SO - JAMA. 2000 Feb 2;283(5):617-24. PMID- 10620889 OWN - NLM STAT- MEDLINE DA - 19991123 DCOM- 19991123 LR - 20071115 IS - 0002-8045 (Print) IS - 0002-8045 (Linking) VI - 84 IP - 9 DP - 1999 Sep TI - Physicians study tool to help patients select treatment for breast cancer. PG - 24-8 FAU - Sandrick, K AU - Sandrick K LA - eng PT - Journal Article PL - United States TA - Bull Am Coll Surg JT - Bulletin of the American College of Surgeons JID - 7507024 SB - H MH - Breast Neoplasms/*surgery MH - Decision Making MH - Female MH - Humans MH - Mastectomy/*methods/psychology MH - Mastectomy, Segmental MH - Ontario MH - *Patient Education as Topic MH - *Patient Participation EDAT- 2000/01/06 MHDA- 2000/01/06 00:01 CRDT- 2000/01/06 00:00 PST - ppublish SO - Bull Am Coll Surg. 1999 Sep;84(9):24-8. PMID- 10561209 OWN - NLM STAT- MEDLINE DA - 20000113 DCOM- 20000113 LR - 20170210 IS - 0732-183X (Print) IS - 0732-183X (Linking) VI - 17 IP - 6 DP - 1999 Jun TI - Mastectomy or lumpectomy? Helping women make informed choices. PG - 1727-35 AB - PURPOSE: To develop an instrument to help clinicians inform their patients about surgical treatment options for the treatment of breast cancer and to evaluate the impact of the instrument on the clinical encounter. METHODS: We developed an instrument, called the Decision Board, to present information regarding the benefits and risks of breast-conserving therapy (lumpectomy plus radiation therapy) and mastectomy to women with early-stage breast cancer to enable them to express a preference for the type of surgery. Seven surgeons from different communities in Ontario administered the instrument to women with newly diagnosed clinical stage I or II breast cancer over an 18-month period. Patients and surgeons were interviewed regarding acceptability of the instrument. The rates of breast-conserving surgery performed by surgeons before and after the introduction of the instrument were compared. RESULTS: The Decision Board was administered to 175 patients; 98% reported that the Decision Board was easy to understand, and 81% indicated that it helped them make a decision. The average score on a true/false test of comprehension was 11.8 of 14 (84%) (range, 6 to 14). Surgeons found the Decision Board to be helpful in presenting information to patients in 91% of consultations. The rate of breast-conserving surgery decreased when the Decision Board was introduced (88% v 73%, P =.001) CONCLUSION: The Decision Board is a simple method to improve communication and facilitate shared decision making. It was well accepted by patients and surgeons and easily applied in the community. FAU - Whelan, T AU - Whelan T AD - Supportive Cancer Care Research Unit and Departments of Medicine, Clinical Epidemiology and Biostatistics, and Surgery, McMaster University, Hamilton, Ontario, Canada. tim_whelan@hrcc.on.ca FAU - Levine, M AU - Levine M FAU - Gafni, A AU - Gafni A FAU - Sanders, K AU - Sanders K FAU - Willan, A AU - Willan A FAU - Mirsky, D AU - Mirsky D FAU - Schnider, D AU - Schnider D FAU - McCready, D AU - McCready D FAU - Reid, S AU - Reid S FAU - Kobylecky, A AU - Kobylecky A FAU - Reed, K AU - Reed K LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/diagnosis/radiotherapy/*surgery MH - *Choice Behavior MH - Disease Management MH - Female MH - Humans MH - *Informed Consent MH - *Mastectomy/statistics & numerical data MH - *Mastectomy, Segmental/statistics & numerical data MH - Middle Aged MH - Patient Acceptance of Health Care MH - Patient Education as Topic/*methods MH - Time Factors EDAT- 1999/11/24 MHDA- 1999/11/24 00:01 CRDT- 1999/11/24 00:00 AID - 10.1200/JCO.1999.17.6.1727 [doi] PST - ppublish SO - J Clin Oncol. 1999 Jun;17(6):1727-35. PMID- 10478127 OWN - NLM STAT- MEDLINE DA - 20000217 DCOM- 20000217 LR - 20151119 IS - 0741-5206 (Print) IS - 0741-5206 (Linking) VI - 19 IP - 1 DP - 1999 Spring TI - Breast restoration decision making. PG - 22-9 AB - Women diagnosed with breast cancer have many physiological and psychological adjustments to make following mastectomy. The present study described in this article sought to determine the decision-making patterns used by two groups of women. Nurses need to be well informed and professionally confident to provide the individualized care and support deserved by women throughout the breast cancer trajectory. A major outcome of such professional care is confident women who understand their disease, treatments, and methods to manage stresses as they occur. FAU - Reaby, L L AU - Reaby LL AD - School of Nursing, Faculty of Applied Science, University of Canberra, Australia. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Plast Surg Nurs JT - Plastic surgical nursing : official journal of the American Society of Plastic and Reconstructive Surgical Nurses JID - 8403490 SB - N MH - Adult MH - Aged MH - Breast Neoplasms/nursing/*psychology/*surgery MH - *Decision Making MH - Decision Support Techniques MH - Female MH - Humans MH - Mammaplasty/nursing/*psychology MH - Mastectomy/adverse effects/nursing/*psychology MH - Middle Aged MH - Models, Psychological MH - Nursing Methodology Research MH - Patient Education as Topic/methods MH - Social Support MH - Surveys and Questionnaires EDAT- 1999/09/09 09:00 MHDA- 2000/02/19 09:00 CRDT- 1999/09/09 09:00 PST - ppublish SO - Plast Surg Nurs. 1999 Spring;19(1):22-9. PMID- 10467873 OWN - NLM STAT- MEDLINE DA - 19991021 DCOM- 19991021 LR - 20071115 IS - 1023-9332 (Print) IS - 1023-9332 (Linking) VI - 5 IP - 4 DP - 1999 TI - [Evidence-based medicine: modern scientific methods for determining usefulness]. PG - 177-82 AB - For quite some time, clinical epidemiology has introduced the art of critical appraisal of evidence as well as the methods of how to design sound clinical studies and trials. Almost unnoticed by most medical institutions a new hierarchy of evidence has emerged which puts well thought out trials, able to document unbiased treatment benefit in terms of patient suffering, above pathophysiological theory. Many controlled trials have shown, in the meantime, that the control of laboratory or other kind of pathologies and the correction of anatomical abnormalities do not necessarily mean a benefit for the patient. Concepts relating to this dissection of evidence include: Surrogate fallacy ("cosmetics" of laboratory results or ligament or cartilage "cosmetics" in surgery), confounding (spurious causal relationships), selection bias (comparison with selected groups) as well as lead-time bias (mistaking earlier diagnosis as increase of survival), length bias (overlooking differences in the aggressiveness of diseases as determinants of disease stage distributions) and overdiagnosis bias (mistaking the increasing detection of clinically silent pathologies as improvement of prognosis). Moreover, absolute instead of relative risk reduction needs to be used to measure patient benefit. The incorporation of decision-analysis and of the concepts or clinical epidemiology will improve the efficiency and quality of medicine much more effectively than the sole focus on technical medical performance. Evidence based medicine is the systematic and critical appraisal of medical interventions, based on the understanding how to avoid the fallacies and biases mentioned. FAU - Schmidt, J G AU - Schmidt JG AD - Institut fur Klinische Epidemiologie, Einsiedeln. LA - ger PT - English Abstract PT - Journal Article TT - Evidence Based Medicine: Moderne wissenschaftliche Methoden zur Bestimmung des Nutzens. PL - Switzerland TA - Swiss Surg JT - Swiss surgery = Schweizer Chirurgie = Chirurgie suisse = Chirurgia svizzera JID - 9514313 SB - IM MH - Adult MH - Aged MH - Bias (Epidemiology) MH - Breast Neoplasms/mortality/surgery MH - *Clinical Trials as Topic/statistics & numerical data MH - Decision Support Techniques MH - *Evidence-Based Medicine MH - Female MH - Humans MH - Mastectomy, Radical/statistics & numerical data MH - Mastectomy, Segmental/statistics & numerical data MH - Middle Aged MH - Outcome and Process Assessment (Health Care)/statistics & numerical data MH - Patient Satisfaction MH - Prognosis EDAT- 1999/09/01 MHDA- 1999/09/01 00:01 CRDT- 1999/09/01 00:00 PST - ppublish SO - Swiss Surg. 1999;5(4):177-82. PMID- 10424830 OWN - NLM STAT- MEDLINE DA - 19990930 DCOM- 19990930 LR - 20170214 IS - 0272-989X (Print) IS - 0272-989X (Linking) VI - 19 IP - 3 DP - 1999 Jul-Sep TI - Evaluation of a shared decision making program for women suspected to have a genetic predisposition to breast cancer: preliminary results. PG - 230-41 AB - BACKGROUND: Women suspected to have a genetic predisposition to breast cancer face the difficult choice between regular breast cancer screening and prophylactic mastectomy. The authors developed a shared decision making program (SDMP) to support this decision. OBJECTIVES: To evaluate the SDMP in terms of practicality, beneficial effects, and patient satisfaction. DESIGN: A one-group pretest-posttest design was used. MEASURES: Decision uncertainty, decision burden, subjective knowledge, and risk comprehension were assessed before and after the SDMP. Additional measures were obtained for concepts related to breast cancer concern, desire to participate in the program, satisfaction, program acceptability, and emotional reaction to the program information. RESULTS: Seventy-two women, most of whom were awaiting the genetic test results, participated. Decision uncertainty (effect size d = 0.37) and decision burden (d = 0.41) were reduced by the SDMP. Subjective knowledge (averaged d = 0.94) and risk comprehension were improved. The women were satisfied with the SDMP and found its rationale acceptable. Women who had strong emotional reactions to the information benefited less from the SDMP, whereas women with strong desires to participate in the decision benefited more. CONCLUSIONS: There is a need to give patients more information, especially about prophylactic mastectomy and among gene carriers. Beneficial effects were observed irrespective of whether genetic status was known, suggesting that information concerning treatment options should be made available as soon as DNA testing begins. The better psychological outcomes of women with stronger desires to participate may arise because the desire to participate is characteristic of emotional stability. FAU - Stalmeier, P F AU - Stalmeier PF AD - Nijmegen Institute for Cognition and Information, The Netherlands. Stalmeier@nici.kun.nl FAU - Unic, I J AU - Unic IJ FAU - Verhoef, L C AU - Verhoef LC FAU - Van Daal, W A AU - Van Daal WA LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Med Decis Making JT - Medical decision making : an international journal of the Society for Medical Decision Making JID - 8109073 SB - IM MH - Adult MH - Breast Neoplasms/*genetics/prevention & control/psychology MH - Cost of Illness MH - *Decision Making MH - Decision Support Techniques MH - Female MH - Genetic Predisposition to Disease/*genetics/psychology MH - Genetic Testing/psychology MH - Heterozygote Detection MH - Humans MH - Mass Screening/psychology MH - Mastectomy, Modified Radical/psychology MH - Middle Aged MH - *Patient Participation MH - Patient Satisfaction MH - Risk Assessment EDAT- 1999/07/29 MHDA- 1999/07/29 00:01 CRDT- 1999/07/29 00:00 AID - 10.1177/0272989X9901900302 [doi] PST - ppublish SO - Med Decis Making. 1999 Jul-Sep;19(3):230-41. PMID- 10394256 OWN - NLM STAT- MEDLINE DA - 19990803 DCOM- 19990803 LR - 20071115 IS - 0040-5957 (Print) IS - 0040-5957 (Linking) VI - 54 IP - 2 DP - 1999 Mar-Apr TI - [Patient-centered consultation of "good practice guidelines": OncoDoc, a decision support system for the management of breast cancer patients]. PG - 209-15 AB - Beyond considerations of cost-effectiveness, clinical practice guidelines (CPG) can reduce practice variations and thus improve the quality of care. However, despite the proliferation of implemented CPG and their wide diffusion thanks to Internet-based technologies, physicians' compliance with formal standards is weak. Developed according to a document-based paradigm, OncoDoc proposes an original framework for implementing CPG. Domain knowledge has been encoded as a decision tree whose branches are both exclusive and exhaustive. This generic knowledge is operationalized at the point of care by the interactive building, through hypertextual navigation, of a patient-based clinical context leading to specific therapeutic recommendations. OncoDoc has first been applied to the management of breast cancer patients and demonstrated within a full-scale experimentation in a clinical setting a compliance of 80 per cent. FAU - Bouaud, J AU - Bouaud J AD - Service d'Informatique Medicale, AP-HP, Universite Paris 6, France. FAU - Seroussi, B AU - Seroussi B FAU - Antoine, E C AU - Antoine EC FAU - Gozy, M AU - Gozy M FAU - Khayat, D AU - Khayat D FAU - Boisvieux, J F AU - Boisvieux JF LA - fre PT - English Abstract PT - Journal Article PT - Review TT - Consultation centree-patient d'un 'guide de bonnes pratiques': OncoDoc, un systeme d'aide a la decision therapeutique applique au cancer du sein. PL - France TA - Therapie JT - Therapie JID - 0420544 SB - IM MH - Breast Neoplasms/economics/*therapy MH - *Decision Making, Computer-Assisted MH - *Decision Support Systems, Clinical MH - Female MH - Humans MH - Internet MH - *Patient-Centered Care MH - Practice Guidelines as Topic RF - 7 EDAT- 1999/07/08 MHDA- 1999/07/08 00:01 CRDT- 1999/07/08 00:00 PST - ppublish SO - Therapie. 1999 Mar-Apr;54(2):209-15. PMID- 10372578 OWN - NLM STAT- MEDLINE DA - 19990803 DCOM- 19990803 LR - 20170214 IS - 0272-989X (Print) IS - 0272-989X (Linking) VI - 18 IP - 4 DP - 1998 Oct-Dec TI - Testing for the BRCA1 and BRCA2 breast-ovarian cancer susceptibility genes: a decision analysis. PG - 365-75 AB - OBJECTIVE: The authors developed a Markov decision model to evaluate the health implications of testing for mutations in the BRCA1 and BRCA2 breast-ovarian cancer susceptibility genes. Prophylactic measures considered included various combinations of immediate and delayed bilateral mastectomy and oophorectomy or taking no action. METHODS: The model incorporated the likelihood of developing breast and/or ovarian cancer, survival, and quality of life. Parameter values were taken from public databases, the published literature, and a survey of cancer experts. Outcomes considered were additional life expectancy and quality-adjusted life years (QALYs). Results are reported for 30-year-old cancer-free women at various levels of hereditary risk. RESULTS AND CONCLUSIONS: The vast majority of women will not benefit from testing because their pre-test risks are low and surgical prophylaxis is undesirable. However, women who have family histories of early breast and/or ovarian cancer may gain up to 2 QALYs by allowing genetic testing to inform their decisions. FAU - Tengs, T O AU - Tengs TO AD - School of Social Ecology, University of California at Irvine, 92697-7075, USA. tengs@uci.edu FAU - Winer, E P AU - Winer EP FAU - Paddock, S AU - Paddock S FAU - Aguilar-Chavez, O AU - Aguilar-Chavez O FAU - Berry, D A AU - Berry DA LA - eng GR - P50 CA68438/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. PL - United States TA - Med Decis Making JT - Medical decision making : an international journal of the Society for Medical Decision Making JID - 8109073 SB - IM MH - Adult MH - Aged MH - Breast Neoplasms/epidemiology/genetics/prevention & control MH - *Decision Support Techniques MH - Female MH - Genes, BRCA1/*physiology MH - Genes, Tumor Suppressor/*physiology MH - Genetic Predisposition to Disease MH - *Genetic Testing MH - Humans MH - Incidence MH - Markov Chains MH - Mastectomy MH - Middle Aged MH - Ovarian Neoplasms/epidemiology/genetics/prevention & control MH - Ovariectomy MH - Predictive Value of Tests MH - Quality-Adjusted Life Years MH - Risk Assessment/*methods MH - Survival Analysis MH - United States/epidemiology EDAT- 1999/06/18 MHDA- 1999/06/18 00:01 CRDT- 1999/06/18 00:00 AID - 10.1177/0272989X9801800402 [doi] PST - ppublish SO - Med Decis Making. 1998 Oct-Dec;18(4):365-75. PMID- 10339125 OWN - NLM STAT- MEDLINE DA - 19990223 DCOM- 19990223 LR - 20071115 IS - 1094-2521 (Print) IS - 1094-2521 (Linking) VI - 4 IP - 12 DP - 1998 Dec TI - Program finds a better way to manage breast cancer. PG - 186-8 AB - Women faced with a breast cancer diagnosis often find that inattention to their psychosocial needs is nearly as problematic as the disease itself. Find out how this model breast cancer program fills that void. LA - eng PT - Journal Article PL - United States TA - Healthc Demand Dis Manag JT - Healthcare demand & disease management JID - 9891547 SB - H MH - Adult MH - Breast Neoplasms/diagnosis/*psychology/surgery MH - Decision Making MH - *Disease Management MH - Female MH - Humans MH - Mastectomy/psychology MH - Patient Care Planning MH - Patient Education as Topic MH - *Social Support MH - Stress, Psychological MH - Texas MH - Time Management EDAT- 1999/05/26 MHDA- 1999/05/26 00:01 CRDT- 1999/05/26 00:00 PST - ppublish SO - Healthc Demand Dis Manag. 1998 Dec;4(12):186-8. PMID- 9926781 OWN - NLM STAT- MEDLINE DA - 19990211 DCOM- 19990211 LR - 20071115 IS - 0002-9610 (Print) IS - 0002-9610 (Linking) VI - 176 IP - 6 DP - 1998 Dec TI - How breast cancer treatment decisions are made by women in North Dakota. PG - 515-9 AB - BACKGROUND: Although equally effective, women in rural midwestern states choose modified radical mastectomy (MRM) over breast conservation surgery for early stage breast cancer. This study assessed treatment decisions by the women of North Dakota. METHODS: Surveys were sent to women treated for early stage breast cancer from 1990 through 1992. Separate surveys were sent out to surgeons in the state. The questions assessed physician and patient perceptions of treatment and the decision making process. RESULTS: A majority of surgeons believed that the long-term and disease-free survival was equal and that the preference for choosing MRM was due mostly to inconvenience of radiotherapy. The women reported that the surgeon was the most influential in the treatment decision and that concerns over radiation, duration of treatment, and travel restrictions all were factors in the decision. CONCLUSIONS: Education of surgeons and patients plus the early involvement of the radiation oncologist in discussing options is essential in the treatment of early stage breast cancer. FAU - Stafford, D AU - Stafford D AD - University of North Dakota Department of Surgery, Altru Health System, Grand Forks 58206, USA. FAU - Szczys, R AU - Szczys R FAU - Becker, R AU - Becker R FAU - Anderson, J AU - Anderson J FAU - Bushfield, S AU - Bushfield S LA - eng PT - Journal Article PL - United States TA - Am J Surg JT - American journal of surgery JID - 0370473 SB - AIM SB - IM MH - Aged MH - Breast Neoplasms/pathology/radiotherapy/*surgery MH - *Decision Making MH - Female MH - Humans MH - *Mastectomy, Radical MH - *Mastectomy, Segmental MH - Middle Aged MH - Neoplasm Staging MH - North Dakota MH - Patient Education as Topic MH - Physician-Patient Relations MH - Prognosis MH - Radiation Oncology MH - Rural Population EDAT- 1999/02/02 MHDA- 1999/02/02 00:01 CRDT- 1999/02/02 00:00 AID - S0002-9610(98)00257-8 [pii] PST - ppublish SO - Am J Surg. 1998 Dec;176(6):515-9. PMID- 9917577 OWN - NLM STAT- MEDLINE DA - 19990204 DCOM- 19990204 LR - 20091119 IS - 0002-838X (Print) IS - 0002-838X (Linking) VI - 59 IP - 1 DP - 1999 Jan 01 TI - Screening for genetic risk of breast cancer. PG - 99-104, 106 AB - Approximately 10 to 15 percent of all breast cancers are thought to be familial and about one third of these cases are due to an inherited mutation in a BRCA1 or BRCA2 breast cancer-susceptibility gene. The lifetime incidence of breast cancer in mutation carriers is above 50 percent, and carriers of BRCA1 mutation also have a substantially increased risk of ovarian cancer. BRCA1 and 2 mutations are associated with early-onset breast cancer, and some experts call for aggressive screening of affected persons. Monthly self-examination of the breasts beginning at age 18 and annual clinical examinations and mammography after age 25 have been recommended but are of unproven benefit. Prophylactic mastectomy and oophorectomy have been advocated by some authorities, but these interventions are disfiguring and for some carriers of the gene, they are unnecessary. The patient's decision to undergo genetic screening is complicated by the technical difficulty of the test, the substantial cost and the still incomplete understanding of the penetrance of disease in known mutation carriers. FAU - Rosenthal, T C AU - Rosenthal TC AD - Department of Family Medicine, State University of New York at Buffalo, USA. FAU - Puck, S M AU - Puck SM LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review PL - United States TA - Am Fam Physician JT - American family physician JID - 1272646 SB - AIM SB - IM CIN - Am Fam Physician. 1999 Jan 1;59(1):43-4, 46. PMID: 9917573 MH - Algorithms MH - Breast Neoplasms/*genetics/prevention & control MH - Decision Making MH - Female MH - Genes, BRCA1/genetics MH - Genes, Tumor Suppressor/*genetics MH - *Genetic Testing MH - *Heterozygote MH - Humans MH - *Mutation MH - Patient Education as Topic MH - Practice Guidelines as Topic MH - Teaching Materials RF - 23 EDAT- 1999/01/26 MHDA- 1999/01/26 00:01 CRDT- 1999/01/26 00:00 PST - ppublish SO - Am Fam Physician. 1999 Jan 1;59(1):99-104, 106. PMID- 9807191 OWN - NLM STAT- MEDLINE DA - 19990113 DCOM- 19990113 LR - 20140912 IS - 0256-9574 (Print) VI - 88 IP - 10 DP - 1998 Oct TI - A review of selection criteria used by medical scheme advisers to approve or deny procedures with a cosmetic component. PG - 1334-7 AB - OBJECTIVE: To review and apply statistical tests to the selection criteria used by two medical advisers to approve or deny applications for three common cosmetic or reconstructive procedures within a large group of medical schemes. DESIGN: A retrospective descriptive study which applied multiple regression analysis, frequency analysis, comparison of means and simple correlations to the data sets for three procedures. SETTING: Administrative records from the clinical files of medical advisers and the administrator's claims database. SUBJECTS: Data were reviewed for 1,143 members who, between January and December 1996, submitted applications for breast reduction, excimer laser refractive surgery, or otoplasty. MAIN OUTCOME MEASURES: The primary outcome measure was the statistical relationship between medical advisers' selection criteria and final decision. In addition, the financial implications of these cosmetic/reconstructive procedures were assessed. RESULTS: For the three procedures reviewed there was a statistically significant relationship between 5 of 13 preoperative criteria requested and the medical advisers' opinion. Excimer laser surgery was generally approved on the basis of the refractive error (myopia > -3.00; astigmatism > -1.5 dioptres); otoplasty was generally approved for children aged > or = 12 years; and breast reduction was usually covered for women with a sternal-nipple distance > 29.0 cm and with a cup size > or = DD. The other data submitted were similarly distributed between the approved and denied groups. CONCLUSIONS: Review of medical advisers' decisions is important in an era of protocols, guidelines and 'standard operating procedures'. Selection criteria for approval of applications for medically necessary cosmetic/reconstructive surgery must be reviewed and revised to provide a reliable, reproducible and statistically valid process. FAU - Rothberg, A D AU - Rothberg AD AD - Medscheme Managed Healthcare Division, Randburg, Gauteng. FAU - Desmond Sonnenfeld, E AU - Desmond Sonnenfeld E FAU - Mogari, D AU - Mogari D LA - eng PT - Journal Article PL - South Africa TA - S Afr Med J JT - South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde JID - 0404520 SB - IM CIN - S Afr Med J. 1999 Mar;89(3):212, 214. PMID: 10226660 CIN - S Afr Med J. 1999 Aug;89(8):814-5. PMID: 10488347 MH - Child MH - Data Interpretation, Statistical MH - Ear, External/surgery MH - Female MH - Health Care Costs/statistics & numerical data/trends MH - Humans MH - *Insurance Claim Review MH - *Insurance Coverage MH - Lasers, Excimer MH - Mammaplasty/economics MH - Photorefractive Keratectomy/economics MH - Reconstructive Surgical Procedures/*economics MH - Retrospective Studies EDAT- 1998/11/10 MHDA- 1998/11/10 00:01 CRDT- 1998/11/10 00:00 PST - ppublish SO - S Afr Med J. 1998 Oct;88(10):1334-7. PMID- 9719120 OWN - NLM STAT- MEDLINE DA - 19980831 DCOM- 19980831 LR - 20131121 IS - 0360-3016 (Print) IS - 0360-3016 (Linking) VI - 41 IP - 5 DP - 1998 Jul 15 TI - Analysis of cause-specific failure endpoints using simple proportions: an example from a randomized controlled clinical trial in early breast cancer. PG - 1093-7 AB - PURPOSE: To describe a statistically valid method for analyzing cause-specific failure data based on simple proportions, that is easy to understand and apply, and outline under what conditions its implementation is well-suited. METHODS AND MATERIALS: In the comparison of treatment groups, time to first failure (in any site) was analyzed first, followed by an analysis of the pattern of first failure, preferably at the latest complete follow-up time common to each group. RESULTS: A retrospective analysis of time to contralateral breast cancer in 777 early breast cancer patients was undertaken. Patients previously treated by mastectomy plus radiation therapy to the chest wall and regional nodal areas were randomized to receive further radiation and prednisone (R+P), radiation alone (R), or no further treatment (NT). Those randomized to R+P had a statistically significantly delayed time to first failure compared to the group randomized to NT (p = 0.0008). Patients randomized to R also experienced a delayed time to first failure compared to NT, but the difference was not statistically significant (p = 0.14). At 14 years from the date of surgery (the latest common complete follow-up time) the distribution of first failures was statistically significantly different between R+P and NT (p = 0.005), but not between R and NT (p = 0.09). The contralateral breast cancer first failure rate at 14 years from surgery was 7.2% for NT, 4.6% for R, and 3.7% for R+P. The corresponding Kaplan-Meier estimates were 13.2%, 8.2%, and 5.4%, respectively. CONCLUSION: Analyzing cause-specific failure data using methods developed for survival endpoints is problematic. We encourage the use of the two-step analysis strategy described when, as in the example presented, competing causes of failure are not likely to be statistically independent, and when a treatment comparison at a single time-point is clinically relevant and feasible; that is, all patients have complete follow-up to this point. FAU - Panzarella, T AU - Panzarella T AD - Biostatistics Department, Princess Margaret Hospital, Toronto, Ontario, Canada. FAU - Meakin, J W AU - Meakin JW LA - eng PT - Clinical Trial PT - Journal Article PT - Randomized Controlled Trial PL - United States TA - Int J Radiat Oncol Biol Phys JT - International journal of radiation oncology, biology, physics JID - 7603616 RN - 0 (Antineoplastic Agents, Hormonal) RN - VB0R961HZT (Prednisone) SB - IM MH - Adult MH - Aged MH - Antineoplastic Agents, Hormonal/therapeutic use MH - Breast Neoplasms/drug therapy/mortality/pathology/*radiotherapy/*surgery MH - Combined Modality Therapy MH - *Data Interpretation, Statistical MH - Female MH - Humans MH - Middle Aged MH - Prednisone/therapeutic use MH - Radiotherapy Dosage MH - Retrospective Studies MH - Time Factors MH - Treatment Failure EDAT- 1998/08/27 MHDA- 1998/08/27 00:01 CRDT- 1998/08/27 00:00 AID - S0360-3016(98)00146-1 [pii] PST - ppublish SO - Int J Radiat Oncol Biol Phys. 1998 Jul 15;41(5):1093-7. PMID- 9704741 OWN - NLM STAT- MEDLINE DA - 19980831 DCOM- 19980831 LR - 20170210 IS - 0732-183X (Print) IS - 0732-183X (Linking) VI - 16 IP - 8 DP - 1998 Aug TI - Decision-making about breast cancer susceptibility testing: how similar are the attitudes of physicians, nurse practitioners, and at-risk women? PG - 2868-76 AB - PURPOSE: To determine what consumers and providers would want to discuss about breast cancer susceptibility testing (BCST) and their preferred role in testing decisions. METHODS: We surveyed 426 at-risk women, 143 nurse practitioners, and 296 physicians in five specialties in Maryland. RESULTS: All groups believe it is important to discuss how the chance of breast cancer can be reduced and what the chances are of getting breast cancer if the test is positive. Both provider groups attributed more importance than consumers to discussing whether cancer can occur if the test is negative. Discussing the risk of depression and anxiety was more important to providers than consumers. Eighty-two percent of women would want their providers to make a recommendation about testing, but only 43% of nurse practitioners and 68% of physicians would do so. Eighteen percent of physicians underestimated the importance of informed consent for testing and 34% of discussing the risk of insurance discrimination. Fewer than 6% of women, if found to have a mutation, would be likely to undergo prophylactic mastectomy, whereas 12% of nurse practitioners and 34% of physicians would be likely to recommend such surgery. One third of respondents in all three groups supported testing a 13-year old daughter of a mutation-carrier. CONCLUSION: Physicians should place greater value on informed consent and discussing practical aspects of testing, and physicians and nurse practitioners should pay more attention to the limitations of testing children, insurance discrimination, and consumers' desire for provider recommendations. In light of the limited discordance between nurse practitioners and consumers, nurse practitioners can play an increasing role in education and counseling about BCST. FAU - Geller, G AU - Geller G AD - Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA. ggeller@welchlink.welch.jhu.edu FAU - Bernhardt, B A AU - Bernhardt BA FAU - Doksum, T AU - Doksum T FAU - Helzlsouer, K J AU - Helzlsouer KJ FAU - Wilcox, P AU - Wilcox P FAU - Holtzman, N A AU - Holtzman NA LA - eng GR - R01 NR04062-01/NR/NINR NIH HHS/United States PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 SB - E SB - IM MH - Adult MH - *Attitude of Health Personnel MH - Breast Neoplasms/*genetics/prevention & control/psychology MH - Decision Making MH - Disease Susceptibility MH - Female MH - Genetic Testing/*psychology MH - Humans MH - Informed Consent MH - Medicine MH - Middle Aged MH - Nurse Practitioners/psychology MH - Patient Education as Topic MH - Risk Factors MH - Specialization MH - Surveys and Questionnaires OID - KIE: 110557 OID - NRCBL: VF 9.5.5 OTO - KIE OT - Empirical Approach OT - Genetics and Reproduction GN - KIE: 38 refs. GN - KIE: KIE Bib: genetic screening EDAT- 1998/08/15 MHDA- 1998/08/15 00:01 CRDT- 1998/08/15 00:00 AID - 10.1200/JCO.1998.16.8.2868 [doi] PST - ppublish SO - J Clin Oncol. 1998 Aug;16(8):2868-76. PMID- 9681904 OWN - NLM STAT- MEDLINE DA - 19981015 DCOM- 19981015 LR - 20060807 IS - 0277-9536 (Print) IS - 0277-9536 (Linking) VI - 47 IP - 3 DP - 1998 Aug TI - The physician-patient encounter: the physician as a perfect agent for the patient versus the informed treatment decision-making model. PG - 347-54 AB - Assuming a goal of arriving at a treatment decision which is based on the physician's knowledge and the patient's preferences, we discuss the feasibility of implementing two treatment decision-making models: (1) the physician as a perfect agent for the patient, and (2) the informed treatment decision-making models. Both models fall under the rubric of agency models, however, the requirements from the physician and the patient are different. An important distinction between the two models is that in the former the patient delegates authority to her doctor to make medical decisions and thus the challenge is to encourage the physician to find out the patient's preferences. In the latter, the patient retains the authority to make medical decisions and the physician role is that of information transfer. The challenge here is to encourage the physician to transfer the knowledge in a clear and nonbiased way. We argue that the choice of model depends among other things on the ease of implementation (e.g., is it simpler to transfer patient's preferences to doctors or to transfer technical knowledge to patients?). Also the choice of treatment decision-making model is likely to have an impact on the type of incentives or regulations (i.e., contracts) needed to promote the chosen model. We show that in theory both models result in the same outcome. We argue that the approach of transferring information to the patient is easier (but not easy) and, hence, more feasible than transferring each patient's preferences to the physician in each medical encounter. We also argue that because better "technology" exists to transfer medical information to patients and time costs are involved in both tasks (i.e. transferring preferences or information), it is more feasible to design contracts to motivate physicians to transfer information to patients than to design contracts to motivate physicians to find out their patients' utility functions. We illustrate our arguments using a clinical example of the choice of adjuvant chemotherapy versus no adjuvant chemotherapy for women with early stage breast cancer. We also discuss issues relating to the current realities of clinical practice and their potential implications for the way that economists model physician-patient clinical encounters. FAU - Gafni, A AU - Gafni A AD - Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada. FAU - Charles, C AU - Charles C FAU - Whelan, T AU - Whelan T LA - eng PT - Journal Article PL - England TA - Soc Sci Med JT - Social science & medicine (1982) JID - 8303205 SB - E SB - IM CIN - Soc Sci Med. 1998 Aug;47(3):355-6. PMID: 9681905 MH - Breast Neoplasms/drug therapy MH - Chemotherapy, Adjuvant MH - *Decision Making MH - Decision Support Techniques MH - Female MH - Humans MH - *Informed Consent MH - *Patient Advocacy MH - Patient Care Planning MH - *Patient Participation MH - Physician-Patient Relations OID - KIE: 127957 OID - NRCBL: VF 8.1 OTO - KIE OT - Analytical Approach OT - Professional Patient Relationship GN - KIE: 49 refs. GN - KIE: KIE Bib: professional patient relationship EDAT- 1998/07/29 MHDA- 1998/07/29 00:01 CRDT- 1998/07/29 00:00 AID - S0277953698000914 [pii] PST - ppublish SO - Soc Sci Med. 1998 Aug;47(3):347-54. PMID- 9679991 OWN - NLM STAT- MEDLINE DA - 19980921 DCOM- 19980921 LR - 20170214 IS - 0272-989X (Print) IS - 0272-989X (Linking) VI - 18 IP - 3 DP - 1998 Jul-Sep TI - Assessment of the time-tradeoff values for prophylactic mastectomy of women with a suspected genetic predisposition to breast cancer. PG - 268-77 AB - BACKGROUND: Female carriers of the breast-cancer-susceptibility genes BRCA1 and BRCA2 are at high risk for breast cancer (85%). They face the choice between prophylactic mastectomy (PM) and breast cancer screening. For this treatment choice, a shared-decision-making program was developed. In this program, the time tradeoff (TTO) was used to assess preferences for PM. PURPOSE: Assessment of the feasibility, constant proportional tradeoff, and reliability of using the TTO for this purpose. METHODS: Fifty-four women suspected to carry the BRCA1/2 mutation were provided with comprehensive relevant information. Their preferences for PM were assessed on two occasions. Discrepancies between preferences indicated by the two tests were resolved by testing a third time. The preferences assessed on the last occasion were used for individual decision analyses. In order to test constant proportional tradeoff, the TTO consisted of four items with different numbers of life years. RESULTS: Forty-two women (78%) completed the TTO twice and nine women (17%) performed the test a third time. Three women (5%) completed the TTO only once. The mean TTO value for PM at the last replication was 0.69 (SD=0.30). Violations of constant proportional tradeoff were significant: the largest tradeoffs were recorded for the shortest durations. Pearson's correlation coefficient between the TTO values for the two last sessions was 0.96. CONCLUSION: Assessment of individual preferences by the TTO in this patient group is feasible and reliable. Therefore, the TTO can be used in clinical settings to elicit treatment preferences of women proven or suspected to have a genetic predisposition to breast cancer. FAU - Unic, I AU - Unic I AD - Institute for Radiotherapy, Radboud University Hospital, Nijmegen, The Netherlands. FAU - Stalmeier, P F AU - Stalmeier PF FAU - Verhoef, L C AU - Verhoef LC FAU - van Daal, W A AU - van Daal WA LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Med Decis Making JT - Medical decision making : an international journal of the Society for Medical Decision Making JID - 8109073 SB - IM MH - Adult MH - Aged MH - Breast Neoplasms/*genetics/*prevention & control/psychology MH - *Choice Behavior MH - *Decision Support Techniques MH - Feasibility Studies MH - Female MH - Genes, BRCA1/genetics MH - Genetic Predisposition to Disease MH - Heterozygote MH - Humans MH - Life Expectancy MH - Mass Screening MH - *Mastectomy/adverse effects MH - Middle Aged MH - Patient Education as Topic/methods MH - Patient Participation/*methods/psychology MH - Primary Prevention/*methods MH - Reproducibility of Results MH - Surveys and Questionnaires/standards MH - Time Factors EDAT- 1998/07/29 MHDA- 1998/07/29 00:01 CRDT- 1998/07/29 00:00 AID - 10.1177/0272989X9801800303 [doi] PST - ppublish SO - Med Decis Making. 1998 Jul-Sep;18(3):268-77. PMID- 9656665 OWN - NLM STAT- MEDLINE DA - 19980728 DCOM- 19980728 LR - 20170410 IS - 0026-1270 (Print) IS - 0026-1270 (Linking) VI - 37 IP - 2 DP - 1998 Jun TI - Interactive video assists in clinical decision making. PG - 201-5 AB - The Hawaii Quality and Cost Consortium began a project in 1993 to implement and evaluate interactive videodisk programs to assist in clinical decision-making for breast cancer. Communication problems between physicians and patients, limitations of available outcomes data and varying preferences of individual patients can result in treatment outcomes that are less than satisfactory. Shared Decision-making Programs (SDPs) were developed by the Foundation for Informed Medical Decision Making (FIMDM) in Hanover, New Hampshire, to assist in the treatment decision-making process. Utilizing interactive videodisks, the programs provide patients with clear, unbiased information about available treatment options. With this information, patients can become more active participants in making treatment decisions. The SDPs for breast cancer were implemented at two sites in Hawaii. Evaluation data from 103 patients overwhelmingly indicate that patients find the programs clear, balanced and very good or excellent in terms of the amount of information presented and overall rating. FAU - Gramlich, E P AU - Gramlich EP AD - Hawaii Quality and Cost Consortium, Pacific Health Research Institute, Honolulu, USA. gramlich@jabsom.biomed.hawaii.edu FAU - Waitzfelder, B E AU - Waitzfelder BE LA - eng PT - Journal Article PL - Germany TA - Methods Inf Med JT - Methods of information in medicine JID - 0210453 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Attitude of Health Personnel MH - Breast Neoplasms/*surgery MH - *Decision Making MH - Decision Making, Organizational MH - Decision Support Techniques MH - Female MH - Follow-Up Studies MH - Hawaii MH - Humans MH - Mastectomy MH - Middle Aged MH - Minimally Invasive Surgical Procedures MH - Patient Education as Topic MH - *Patient Participation MH - Patient Satisfaction MH - Physician-Patient Relations MH - Program Evaluation MH - Treatment Outcome MH - *Videotape Recording EDAT- 1998/07/10 MHDA- 1998/07/10 00:01 CRDT- 1998/07/10 00:00 AID - 98020201 [pii] PST - ppublish SO - Methods Inf Med. 1998 Jun;37(2):201-5. PMID- 9638787 OWN - NLM STAT- MEDLINE DA - 19980916 DCOM- 19980916 LR - 20141120 IS - 1057-9249 (Print) IS - 1057-9249 (Linking) VI - 7 IP - 3 DP - 1998 May-Jun TI - 'You don't want to lose your ovaries because you think 'I might become a man". Women's perceptions of prophylactic surgery as a cancer risk management option. PG - 263-75 AB - This preliminary study provides insight into the meaning of prophylactic surgery as a risk management strategy for women who have a familial risk of breast or ovarian cancer. Data were collected during observations of genetic consultations and in semi-structured interviews with 41 women following their attendance at genetic counselling. The option of prophylactic surgery was raised in 29 consultations and discussed in 35 of the post-clinic interviews. Fifteen women said they would consider having an oophorectomy in the future and nine said they would consider having a mastectomy. The implications of undergoing oophorectomy and mastectomy were discussed during the post-clinic interviews. Prophylactic surgery was described by the counsellees as providing individuals with a means to (a) fulfil their obligations to other family members and (b) reduce risk and contain their fear of cancer. The costs of this form of risk management, were described as: (a) compromising social obligations; (b) upsetting the natural balance of the body; (c) not offering protection from cancer; (d) operative and post-operative complications; (e) the onset of menopause (f) the effects on body image, gender and personal identity and (g) potential effects on sexual relationships. FAU - Hallowell, N AU - Hallowell N AD - Centre for Family Research, Faculty of Social and Political Sciences, University of Cambridge, UK. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Psychooncology JT - Psycho-oncology JID - 9214524 SB - IM MH - Adult MH - Body Image MH - Cost of Illness MH - Decision Making MH - Elective Surgical Procedures/*psychology MH - England MH - *Family Health MH - Female MH - Follow-Up Studies MH - Gender Identity MH - Humans MH - Interview, Psychological MH - Mastectomy/*psychology MH - Menopause/psychology MH - Middle Aged MH - Neoplasms/genetics/prevention & control/*psychology/surgery MH - Observation MH - Ovariectomy/*psychology MH - *Patient Acceptance of Health Care MH - Patient Education as Topic MH - Risk Assessment MH - Social Responsibility MH - Women's Health EDAT- 1998/06/25 MHDA- 1998/06/25 00:01 CRDT- 1998/06/25 00:00 AID - 10.1002/(SICI)1099-1611(199805/06)7:3<263::AID-PON307>3.0.CO;2-Q [doi] PST - ppublish SO - Psychooncology. 1998 May-Jun;7(3):263-75. PMID- 9638786 OWN - NLM STAT- MEDLINE DA - 19980916 DCOM- 19980916 LR - 20071115 IS - 1057-9249 (Print) IS - 1057-9249 (Linking) VI - 7 IP - 3 DP - 1998 May-Jun TI - The quality and coping patterns of women's decision-making regarding breast cancer surgery. PG - 252-62 AB - This study addressed issues regarding the decision-making process used by women who had mastectomy as their surgical treatment for breast cancer. The seven criteria for quality decision-making and the conflict model proposed by Janis and Mann (1977) were used as the study's conceptual framework along with the notion by Simon (1957) of 'bounded rationality'. Four coping patterns emerged: vigilance (actively searches for information and advice), satisficing (being satisfied, chooses first solution that meets the desired objectives), complacency (accepts advice without questions or fully comprehending), and defensive avoidance (rationalises and avoids discussion and consideration of the problem). The participants primarily left the decision for surgical treatment of breast cancer to their surgeons using satisficing, complacency and defensive avoidance. When the option of lumpectomy was offered to some of the participants (34%), they rejected this treatment alternative using the coping patterns of satisfying and defensive avoidance. Those women who were not offered lumpectomy (66%) did not seek a rationale for not being given this alternative. The findings indicated that the women's decision-making process was halted in Stage 2 of the criteria for quality decision-making actively searched for and viewed a number of alternatives. The study's findings are discussed in relation to improving the quality of the decision-making process for women regarding their breast cancer surgical treatment. FAU - Reaby, L L AU - Reaby LL AD - School of Nursing, Faculty of Applied Science, University of Canberra, ACT, Australia. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Psychooncology JT - Psycho-oncology JID - 9214524 SB - IM MH - *Adaptation, Psychological MH - *Breast Neoplasms/psychology/surgery MH - *Decision Making MH - Female MH - Health Surveys MH - Humans MH - Interview, Psychological MH - Mastectomy/*psychology MH - Middle Aged MH - New South Wales MH - *Patient Acceptance of Health Care MH - Patient Education as Topic MH - Patient Participation MH - Physician-Patient Relations MH - Retrospective Studies MH - Women's Health EDAT- 1998/06/25 MHDA- 1998/06/25 00:01 CRDT- 1998/06/25 00:00 AID - 10.1002/(SICI)1099-1611(199805/06)7:3<252::AID-PON309>3.0.CO;2-O [doi] PST - ppublish SO - Psychooncology. 1998 May-Jun;7(3):252-62. PMID- 9527266 OWN - NLM STAT- MEDLINE DA - 19980611 DCOM- 19980611 LR - 20151119 IS - 1068-9265 (Print) IS - 1068-9265 (Linking) VI - 5 IP - 2 DP - 1998 Mar TI - Axillary lymph node dissection for breast cancer: a decision analysis of T1 lesions. PG - 131-9 AB - BACKGROUND: The value of routine axillary dissection for patients with breast cancer is still being debated. The argument centers around whether the information gained by knowing the lymph node status, which aids in making the decision about adjuvant chemotherapy, justifies the morbidity. This study quantitatively analyzes the potential outcomes of routine, selective, and no axillary dissection. METHODS: A decision analysis was performed of the strategies of lumpectomy and radiation versus simple mastectomy followed by no dissection, selective dissection, or routine dissection. Factors included biologic markers to identify high-risk lesions, the morbidity of axillary dissection, the effects of adjuvant chemotherapy on lymph node-negative and lymph node-positive disease, and the life expectancy of patients with high-risk and low-risk node-negative and node-positive lesions. Sensitivity analysis was done to determine threshold levels of these factors in choosing an option. RESULTS: We discovered an advantage in quality-adjusted life expectancy (QALE) for no axillary dissection until the probability of positive lymph nodes reaches >15%; after that, selective node dissection is superior. Selective dissection is superior for lower morbidity rates of axillary dissection. Routine dissection is never a superior strategy. The difference among these strategies is small, however, with no one strategy providing a QALE greater than 1 year longer than any other. CONCLUSIONS: Axillary dissection can be avoided in patients with high-risk lesions who would be candidates for adjuvant chemotherapy regardless of lymph node status, and possibly in patients with low-risk T1a lesions, but it should be recommended for low-risk T1b and T1c lesions for which lymph node status may determine the need for adjuvant chemotherapy. FAU - Velanovich, V AU - Velanovich V AD - Department of Surgery, Henry Ford Hospital, Detroit, Michigan 48202-2689, USA. LA - eng PT - Journal Article PL - United States TA - Ann Surg Oncol JT - Annals of surgical oncology JID - 9420840 RN - 0 (Biomarkers, Tumor) SB - IM SB - X MH - Axilla MH - Biomarkers, Tumor/analysis MH - Breast Neoplasms/drug therapy/pathology/radiotherapy/*surgery MH - Chemotherapy, Adjuvant MH - Decision Making MH - *Decision Support Techniques MH - Female MH - Humans MH - Life Expectancy MH - *Lymph Node Excision/adverse effects MH - Lymph Nodes/pathology MH - Lymphatic Metastasis/pathology MH - Mastectomy, Modified Radical MH - Mastectomy, Segmental MH - Mastectomy, Simple MH - Neoplasm Staging MH - Probability MH - Quality of Life MH - Quality-Adjusted Life Years MH - Radiotherapy, Adjuvant MH - Risk Factors MH - Sensitivity and Specificity MH - Treatment Outcome EDAT- 1998/04/04 MHDA- 1998/04/04 00:01 CRDT- 1998/04/04 00:00 PST - ppublish SO - Ann Surg Oncol. 1998 Mar;5(2):131-9. PMID- 9517288 OWN - NLM STAT- MEDLINE DA - 19980508 DCOM- 19980508 LR - 20071115 IS - 0017-7768 (Print) IS - 0017-7768 (Linking) VI - 134 IP - 2 DP - 1998 Jan 15 TI - [Accessibility of information and informed consent: experiences of breast cancer patients]. PG - 88-92, 160 AB - We studied the social and cultural frameworks that impact on breast cancer patients in the medical system. The subjects were 98 Jewish women who had undergone mastectomy or lumpectomy for cancer 6 months to 3 years prior to the interview. They emanated from a variety of socioeconomic and ethnic backgrounds, and reflected the age range of women with breast cancer in the general Jewish population of Israel. Patients were asked about each stage of the medical process they had experienced: diagnosis, surgery, oncological care, and follow-up care. The interview revealed a general perception of having received insufficient information regarding their medical condition and treatment. The problem tended to be most severe during the diagnostic stage, when women had not yet been officially included as patients within the system. The problem was relatively severe during follow-up care, when they often did not have an address for their questions. Few women received a schedule of follow-up care that allowed them to carry on with the many necessary tests in an orderly and comprehensive manner. Most important, systematic absence of informed consent also characterized the decision-making process regarding surgery and oncological treatment. Few women felt they had been informed about treatment options, side-effects, or long-term implications of the treatment offered. We found no indication of inequitable medical treatment that would suggest a manifest pattern of discrimination, but we did find some social variables related to a feeling of insufficient personal care and information. In particular, older women said they received less attention, support, and information from the medical staff relative to the younger women. FAU - Tabory, E AU - Tabory E AD - Dept. of Sociology and Anthropology, Bar-Ilan University, Ramat Gan. FAU - Sered, S AU - Sered S LA - heb PT - English Abstract PT - Journal Article PL - Israel TA - Harefuah JT - Harefuah JID - 0034351 SB - IM MH - Adult MH - Aged MH - Breast Neoplasms/*psychology/surgery MH - Decision Making MH - Female MH - Humans MH - *Informed Consent MH - Mastectomy MH - Mastectomy, Segmental MH - Middle Aged MH - *Patient Education as Topic MH - Socioeconomic Factors EDAT- 1998/03/28 MHDA- 1998/03/28 00:01 CRDT- 1998/03/28 00:00 PST - ppublish SO - Harefuah. 1998 Jan 15;134(2):88-92, 160. PMID- 9508180 OWN - NLM STAT- MEDLINE DA - 19980324 DCOM- 19980324 LR - 20170210 IS - 0732-183X (Print) IS - 0732-183X (Linking) VI - 16 IP - 3 DP - 1998 Mar TI - Decision analysis of prophylactic mastectomy and oophorectomy in BRCA1-positive or BRCA2-positive patients. PG - 979-85 AB - PURPOSE: Young Ashkenazi Jewish women or those from high-risk families who test positive for BRCA1 or BRCA2 mutant genes have a significant risk of developing breast or ovarian cancer by the age of 70 years. Many question whether they should have prophylactic surgical procedures, ie, bilateral mastectomy and/or oophorectomy. METHODS: A Markov model was developed to determine the survival, quality of life, and cost-effectiveness of prophylactic surgical procedures. The probabilities of developing breast and ovarian cancer were based on literature review among women with the BRCA1 or BRCA2 gene and mortality rates were determined from Surveillance, Epidemiology, and End Results (SEER) data for 1973 to 1992. The costs for hospital and ambulatory care were estimated from Health Care Financing Administration (HCFA) payments in 1995, supplemented by managed care and fee-for-service data. Utility measures for quality-adjusted life-years (QALYs) were explicitly determined using the time-trade off method. Estimated risks for breast and ovarian cancer after prophylactic surgeries were obtained from the literature. RESULTS: For a 30-year-old woman, according to her cancer risks, prophylactic oophorectomy improved survival by 0.4 to 2.6 years; mastectomy, by 2.8 to 3.4 years; and mastectomy and oophorectomy, by 3.3 to 6.0 years over surveillance. The QALYs saved were 0.5 for oophorectomy and 1.9 for the combined procedures in the high-risk model. Prophylactic surgeries were cost-effective compared with surveillance for years of life saved, but not for QALYs. CONCLUSION: Among women who test positive for a BRCA1 or BRCA2 gene mutation, prophylactic surgery at a young age substantially improves survival, but unless genetic risk of cancer is high, provides no benefit for quality of life. Prophylactic surgery is cost-effective for years of life saved compared with other medical interventions that are deemed cost-effective. FAU - Grann, V R AU - Grann VR AD - Herbert Irving Comprehensive Cancer Center of Columbia University, School of Public Health, New York, NY 10032, USA. VRG2@columbia.edu FAU - Panageas, K S AU - Panageas KS FAU - Whang, W AU - Whang W FAU - Antman, K H AU - Antman KH FAU - Neugut, A I AU - Neugut AI LA - eng PT - Journal Article PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 RN - 0 (BRCA2 Protein) RN - 0 (Neoplasm Proteins) RN - 0 (Transcription Factors) SB - IM CIN - J Clin Oncol. 1998 Jul;16(7):2573-5. PMID: 9667284 MH - Adult MH - Aged MH - BRCA2 Protein MH - Breast Neoplasms/genetics/mortality/*prevention & control MH - Cost-Benefit Analysis MH - *Decision Support Techniques MH - Female MH - *Genes, BRCA1 MH - Humans MH - Markov Chains MH - *Mastectomy/economics MH - Middle Aged MH - Mutation MH - Neoplasm Proteins/*analysis MH - Ovarian Neoplasms/genetics/mortality/*prevention & control MH - *Ovariectomy/economics MH - Probability MH - Quality of Life MH - Quality-Adjusted Life Years MH - Risk Factors MH - Survival Analysis MH - Transcription Factors/*analysis EDAT- 1998/03/21 MHDA- 1998/03/21 00:01 CRDT- 1998/03/21 00:00 AID - 10.1200/JCO.1998.16.3.979 [doi] PST - ppublish SO - J Clin Oncol. 1998 Mar;16(3):979-85. PMID- 9289640 OWN - NLM STAT- MEDLINE DA - 19970911 DCOM- 19970911 LR - 20041117 IS - 0028-4793 (Print) IS - 0028-4793 (Linking) VI - 337 IP - 11 DP - 1997 Sep 11 TI - Risk of breast cancer in carriers of BRCA gene mutations. PG - 788; author reply 789 FAU - Meijer, W J AU - Meijer WJ FAU - van Lindert, A C AU - van Lindert AC LA - eng PT - Comment PT - Letter PL - United States TA - N Engl J Med JT - The New England journal of medicine JID - 0255562 SB - AIM SB - IM CON - N Engl J Med. 1997 May 15;336(20):1465-71. PMID: 9148160 MH - Breast Neoplasms/*prevention & control MH - Decision Support Techniques MH - Female MH - Humans MH - Life Expectancy MH - Mastectomy MH - Models, Theoretical MH - *Ovariectomy MH - Risk EDAT- 1997/09/11 MHDA- 1997/09/11 00:01 CRDT- 1997/09/11 00:00 PST - ppublish SO - N Engl J Med. 1997 Sep 11;337(11):788; author reply 789. PMID- 9289638 OWN - NLM STAT- MEDLINE DA - 19970911 DCOM- 19970911 LR - 20041117 IS - 0028-4793 (Print) IS - 0028-4793 (Linking) VI - 337 IP - 11 DP - 1997 Sep 11 TI - Risk of breast cancer in carriers of BRCA gene mutations. PG - 787-8; author reply 789 FAU - Birkmeyer, J D AU - Birkmeyer JD FAU - Welch, H G AU - Welch HG LA - eng PT - Comment PT - Letter PL - United States TA - N Engl J Med JT - The New England journal of medicine JID - 0255562 RN - 0 (BRCA2 Protein) RN - 0 (Neoplasm Proteins) RN - 0 (Transcription Factors) SB - AIM SB - IM CON - N Engl J Med. 1997 May 15;336(20):1465-71. PMID: 9148160 MH - BRCA2 Protein MH - Breast Neoplasms/genetics/*prevention & control MH - Decision Support Techniques MH - Female MH - Genes, BRCA1 MH - Humans MH - *Life Expectancy MH - Mastectomy MH - Mutation MH - Neoplasm Proteins/genetics MH - Ovarian Neoplasms/genetics/*prevention & control MH - Ovariectomy MH - Transcription Factors/genetics EDAT- 1997/09/11 MHDA- 1997/09/11 00:01 CRDT- 1997/09/11 00:00 PST - ppublish SO - N Engl J Med. 1997 Sep 11;337(11):787-8; author reply 789. PMID- 9289637 OWN - NLM STAT- MEDLINE DA - 19970911 DCOM- 19970911 LR - 20041117 IS - 0028-4793 (Print) IS - 0028-4793 (Linking) VI - 337 IP - 11 DP - 1997 Sep 11 TI - Risk of breast cancer in carriers of BRCA gene mutations. PG - 787; author reply 789 FAU - Orlando, R 3rd AU - Orlando R 3rd LA - eng PT - Comment PT - Letter PL - United States TA - N Engl J Med JT - The New England journal of medicine JID - 0255562 RN - 0 (BRCA2 Protein) RN - 0 (Neoplasm Proteins) RN - 0 (Transcription Factors) SB - AIM SB - IM CON - N Engl J Med. 1997 May 15;336(20):1465-71. PMID: 9148160 MH - BRCA2 Protein MH - Breast Neoplasms/genetics/*prevention & control MH - *Decision Support Techniques MH - Female MH - Genes, BRCA1 MH - Humans MH - Life Expectancy MH - Mastectomy MH - Mutation MH - Neoplasm Proteins/genetics MH - Ovarian Neoplasms/genetics/*prevention & control MH - Ovariectomy MH - Transcription Factors/genetics EDAT- 1997/09/11 MHDA- 2001/03/28 10:01 CRDT- 1997/09/11 00:00 AID - 10.1056/NEJM199709113371113 [doi] PST - ppublish SO - N Engl J Med. 1997 Sep 11;337(11):787; author reply 789. PMID- 9275783 OWN - NLM STAT- MEDLINE DA - 19970904 DCOM- 19970904 LR - 20071115 IS - 0741-5206 (Print) IS - 0741-5206 (Linking) VI - 17 IP - 2 DP - 1997 Summer TI - Factors that influence plastic surgeons' advice about reconstruction to women with breast cancer. PG - 61-7 AB - The purpose of this pilot study was to describe the factors that influence the advice of plastic surgeons who offer reconstructive surgery to women with breast cancer. Answers to the following question were sought: What anatomical, technical, and personal factors are considered by plastic surgeons in their recommendations for reconstruction to women with breast cancer? Five themes emerged that explained approaches used with these patients: (1) technical issues and challenges, (2) patient-centered challenges, (3) aids to patient decision-making, (4) illusion of no loss, and (5) age. FAU - Neill, K M AU - Neill KM AD - School of Nursing, Georgetown University Medical Center, Washington, DC, USA. FAU - Briefs, B A AU - Briefs BA LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Plast Surg Nurs JT - Plastic surgical nursing : official journal of the American Society of Plastic and Reconstructive Surgical Nurses JID - 8403490 SB - N MH - *Attitude of Health Personnel MH - Breast Neoplasms/surgery MH - Female MH - Humans MH - Male MH - Mammaplasty/*psychology MH - Nursing Methodology Research MH - Patient Education as Topic/*methods MH - *Patient Selection MH - Physicians/*psychology MH - Pilot Projects EDAT- 1997/07/01 MHDA- 1997/07/01 00:01 CRDT- 1997/07/01 00:00 PST - ppublish SO - Plast Surg Nurs. 1997 Summer;17(2):61-7. PMID- 9219198 OWN - NLM STAT- MEDLINE DA - 19970904 DCOM- 19970904 LR - 20170214 IS - 0272-989X (Print) IS - 0272-989X (Linking) VI - 17 IP - 3 DP - 1997 Jul-Sep TI - Patient participation and decision control: are patient autonomy and well-being associated? PG - 353-4 FAU - de Haes, H C AU - de Haes HC FAU - Molenaar, S AU - Molenaar S LA - eng PT - Comment PT - Editorial PL - United States TA - Med Decis Making JT - Medical decision making : an international journal of the Society for Medical Decision Making JID - 8109073 SB - IM CON - Med Decis Making. 1997 Jul-Sep;17(3):298-306. PMID: 9219190 MH - Breast Neoplasms/psychology/surgery MH - *Decision Support Techniques MH - Female MH - Humans MH - Internal-External Control MH - Mastectomy, Segmental/psychology MH - *Patient Participation MH - *Patient Satisfaction MH - *Quality of Life EDAT- 1997/07/01 MHDA- 1997/07/01 00:01 CRDT- 1997/07/01 00:00 AID - 10.1177/0272989X9701700314 [doi] PST - ppublish SO - Med Decis Making. 1997 Jul-Sep;17(3):353-4. PMID- 9219190 OWN - NLM STAT- MEDLINE DA - 19970904 DCOM- 19970904 LR - 20170214 IS - 0272-989X (Print) IS - 0272-989X (Linking) VI - 17 IP - 3 DP - 1997 Jul-Sep TI - Patient participation in deciding breast cancer treatment and subsequent quality of life. PG - 298-306 AB - This investigation of patients with early breast cancer examined relationships among patient involvement in deciding treatment (i.e., whether to undergo breast removal or breast conservation), perceptions of control over treatment decisions, and subsequent health-related quality of life. It was predicted 1) that patients who more actively participated in consultations to decide treatment would perceive more decision control than would more passive patients and 2) that patients who perceived greater decision control would report better health-related quality of life following treatment than would patients perceiving less decision control. Sixty patients with stage I or II breast cancer allowed their consultations with surgeons to be audiorecorded. Following these visits, patients reported on their involvement in the consultation, optimism for the future, knowledge about treatment, and two aspects of perceived decision control, the perception of having a choice for treatment and the extent to which the doctor or patient was responsible for the decision. Six and 12 months postoperatively, 51 patients (85%) returned a follow-up survey assessing perceived decision control and health-related quality of life. The first prediction received some support. The patients who had more actively participated in their consultations, particularly in terms of offering opinions, assumed more responsibility for treatment decisions during the year following surgery than did less expressive patients. Also, the patients who reported more involvement in their consultations later believed they had had more of a choice for treatment. The second hypothesis was partially supported. Six and 12 months following treatment, the patients who believed they were more responsible for treatment decisions and believed they had more choice of treatment reported higher levels of quality of life than did the patients who perceived themselves to have less decision control. However, perceived control at the time of treatment did not predict later quality of life. Theoretical and clinical implications are discussed. FAU - Street, R L Jr AU - Street RL Jr AD - Department of Speech Communication, Texas A&M University, College Station 77843-4234, USA. r-street@tamu.edu FAU - Voigt, B AU - Voigt B LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Med Decis Making JT - Medical decision making : an international journal of the Society for Medical Decision Making JID - 8109073 SB - IM CIN - Med Decis Making. 1997 Jul-Sep;17(3):353-4. PMID: 9219198 MH - Adult MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/psychology/*surgery MH - *Decision Support Techniques MH - Female MH - Follow-Up Studies MH - Humans MH - Internal-External Control MH - *Mastectomy, Segmental/psychology MH - Middle Aged MH - Patient Care Team MH - *Patient Participation MH - Patient Satisfaction MH - *Quality of Life MH - Treatment Outcome EDAT- 1997/07/01 MHDA- 2001/03/28 10:01 CRDT- 1997/07/01 00:00 AID - 10.1177/0272989X9701700306 [doi] PST - ppublish SO - Med Decis Making. 1997 Jul-Sep;17(3):298-306. PMID- 9148160 OWN - NLM STAT- MEDLINE DA - 19970515 DCOM- 19970515 LR - 20061115 IS - 0028-4793 (Print) IS - 0028-4793 (Linking) VI - 336 IP - 20 DP - 1997 May 15 TI - Decision analysis--effects of prophylactic mastectomy and oophorectomy on life expectancy among women with BRCA1 or BRCA2 mutations. PG - 1465-71 AB - BACKGROUND: Women with BRCA1 or BRCA2 mutations have an increased risk of breast cancer and ovarian cancer. Prophylactic mastectomy and oophorectomy are often considered as ways of reducing these risks, but the effect of the procedures on life expectancy has not been established. METHODS: In a decision analysis, we compared prophylactic mastectomy and prophylactic oophorectomy with no prophylactic surgery among women who carry mutations in the BRCA1 or BRCA2 gene. We used available data about the incidence of cancer, the prognosis for women with cancer, and the efficacy of prophylactic mastectomy and oophorectomy in preventing breast and ovarian cancer to estimate the effects of these interventions on life expectancy among women with different levels of risk of cancer. RESULTS: We calculated that, on average, 30-year-old women who carry BRCA1 or BRCA2 mutations gain from 2.9 to 5.3 years of life expectancy from prophylactic mastectomy and from 0.3 to 1.7 years of life expectancy from prophylactic oophorectomy, depending on their cumulative risk of cancer. Gains in life expectancy decline with age at the time of prophylactic surgery and are minimal for 60-year-old women. Among 30-year-old women, oophorectomy may be delayed 10 years with little loss of life expectancy. CONCLUSIONS: On the basis of a range of estimates of the incidence of cancer, prognosis, and efficacy of prophylactic surgery, our model suggests that prophylactic mastectomy provides substantial gains in life expectancy and prophylactic oophorectomy more limited gains for young women with BRCA1 or BRCA2 mutations. FAU - Schrag, D AU - Schrag D AD - Center for Outcomes and Policy Research, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, USA. FAU - Kuntz, K M AU - Kuntz KM FAU - Garber, J E AU - Garber JE FAU - Weeks, J C AU - Weeks JC LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. PL - United States TA - N Engl J Med JT - The New England journal of medicine JID - 0255562 RN - 0 (BRCA2 Protein) RN - 0 (Neoplasm Proteins) RN - 0 (Transcription Factors) SB - AIM SB - IM CIN - N Engl J Med. 1997 May 15;336(20):1448-9. PMID: 9145684 CIN - N Engl J Med. 1997 Sep 11;337(11):787; author reply 789. PMID: 9289637 CIN - N Engl J Med. 1997 Sep 11;337(11):788; author reply 789. PMID: 9289640 CIN - N Engl J Med. 1997 Sep 11;337(11):787-8; author reply 789. PMID: 9289638 EIN - N Engl J Med 1997 Aug 7;337(6):434 MH - Adult MH - BRCA2 Protein MH - Breast Neoplasms/genetics/*prevention & control MH - *Decision Support Techniques MH - Female MH - *Genes, BRCA1 MH - Humans MH - Life Expectancy MH - *Mastectomy MH - Middle Aged MH - Mutation MH - Neoplasm Proteins/*genetics MH - Ovarian Neoplasms/genetics/*prevention & control MH - *Ovariectomy MH - Primary Prevention MH - Probability MH - Transcription Factors/*genetics EDAT- 1997/05/15 MHDA- 1997/05/15 00:01 CRDT- 1997/05/15 00:00 AID - 10.1056/NEJM199705153362022 [doi] PST - ppublish SO - N Engl J Med. 1997 May 15;336(20):1465-71. PMID- 9104377 OWN - NLM STAT- MEDLINE DA - 19970523 DCOM- 19970523 LR - 20071115 IS - 0738-3991 (Print) IS - 0738-3991 (Linking) VI - 30 IP - 3 DP - 1997 Mar TI - Offering choice of surgical treatment to women with breast cancer. PG - 209-14 AB - Much has been written about the psychosocial and sexual dysfunction associated with the diagnosis and treatment of breast cancer. Hopes that breast conserving techniques would lead to a reduction in some of the psychosocial morbidity experienced, have not materialised. Most of the methodologically sound studies reported to date demonstrate few differences in quality of life domains between women whatever their primary surgical treatment. Some researchers suggested that if women were offered an opportunity to select the surgical option they preferred, then two things would occur: (1) women would choose breast-conserving techniques, and (2) choice in itself would prevent psychosocial morbidity. Despite strong support for both of these assumptions, neither have been borne out. Significant numbers of women, when offered choice, opt for mastectomy and choice in itself does not convey protection from psychological morbidity. The majority of women seem to welcome being given clear information about the options available, together with the reasons as to why a clinician would advise one policy rather than another. However, fewer women than expected wish to take a major role in decision-making about their breast cancer treatment. FAU - Fallowfield, L AU - Fallowfield L AD - Department of Oncology, University College, London Medical School, Bland Sutton Institute, UK. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Review PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Breast Neoplasms/*psychology/*surgery MH - *Decision Making MH - Female MH - Humans MH - Mastectomy/psychology MH - Patient Education as Topic MH - *Patient Participation RF - 28 EDAT- 1997/03/01 MHDA- 1997/03/01 00:01 CRDT- 1997/03/01 00:00 AID - S0738399196009470 [pii] PST - ppublish SO - Patient Educ Couns. 1997 Mar;30(3):209-14. PMID- 9128616 OWN - NLM STAT- MEDLINE DA - 19970515 DCOM- 19970515 LR - 20151119 IS - 0738-3991 (Print) IS - 0738-3991 (Linking) VI - 30 IP - 2 DP - 1997 Feb TI - Physicians' opinions about decision aids for patients considering systemic adjuvant therapy for axillary-node negative breast cancer. PG - 143-53 AB - PURPOSE: To examine variations in physicians' opinions about the appropriateness and content of decision aids for women with breast cancer and criteria for their evaluation. METHODS: Cross-sectional survey of all 144 Ontario oncologists by Dillman's mailed survey design. The response rate was 87%. RESULTS: The predominant current practice pattern was to spontaneously inform patients about the treatment recommendations, degree of certainty regarding the recommendations, treatment regime, benefits and side effects. Most respondents (94%) endorsed patient decision aids, particularly when there was high uncertainty about providing adjuvant treatment. Over three-quarters endorsed measuring the following outcomes of decision aids: patients' clarity of trade-offs involved (e.g. survival vs. side effects); comprehension of treatment alternatives, risks and benefits; accuracy of expectations; decision satisfaction; anxiety; commitment to the decision; length of time to complete the decision aid; and decision uncertainty. The least support was for the use of the decision itself as an outcome measure. CONCLUSIONS: There is considerable consensus regarding the indications for, content and criteria for evaluating decision aids which should be considered when developing aids relevant to the needs of clinicians and patients. FAU - O'Connor, A M AU - O'Connor AM AD - Clinical Epidemiology Unit, Ottawa Civic Hospital, Ontario, Canada. FAU - Llewellyn-Thomas, H A AU - Llewellyn-Thomas HA FAU - Sawka, C AU - Sawka C FAU - Pinfold, S P AU - Pinfold SP FAU - To, T AU - To T FAU - Harrison, D E AU - Harrison DE LA - eng PT - Journal Article PL - Ireland TA - Patient Educ Couns JT - Patient education and counseling JID - 8406280 SB - N MH - Adult MH - Aged MH - *Attitude of Health Personnel MH - Axilla MH - Breast Neoplasms/*therapy MH - Combined Modality Therapy MH - Cross-Sectional Studies MH - *Decision Support Techniques MH - Female MH - Humans MH - Lymph Nodes/pathology MH - Male MH - Middle Aged MH - Patient Education as Topic/*methods MH - Physicians/*psychology MH - Surveys and Questionnaires EDAT- 1997/02/01 MHDA- 1997/02/01 00:01 CRDT- 1997/02/01 00:00 AID - S0738-3991(96)00948-2 [pii] PST - ppublish SO - Patient Educ Couns. 1997 Feb;30(2):143-53. PMID- 10167173 OWN - NLM STAT- MEDLINE DA - 19970617 DCOM- 19970617 LR - 20131121 IS - 0748-383X (Print) IS - 0748-383X (Linking) VI - 7 IP - 1 DP - 1997 Winter TI - BRCA1: to test or not to test, that is the question. PG - 163-85 FAU - Singer, M E AU - Singer ME AD - School of Medicine, Case Western Reserve University, USA. FAU - Cebul, R D AU - Cebul RD LA - eng PT - Journal Article PL - United States TA - Health Matrix Clevel JT - Health matrix (Cleveland, Ohio : 1991) JID - 9311154 RN - 0 (Antineoplastic Agents, Hormonal) RN - 094ZI81Y45 (Tamoxifen) SB - E SB - H MH - Adult MH - Antineoplastic Agents, Hormonal/therapeutic use MH - Breast Neoplasms/*genetics/*prevention & control/psychology/therapy MH - Decision Support Techniques MH - Female MH - *Genes, BRCA1 MH - *Genetic Testing/economics/psychology MH - Humans MH - Insurance, Health MH - Jews MH - Mastectomy MH - *Patient Participation MH - Prejudice MH - Risk Factors MH - Tamoxifen/therapeutic use MH - Uncertainty MH - United States OID - KIE: 54782 OTO - KIE OT - Genetics and Reproduction GN - KIE: 71 fn. GN - KIE: KIE BoB Subject Heading: genetic screening GN - KIE: Full author name: Singer, Mendel E GN - KIE: Full author name: Cebul, Randall D EDAT- 1997/01/01 00:00 MHDA- 1997/12/03 00:01 CRDT- 1997/01/01 00:00 PST - ppublish SO - Health Matrix Clevel. 1997 Winter;7(1):163-85. PMID- 9206919 OWN - NLM STAT- MEDLINE DA - 19970701 DCOM- 19970701 LR - 20080211 IS - 0044-4197 (Print) IS - 0044-4197 (Linking) VI - 119 IP - 4 DP - 1997 TI - [Quality of life in relation to patient education regarding surgical procedures in primary breast carcinoma]. PG - 149-53 AB - Breast conserving therapy is seen as a profit according to life quality. The patients have been subjected to the surgeon suggestions during decision-making about the primary therapy. The purpose of this study was to examine the relationship between the degree of preoperative information of breast cancer therapy and patients' choices of treatments in cases suited for breast conserving therapy. 138 recurrence free patients after breast conserving therapy (BCT) or mastectomies (ME) due to a breast cancer staged as pT1-2N0-1M0 and missing contraindication to BCT were interviewed using an observer checklist. The degrees of preoperative information, reasons for decision to mastectomy, though BCT was possible, were correlated with the postoperative life quality. Patients decided for BCT were averaging 56.0 + 12.3 years and significantly (p < 0.05) younger than patients decided for ME (60.4 + 10.5), whereas tumor size, nodal status and adjuvant therapies were comparable. The results indicate, that subjects' choice of treatment was unrelated to the amount of information. 87% (BET) respectively 78.3% (ME) patients evaluated, that preoperative information was enough (p = 0.19). The most frequent reasons for preference of mastectomy were the "perception that survival would be diminished if mastectomy was not done" (93.5%), "avoidance of radiotherapy" (60.9%) and "no partner" (34.8%). According to expectation the body image in the BCT-group (84.8%) was significantly (p = 0.0007) more positive than in the ME-group (58.9%). Nevertheless only 5 (10.9%) patients after ME have felt sorry for their earlier decision. There were no significant differences between the two groups with regard to partner- and sexual adjustment as well as physical well-being. Despite being fully informed of treatment possibilities and no medical contraindications to BCT nearly one third preferred mastectomy due to different reasons. When the patient was involved in the clinical decision-making process the mastectomy indicates not generally a loss of life quality, though nearly 40% are dissatisfied with their nude body image. FAU - Gerber, B AU - Gerber B AD - Frauenklinik der Universitat Rostock. FAU - Krause, A AU - Krause A LA - ger PT - English Abstract PT - Journal Article TT - Lebensqualitat in Abhangigkeit von der Aufklarung uber mogliche Operationsverfahren beim primaren Mammakarzinom. PL - Germany TA - Zentralbl Gynakol JT - Zentralblatt fur Gynakologie JID - 21820100R SB - IM MH - Adult MH - Aged MH - Breast Neoplasms/pathology/*psychology/surgery MH - Chemotherapy, Adjuvant/psychology MH - Combined Modality Therapy MH - Female MH - Follow-Up Studies MH - Humans MH - Mastectomy/psychology MH - Mastectomy, Segmental/*psychology MH - Middle Aged MH - Neoplasm Staging MH - *Patient Education as Topic MH - Patient Satisfaction MH - *Quality of Life MH - Radiotherapy, Adjuvant/psychology EDAT- 1997/01/01 MHDA- 1997/01/01 00:01 CRDT- 1997/01/01 00:00 PST - ppublish SO - Zentralbl Gynakol. 1997;119(4):149-53. PMID- 8726184 OWN - NLM STAT- MEDLINE DA - 19960917 DCOM- 19960917 LR - 20071115 IS - 1068-9265 (Print) IS - 1068-9265 (Linking) VI - 3 IP - 3 DP - 1996 May TI - Patient satisfaction with decision-making for breast cancer therapy. PG - 285-9 AB - BACKGROUND: Many sources have suggested that mastectomy is inappropriately performed too frequently for breast cancer, leading to excessive patient dissatisfaction and unnecessary mutilation. Hurried decision-making based on inadequate information has been proposed as an explanation. METHODS: After confirming the diagnosis of breast cancer, patients were informed of the diagnosis, prognosis, and treatment options according to a standard protocol. The protocol was similar to that used by many surgeons in similar circumstances. Six months after completion of either mastectomy or breast conservation therapy, patients were surveyed about their satisfaction with the decision-making process and choice of treatment. RESULTS: The majority of patients, whether they had undergone mastectomy or breast conservation, thought they had been adequately informed of treatment options and that they had made the appropriate choice of therapy. A significant percentage of mastectomy patients found that procedure more disfiguring than anticipated, but still thought they had made the appropriate choice of therapy. Despite having been informed to the contrary, most patients said their chosen treatment provided the best chance for cure. CONCLUSIONS: When informed of the diagnosis and treatment options in an unhurried, supportive setting, and when encouraged to seek further consultations as desired, breast cancer patients make appropriate therapeutic choices about mastectomy or breast conservation therapy. FAU - Weiss, S M AU - Weiss SM AD - Department of Surgery, Polyclinic Medical Center, Harrisburg, Pennsylvania 17110, USA. FAU - Wengert, P A Jr AU - Wengert PA Jr FAU - Martinez, E M AU - Martinez EM FAU - Sewall, W AU - Sewall W FAU - Kopp, E AU - Kopp E LA - eng PT - Journal Article PL - United States TA - Ann Surg Oncol JT - Annals of surgical oncology JID - 9420840 SB - IM MH - Breast Neoplasms/psychology/*surgery MH - *Decision Making MH - Female MH - Humans MH - Mastectomy/methods MH - Patient Education as Topic MH - *Patient Participation MH - *Patient Satisfaction EDAT- 1996/05/01 MHDA- 2001/03/28 10:01 CRDT- 1996/05/01 00:00 PST - ppublish SO - Ann Surg Oncol. 1996 May;3(3):285-9. PMID- 8646518 OWN - NLM STAT- MEDLINE DA - 19960719 DCOM- 19960719 LR - 20071115 IS - 1068-9265 (Print) IS - 1068-9265 (Linking) VI - 3 IP - 2 DP - 1996 Mar TI - Clinicopathologic factors and patient perceptions associated with surgical breast-conserving treatment. PG - 169-75 AB - BACKGROUND: Clinical studies have shown equivalent survival rates between breast-conserving surgery (BCS) and mastectomy in early breast cancer; however, rates for BCS remain low. The purpose of this study was to determine (a) the prevalence of BCS in a regional medical center, (b) clinicopathologic factors associated with BCS, and (c) patient perceptions of the treatment decision-making process. METHODS: We retrospectively reviewed 251 consecutive breast cancer cases during January 1990-December 1991; 77 patients were ineligible for BCS because of unfavorable pathology. We then interviewed 118 of the 160 women available for interview. RESULTS: BCS was performed in 31 of the eligible patients (18%). Multivariate analysis revealed that tumor size < 10 mm (p = 0.03) was the only significant predictive variable for BCS. Patient interviews revealed that 93% said their surgeon was the primary source of information regarding treatment options. Among 69% of the women whose surgeons reportedly recommended a particular option, 89% recommended mastectomy with 93% compliance, and 11% recommended BCS with 89% compliance. The BCS group more often obtained a second opinion (p = 0.04) and 60% said they made the decision themselves compared with only 37% of the mastectomy group (p = 0.05). CONCLUSION: Limiting BCS to women whose tumor size is < 10 mm is too restrictive; this excludes a large number of women who are clinically eligible for BCS. The surgical decision-making process for early-stage breast cancer is very much surgeon-driven, with a high degree of patient compliance. FAU - Kotwall, C A AU - Kotwall CA AD - Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, USA. FAU - Maxwell, J G AU - Maxwell JG FAU - Covington, D L AU - Covington DL FAU - Churchill, P AU - Churchill P FAU - Smith, S E AU - Smith SE FAU - Covan, E K AU - Covan EK LA - eng PT - Journal Article PL - United States TA - Ann Surg Oncol JT - Annals of surgical oncology JID - 9420840 SB - IM MH - Aged MH - Breast Neoplasms/pathology/*surgery MH - Decision Making MH - Female MH - Humans MH - *Mastectomy, Segmental MH - Middle Aged MH - *Patient Compliance MH - Patient Education as Topic MH - Retrospective Studies MH - *Self Concept MH - Treatment Outcome EDAT- 1996/03/01 MHDA- 1996/03/01 00:01 CRDT- 1996/03/01 00:00 PST - ppublish SO - Ann Surg Oncol. 1996 Mar;3(2):169-75. PMID- 8717597 OWN - NLM STAT- MEDLINE DA - 19961016 DCOM- 19961016 LR - 20170214 IS - 0272-989X (Print) IS - 0272-989X (Linking) VI - 16 IP - 1 DP - 1996 Jan-Mar TI - Proportional heuristics in time tradeoff and conjoint measurement. PG - 36-44 AB - The time-tradeoff (TTO) test is widely used to measure quality of life for different health states. Subjects are asked to equate the value of living a given period in an inferior health state to the value of living a shorter period in good health. Applications of TTOs have been criticized based on the fact that the value of future life duration is taken as the future life duration itself. The authors show that for a health state in which a subject does not want to live longer than a specified amount of time, subjects' responses do not comply with the assumption that the value of the period in inferior health is equated to the value of the shorter period in good health. Actually, preference reversals with respect to such a health state point to the use of a proportional heuristic in the TTO test. Comparisons of the TTO test in these subjects with category scaling and difference measurements also favor a proportional interpretation of the TTO test. In tests based on conjoint measurement, these subjects also appear to use a proportional heuristic. Consequences of the use of the TTO test and conjoint measurement in quality-of-life models are discussed. FAU - Stalmeier, P F AU - Stalmeier PF AD - Nijmegen Institute for Cognition and Information (NICI), Department of Mathematical Psychology, University of Nijmegen, The Netherlands. FAU - Bezembinder, T G AU - Bezembinder TG FAU - Unic, I J AU - Unic IJ LA - eng PT - Clinical Trial PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - Med Decis Making JT - Medical decision making : an international journal of the Society for Medical Decision Making JID - 8109073 SB - IM MH - Adult MH - Breast Neoplasms/*psychology MH - *Choice Behavior MH - Data Interpretation, Statistical MH - *Decision Support Techniques MH - Effect Modifier, Epidemiologic MH - Female MH - Genetic Counseling MH - Health Status MH - Humans MH - Linear Models MH - Mastectomy MH - Neoplasm Metastasis MH - *Quality-Adjusted Life Years MH - Time Factors EDAT- 1996/01/01 MHDA- 1996/01/01 00:01 CRDT- 1996/01/01 00:00 AID - 10.1177/0272989X9601600111 [doi] PST - ppublish SO - Med Decis Making. 1996 Jan-Mar;16(1):36-44. PMID- 8558224 OWN - NLM STAT- MEDLINE DA - 19960223 DCOM- 19960223 LR - 20170210 IS - 0732-183X (Print) IS - 0732-183X (Linking) VI - 14 IP - 1 DP - 1996 Jan TI - Trade-offs between survival and breast preservation for three initial treatments of ductal carcinoma-in-situ of the breast. PG - 70-7 AB - PURPOSE: To assess the trade-offs between survival and breast preservation of currently accepted approaches for ductal carcinoma-in-situ (DCIS) of the breast. PATIENTS AND METHODS: Decision analysis was performed using the Markov model of hypothetical cohorts of 55-year-old white women with nonpalpable mammographic abnormalities found to be DCIS. Strategies were breast-conserving surgery (BCS), BCS with 50-Gy radiation (RT) or initial mastectomy. Recurrence rates were derived from the published literature. Main outcomes were overall, breast cancer-free, and event-free survival plus years of both breasts preserved. RESULTS: Using the conditions defined in this model, the actuarial survival rates at 10 and 20 years were 91.7% and 74.1% for the initial mastectomy strategy, 91.0% and 72.1% for BCS plus RT, and 89.6% and 68.2% for BCS alone. At 20 years, the initial mastectomy strategy also had a greater breast cancer-free survival rate of 74.5%, compared with 63.3% for BCS plus RT, or 46.8% for BCS alone. However, BCS alone had the highest survival rate with both breasts preserved (64.2%) compared with BCS plus RT (56.0%) or initial mastectomy (0%). Of the breast-conserving strategies at 20 years, the breast event-free survival rate (no invasive cancer or DCIS) was greater for BCS plus RT (47.2%) compared with BCS alone (28.4%). Using just survival as the primary end point, mastectomy is the optimal strategy by a small margin. However, if quality-adjusted survival is at issue, mastectomy is the choice only if the yearly reduction in quality of life due to mastectomy is less than 1%. CONCLUSION: BCS with or without radiation compared with mastectomy as initial management of DCIS of the breast trades a slight decrease in survival rates for the value of breast preservation. This model should aid clinicians in matching treatments to their patients' preferences. FAU - Hillner, B E AU - Hillner BE AD - Massey Cancer Center, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0170, USA. FAU - Desch, C E AU - Desch CE FAU - Carlson, R W AU - Carlson RW FAU - Smith, T J AU - Smith TJ FAU - Esserman, L AU - Esserman L FAU - Bear, H D AU - Bear HD LA - eng PT - Clinical Trial PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Clin Oncol JT - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JID - 8309333 SB - IM MH - Aged MH - Breast Neoplasms/diagnostic imaging/mortality/surgery/*therapy MH - Carcinoma in Situ/mortality/radiotherapy/surgery/*therapy MH - Carcinoma, Ductal, Breast/mortality/radiotherapy/surgery/*therapy MH - Cohort Studies MH - Combined Modality Therapy MH - Decision Support Techniques MH - Disease-Free Survival MH - Female MH - Humans MH - Markov Chains MH - Mastectomy MH - Middle Aged MH - Models, Statistical MH - Neoplasm Recurrence, Local/prevention & control MH - Neoplasms, Second Primary/prevention & control MH - Predictive Value of Tests MH - Probability MH - Prognosis MH - Quality of Life MH - Radiography MH - Survival Rate EDAT- 1996/01/01 MHDA- 1996/01/01 00:01 CRDT- 1996/01/01 00:00 AID - 10.1200/JCO.1996.14.1.70 [doi] PST - ppublish SO - J Clin Oncol. 1996 Jan;14(1):70-7. PMID- 8577618 OWN - NLM STAT- MEDLINE DA - 19960314 DCOM- 19960314 LR - 20071115 IS - 0190-535X (Print) IS - 0190-535X (Linking) VI - 22 IP - 10 DP - 1995 Nov-Dec TI - Impact of silicone implants on the lives of women with breast cancer. PG - 1493-500 AB - PURPOSE/OBJECTIVES: To describe the impact of silicone implants on the lives of women with breast cancer. DESIGN: Qualitative analysis of telephone interview data. SAMPLE: 120 women from across the United States who have reported to the Food and Drug Administration problems with breast implants following mastectomies. METHODS: Telephone interviews were used to gather responses to 110 questions. Qualitative analysis of narrative data was linked with quantitative data. MAIN RESEARCH VARIABLES: Concerns and feelings about breast implants; potential problems with silicone implants; source of information about problems; how they coped with the silicone implant controversy; problems related to their breast implants; the effect of health problems on day-to-day activities, relationships with significant others, work, and any other important aspects of their lives; and advice they would give other women regarding breast implant surgery. By linking the qualitative analysis of narrative data with quantitative data, the investigators sought to answer the following research question: Do the patterns of responses differ based on specific systemic physical problems, reported localized breast problems, or implant problems? FINDINGS: The women reported poorer quality of life and feelings of worry and anger because of health problems. They perceived they had received incomplete information and often had complaints dismissed by their healthcare providers. Most of them would not recommend silicone implants for patients undergoing mastectomy. The women's levels of satisfaction were directly associated with their feelings of being informed and the type of health problems they experienced. CONCLUSIONS: Women need reconstruction options following mastectomy, however, use of silicone implants can result in additional health problems and decreased quality of life as a result of those problems. IMPLICATIONS FOR NURSING PRACTICE: Nurses can assume the role of breast health educator, which includes counseling women with breast cancer about breast implants and other reconstructive options. Study results will help health providers care both for those patients considering treatment options and those coping with the problems and concerns related to their breast implants. Women should be told the inherent risks and complications associated with breast implants and also told when "we don't know." FAU - Coleman, E A AU - Coleman EA AD - College of Nursing, University of Arkansas for Medical Sciences (UAMS), Little Rock, USA. FAU - Coon, S K AU - Coon SK FAU - Thompson, P J AU - Thompson PJ FAU - Lemon, S J AU - Lemon SJ FAU - Depuy, R S AU - Depuy RS LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. PL - United States TA - Oncol Nurs Forum JT - Oncology nursing forum JID - 7809033 RN - 0 (Silicones) SB - IM SB - N MH - Adult MH - Aged MH - Anger MH - Attitude to Health MH - Breast Implants/*adverse effects MH - Breast Neoplasms/*surgery MH - Decision Making MH - Female MH - Humans MH - *Mammaplasty/nursing MH - Mastectomy/*rehabilitation MH - Middle Aged MH - Patient Education as Topic MH - *Patient Satisfaction MH - Physician-Patient Relations MH - *Silicones MH - Truth Disclosure MH - United States EDAT- 1995/11/01 MHDA- 1995/11/01 00:01 CRDT- 1995/11/01 00:00 PST - ppublish SO - Oncol Nurs Forum. 1995 Nov-Dec;22(10):1493-500. PMID- 7564937 OWN - NLM STAT- MEDLINE DA - 19951106 DCOM- 19951106 LR - 20170214 IS - 0272-989X (Print) IS - 0272-989X (Linking) VI - 15 IP - 3 DP - 1995 Jul-Sep TI - Effects of patient education on decisions about breast cancer treatments: a preliminary report. PG - 231-9 AB - The authors examined the effects of materials for educating patients about treatment options for breast cancer on knowledge about the disease, preferences for alternative treatments, and how changes in knowledge and preferences were related. Eighty-two undergraduate students acted as advisors to a hypothetical patient. They completed a knowledge test and rated their preferences for three options--breast-sparing surgery with radiation, mastectomy followed by reconstructive surgery, and mastectomy followed by use of a breast prosthesis--before and after viewing a videotape or a booklet version of the educational materials. Both formats increased knowledge scores. Treatment preferences were not affected by reading the booklet, but viewing the videotape resulted in a preference shift toward breast-sparing surgery. This media difference may be due to features of the video that were not reproduced in the booklet, such as interviews with other patients. Knowledge gains were uncorrelated with preference changes. FAU - Chapman, G B AU - Chapman GB AD - Department of Medical Education, University of Illinois at Chicago 60612, USA. FAU - Elstein, A S AU - Elstein AS FAU - Hughes, K K AU - Hughes KK LA - eng GR - LM4583/LM/NLM NIH HHS/United States PT - Clinical Trial PT - Comparative Study PT - Controlled Clinical Trial PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. PL - United States TA - Med Decis Making JT - Medical decision making : an international journal of the Society for Medical Decision Making JID - 8109073 SB - IM MH - Adolescent MH - Adult MH - Breast Neoplasms/*psychology/*therapy MH - *Decision Making MH - Educational Measurement MH - Female MH - Humans MH - Mammaplasty MH - Mastectomy MH - Middle Aged MH - Pamphlets MH - Patient Education as Topic/*methods MH - Patient Participation MH - Prostheses and Implants MH - *Teaching Materials MH - Videotape Recording EDAT- 1995/07/01 MHDA- 1995/07/01 00:01 CRDT- 1995/07/01 00:00 AID - 10.1177/0272989X9501500306 [doi] PST - ppublish SO - Med Decis Making. 1995 Jul-Sep;15(3):231-9. PMID- 7863336 OWN - NLM STAT- MEDLINE DA - 19950323 DCOM- 19950323 LR - 20071115 IS - 0036-8075 (Print) IS - 0036-8075 (Linking) VI - 267 IP - 5200 DP - 1995 Feb 17 TI - Clinical trials. Fisher clashes with NCI--again. PG - 954 FAU - Marshall, E AU - Marshall E LA - eng PT - Biography PT - Historical Article PT - News PL - United States TA - Science JT - Science (New York, N.Y.) JID - 0404511 SB - IM SB - Q MH - Breast Neoplasms/surgery MH - Clinical Trials as Topic/*standards MH - Data Interpretation, Statistical MH - Female MH - History, 20th Century MH - Humans MH - Mastectomy, Segmental MH - Mastectomy, Simple MH - *National Institutes of Health (U.S.) MH - *Publishing MH - United States PS - Fisher B FPS - Fisher, B EDAT- 1995/02/17 MHDA- 1995/02/17 00:01 CRDT- 1995/02/17 00:00 PST - ppublish SO - Science. 1995 Feb 17;267(5200):954. PMID- 9005128 OWN - NLM STAT- MEDLINE DA - 19970124 DCOM- 19970124 LR - 20091111 IS - 0009-4773 (Print) IS - 0009-4773 (Linking) VI - 47 IP - 4 DP - 1995 TI - [Role of axillary dissection in breast carcinoma]. PG - 23-31 AB - Between 1986 and 1995, 965 patients with T1 breast cancer were treated with wide excision (796 pts) or mastectomy (138 pts). Axillary dissection was performed in 934 patients. Nodal positivity was 8.7% for T1a, 15.6% for T1b and 37.7% for T1c. 68.5% of cases had one to three positive nodes, 18.3% four to ten and 13% more than ten nodes. No differences were observed in the frequency of lymph nodes involved according to the age of patients, menopausal status, pattern at mammography, histology and receptor status. Favourable histology (tubular, cribriform, papillary, colloid) shows a significant difference when compared with all the others histotypes. On the basis of data collected it is impossible to anticipate the axillary status and avoid axillary dissection. FAU - Cataliotti, L AU - Cataliotti L AD - Istituto di Clinica Chirurgica I, Universita degli Studi di Firenze. FAU - Distante, V AU - Distante V FAU - Rontini, M AU - Rontini M FAU - Ponzano, C AU - Ponzano C FAU - Manetti, A AU - Manetti A FAU - Falli, F AU - Falli F LA - ita PT - Comparative Study PT - English Abstract PT - Journal Article TT - Ruolo della dissezione ascellare nel carcinoma mammario. PL - Italy TA - Chir Ital JT - Chirurgia italiana JID - 0151753 SB - IM MH - Adult MH - Aged MH - Axilla MH - Breast Neoplasms/pathology/*surgery MH - Data Interpretation, Statistical MH - Female MH - Follow-Up Studies MH - Humans MH - *Lymph Node Excision MH - Mammography MH - Middle Aged MH - Prognosis MH - Time Factors EDAT- 1995/01/01 MHDA- 1995/01/01 00:01 CRDT- 1995/01/01 00:00 PST - ppublish SO - Chir Ital. 1995;47(4):23-31. PMID- 7850551 OWN - NLM STAT- MEDLINE DA - 19950315 DCOM- 19950315 LR - 20070718 IS - 1068-9265 (Print) IS - 1068-9265 (Linking) VI - 1 IP - 6 DP - 1994 Nov TI - Insurance coverage of patients with breast cancer in the 1991 commission on cancer patient care evaluation study. PG - 462-7 AB - BACKGROUND: Trends in the care of patients with cancer are monitored annually by the Commission on Cancer of the American College of Surgeons. In 1991 a patient care evaluation study of breast cancer was conducted, which among other questions examined the correlation of health insurance with type or quality of care delivered for breast cancer on a national basis. METHODS: The tumor registry system of the American College of Surgeons was used to obtain data on patients with breast cancer diagnosed in 1983 and 1990. Trends in diagnosis and treatment were correlated with the type of insurance or lack of insurance. RESULTS: Data were obtained from hospitals in 50 states on a total of 41,651 patients. The largest number of patients were covered by Medicare. Fewer than 5% were considered medically indigent. Medically indigent patients presented with higher stage disease and did not participate in a trend toward downstaging, which occurred between the two study years. The treatment of medically indigent patients appeared to be appropriate and comparable with better insured patients. Insurance type (health maintenance organization vs. private) did not affect stage, treatment, or outcome. Decisions to use controversial therapies, such as chemotherapy for stage I disease, did not appear to be financially driven. CONCLUSION: A nationwide pattern of care study for breast cancer indicates that medically indigent patients present with more advanced disease compared with better insured patients, but once the diagnosis is made, treatment and outcome have little to do with insurance type. FAU - Osteen, R T AU - Osteen RT AD - Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115. FAU - Winchester, D P AU - Winchester DP FAU - Hussey, D H AU - Hussey DH FAU - Clive, R E AU - Clive RE FAU - Friedman, M A AU - Friedman MA FAU - Cady, B AU - Cady B FAU - Chmiel, J S AU - Chmiel JS FAU - Kraybill, W G AU - Kraybill WG FAU - Urist, M M AU - Urist MM FAU - Doggett, R L AU - Doggett RL LA - eng PT - Journal Article PL - United States TA - Ann Surg Oncol JT - Annals of surgical oncology JID - 9420840 SB - IM MH - Antineoplastic Combined Chemotherapy Protocols/therapeutic use MH - Biopsy, Needle/statistics & numerical data MH - Breast Neoplasms/diagnosis/*economics/prevention & control/therapy MH - Combined Modality Therapy MH - Data Interpretation, Statistical MH - Health Maintenance Organizations/statistics & numerical data MH - Humans MH - Insurance, Health/*statistics & numerical data MH - Mammography/statistics & numerical data MH - Mass Screening/statistics & numerical data MH - Mastectomy/statistics & numerical data MH - Medicaid/statistics & numerical data MH - Medically Uninsured/*statistics & numerical data MH - Medicare/statistics & numerical data MH - Neoplasm Metastasis MH - Neoplasm Staging MH - Program Evaluation MH - *Quality of Health Care MH - *Registries MH - Societies, Medical MH - United States EDAT- 1994/11/01 MHDA- 1994/11/01 00:01 CRDT- 1994/11/01 00:00 PST - ppublish SO - Ann Surg Oncol. 1994 Nov;1(6):462-7. PMID- 8065416 OWN - NLM STAT- MEDLINE DA - 19940922 DCOM- 19940922 LR - 20071115 IS - 0028-4793 (Print) IS - 0028-4793 (Linking) VI - 331 IP - 12 DP - 1994 Sep 22 TI - The NSABP trials. PG - 809-10 FAU - Heitjan, D F AU - Heitjan DF LA - eng PT - Letter PL - United States TA - N Engl J Med JT - The New England journal of medicine JID - 0255562 SB - AIM SB - IM MH - Breast Neoplasms/*surgery MH - *Clinical Trials as Topic MH - Data Interpretation, Statistical MH - Female MH - Humans MH - Mastectomy MH - Mastectomy, Segmental MH - Research Design EDAT- 1994/09/22 MHDA- 1994/09/22 00:01 CRDT- 1994/09/22 00:00 PST - ppublish SO - N Engl J Med. 1994 Sep 22;331(12):809-10. PMID- 8159206 OWN - NLM STAT- MEDLINE DA - 19940519 DCOM- 19940519 LR - 20071115 IS - 0028-4793 (Print) IS - 0028-4793 (Linking) VI - 330 IP - 20 DP - 1994 May 19 TI - Fraud in breast-cancer trials. PG - 1458-60 FAU - Fisher, B AU - Fisher B FAU - Redmond, C K AU - Redmond CK LA - eng PT - Letter PL - United States TA - N Engl J Med JT - The New England journal of medicine JID - 0255562 SB - AIM SB - IM CIN - N Engl J Med. 1994 May 19;330(20):1448-50. PMID: 8159201 MH - Breast Neoplasms/*surgery MH - Clinical Trials as Topic/*standards MH - Data Interpretation, Statistical MH - Female MH - Humans MH - Mastectomy, Segmental MH - Medical Audit MH - Medical Records/statistics & numerical data MH - *Scientific Misconduct EDAT- 1994/05/19 MHDA- 1994/05/19 00:01 CRDT- 1994/05/19 00:00 AID - 10.1056/NEJM199405193302015 [doi] PST - ppublish SO - N Engl J Med. 1994 May 19;330(20):1458-60. PMID- 8159201 OWN - NLM STAT- MEDLINE DA - 19940519 DCOM- 19940519 LR - 20071115 IS - 0028-4793 (Print) IS - 0028-4793 (Linking) VI - 330 IP - 20 DP - 1994 May 19 TI - Setting the record straight in the breast-cancer trials. PG - 1448-50 FAU - Angell, M AU - Angell M FAU - Kassirer, J P AU - Kassirer JP LA - eng PT - Comment PT - Editorial PL - United States TA - N Engl J Med JT - The New England journal of medicine JID - 0255562 SB - AIM SB - IM CON - N Engl J Med. 1994 May 19;330(20):1460. PMID: 8159207 CON - N Engl J Med. 1994 May 19;330(20):1460-1. PMID: 8159208 CON - N Engl J Med. 1994 May 19;330(20):1458-60. PMID: 8159206 CIN - N Engl J Med. 1994 May 19;330(20):1461. PMID: 8159210 CIN - N Engl J Med. 1994 May 19;330(20):1461. PMID: 8159209 CIN - N Engl J Med. 1994 May 19;330(20):1462. PMID: 8159212 CIN - N Engl J Med. 1995 Jan 5;332(1):64. PMID: 7990882 CIN - N Engl J Med. 1994 May 19;330(20):1462. PMID: 8159211 MH - Breast Neoplasms/*surgery MH - Canada MH - Clinical Trials as Topic/standards/*statistics & numerical data MH - Data Interpretation, Statistical MH - Female MH - Humans MH - Mastectomy, Segmental MH - *Scientific Misconduct MH - United States EDAT- 1994/05/19 MHDA- 1994/05/19 00:01 CRDT- 1994/05/19 00:00 AID - 10.1056/NEJM199405193302010 [doi] PST - ppublish SO - N Engl J Med. 1994 May 19;330(20):1448-50. PMID- 8063085 OWN - NLM STAT- MEDLINE DA - 19940922 DCOM- 19940922 LR - 20071115 IS - 0163-8343 (Print) IS - 0163-8343 (Linking) VI - 16 IP - 3 DP - 1994 May TI - A structured psychoeducational intervention for cancer patients. PG - 149-92 FAU - Fawzy, F I AU - Fawzy FI AD - Department of Psychiatry, UCLA School of Medicine. FAU - Fawzy, N W AU - Fawzy NW LA - eng PT - Journal Article PL - United States TA - Gen Hosp Psychiatry JT - General hospital psychiatry JID - 7905527 SB - IM MH - *Adaptation, Psychological MH - Affect MH - Avoidance Learning MH - Behavior Therapy MH - Body Image MH - Breast Neoplasms/diagnosis/*psychology/therapy MH - Communication MH - Comprehensive Health Care MH - Female MH - Humans MH - Interpersonal Relations MH - *Manuals as Topic MH - Mastectomy/psychology MH - Models, Educational MH - Models, Psychological MH - Patient Education as Topic/*methods MH - Physician-Patient Relations MH - Quality of Life MH - Self-Help Groups/organization & administration MH - Social Support MH - Stress, Psychological/prevention & control/psychology MH - *Teaching Materials EDAT- 1994/05/01 MHDA- 1994/05/01 00:01 CRDT- 1994/05/01 00:00 PST - ppublish SO - Gen Hosp Psychiatry. 1994 May;16(3):149-92. PMID- 8032564 OWN - NLM STAT- MEDLINE DA - 19940816 DCOM- 19940816 LR - 20071115 IS - 0007-1064 (Print) IS - 0007-1064 (Linking) VI - 51 IP - 6 DP - 1994 Mar 16-Apr 5 TI - Decision making in surgery: management of symptomatic early breast carcinoma. PG - 287-9 AB - The initial advice given to a patient with a proven breast carcinoma needs to be informed and sensitive. Breast specialists still have firm and differing views of the management of early breast carcinoma and, although a consensus approach is nearer now than it used to be, there is still sufficient variation to make it difficult for the surgical trainee. FAU - Thomas, P AU - Thomas P AD - Whipps Cross Hospital, London. LA - eng PT - Journal Article PL - England TA - Br J Hosp Med JT - British journal of hospital medicine JID - 0171545 RN - 0 (Antineoplastic Agents) SB - IM MH - Antineoplastic Agents/therapeutic use MH - Breast Neoplasms/pathology/*therapy MH - Chemotherapy, Adjuvant MH - Combined Modality Therapy MH - *Decision Support Techniques MH - Female MH - Humans MH - Lymph Node Excision MH - Mastectomy/methods MH - Neoplasm Staging MH - Patient Education as Topic EDAT- 1994/03/05 MHDA- 1994/03/05 00:01 CRDT- 1994/03/05 00:00 PST - ppublish SO - Br J Hosp Med. 1994 Mar 16-Apr 5;51(6):287-9. PMID- 8321703 OWN - NLM STAT- MEDLINE DA - 19930803 DCOM- 19930803 LR - 20071115 IS - 0190-535X (Print) IS - 0190-535X (Linking) VI - 20 IP - 4 DP - 1993 May TI - Decision making by patients with breast cancer: the role of information in treatment selection. PG - 623-8 AB - In recent years, patients have become more involved in the clinical decision-making process, yet the nature of this process, including the role of information, is poorly understood. The purpose of this exploratory study was to examine the relationship between information about breast cancer treatment alternatives and patients' choices of treatments. The target population was all patients with breast cancer in the process of deciding between breast conservation (lumpectomy plus irradiation) and more traditional management (modified radical mastectomy, with or without reconstruction). A convenience sample of 71 female patients with stage I or II breast cancer was drawn from a breast clinic affiliated with a 1,000-bed tertiary medical center. The amount of information provided to each subject and the nature of its presentation were recorded using an observer checklist. Recall of information and final treatment selection were ascertained during telephone interviews conducted six to eight weeks after surgery. The results indicate that subjects' choice of treatment was unrelated to the amount of information they received during the clinic visit. Manner of presentation also did not influence treatment selection. However, treatment selection was related to the amount of information subjects received prior to their clinic visit (p < 0.01). The results also indicate that patients' recall of information about treatments and associated risks is exceedingly poor. Clinical and legal implications are discussed and recommendations for further research are offered in this article. FAU - Hughes, K K AU - Hughes KK AD - Department of Administrative Studies in Nursing, University of Illinois College of Nursing, Chicago. LA - eng PT - Journal Article PL - United States TA - Oncol Nurs Forum JT - Oncology nursing forum JID - 7809033 SB - IM SB - N MH - Adult MH - Aged MH - Aged, 80 and over MH - Breast Neoplasms/pathology/*psychology/therapy MH - Choice Behavior MH - Combined Modality Therapy MH - Decision Theory MH - Female MH - Humans MH - Mastectomy, Modified Radical/*psychology MH - Mastectomy, Segmental/*psychology MH - Memory MH - Middle Aged MH - Neoplasm Staging MH - *Patient Education as Topic MH - *Patient Participation MH - Retrospective Studies EDAT- 1993/05/01 MHDA- 1993/05/01 00:01 CRDT- 1993/05/01 00:00 PST - ppublish SO - Oncol Nurs Forum. 1993 May;20(4):623-8. PMID- 1307183 OWN - NLM STAT- MEDLINE DA - 19930823 DCOM- 19930823 LR - 20061115 IS - 0294-1260 (Print) IS - 0294-1260 (Linking) VI - 37 IP - 5 DP - 1992 Oct TI - [Effect of inadequate filling of deflation of inflatable breast prostheses. Statistical study of 535 inflatable prostheses]. PG - 534-40 AB - This study was based on a series of 535 inflatable prostheses used for breast reconstruction or augmentation with a mean follow-up of 5.15 years. The authors specifically analysed the statistical correlation between underinflation and deflation due to late rupture. They demonstrated a statistically significant difference between the initial filling of the prostheses which subsequently deflated and the initial filling of all prostheses of the series. The mean filling of prostheses which subsequently deflated was 89% while the mean filling of all prosthesis in the series was 100%. The various pathologies are analysed according to the cosmetic or reconstructive indications. The two series, cosmetic and reconstructive, were homogeneous in terms of filling volume and deflation; the only difference concerned the age distribution. Patients undergoing breast reconstruction with a prosthesis were older than patients undergoing augmentation surgery for small breasts. The authors discuss the advantages and disadvantages of this type of prosthesis. FAU - Lantieri, L AU - Lantieri L AD - Service de Chirurgie Plastique, Hopital Henri Mondor, Creteil. FAU - Raulo, Y AU - Raulo Y FAU - Baruch, J AU - Baruch J LA - fre PT - English Abstract PT - Journal Article TT - Influence de l'insuffisance de remplissage sur le degonflement des protheses mammaires gonflables. Etude statistique sur 535 protheses gonflables. PL - France TA - Ann Chir Plast Esthet JT - Annales de chirurgie plastique et esthetique JID - 8305839 RN - 0 (Silicones) SB - IM MH - Adolescent MH - Adult MH - Data Interpretation, Statistical MH - Esthetics MH - Female MH - Humans MH - *Mammaplasty MH - Middle Aged MH - Prostheses and Implants/*adverse effects MH - Silicones EDAT- 1992/10/01 MHDA- 1992/10/01 00:01 CRDT- 1992/10/01 00:00 PST - ppublish SO - Ann Chir Plast Esthet. 1992 Oct;37(5):534-40. PMID- 1454382 OWN - NLM STAT- MEDLINE DA - 19930106 DCOM- 19930106 LR - 20071115 IS - 0304-3959 (Print) IS - 0304-3959 (Linking) VI - 50 IP - 3 DP - 1992 Sep TI - Postoperative analgesia: pain by choice? The influence of patient attitudes and patient education. PG - 257-62 AB - Postoperative pain control can be unsatisfactory for a variety of reasons, including patients' attitudes towards pain treatment itself. To assess patients' expectations and their influence on postoperative analgesia, as well as the prevalence of pain following common gynaecological surgery, a prospective study was performed in 166 patients with either abdominal hysterectomy, mastectomy, laparoscopy or uterine curettage. After a first postoperative period with routine on-demand analgesia, a nurse specialised in pain treatment discussed the purposes and risks of pain treatment with the patients and cared for these patients in the second, subsequent study period. Following this discussion, 30 of 40 patients refusing analgesics in the first study period agreed to be given pain medication. In the groups with hysterectomy or mastectomy, pain control improved in the second postoperative period, even though the doses of analgesics administered were generally lower. Education of patients regarding the aims and risks of pain therapy is an essential part of pain control and can lead to an improvement of postoperative analgesia. FAU - Wilder-Smith, C H AU - Wilder-Smith CH AD - Department of Medicine, Inselspital, University of Berne, Switzerland. FAU - Schuler, L AU - Schuler L LA - eng PT - Journal Article PL - United States TA - Pain JT - Pain JID - 7508686 SB - IM MH - Adult MH - *Analgesia MH - *Attitude to Health MH - Choice Behavior MH - Curettage MH - Female MH - Humans MH - Hysterectomy MH - Laparoscopy MH - Mastectomy MH - Middle Aged MH - *Pain, Postoperative MH - *Patient Education as Topic MH - *Patients MH - *Postoperative Care MH - Prospective Studies EDAT- 1992/09/01 MHDA- 1992/09/01 00:01 CRDT- 1992/09/01 00:00 AID - 0304-3959(92)90029-B [pii] PST - ppublish SO - Pain. 1992 Sep;50(3):257-62. PMID- 1444204 OWN - NLM STAT- MEDLINE DA - 19921216 DCOM- 19921216 LR - 20151119 IS - 0250-7005 (Print) IS - 0250-7005 (Linking) VI - 12 IP - 5 DP - 1992 Sep-Oct TI - A decision support system for predicting a recurrence of breast cancer; a prospective study of serum tumour markers TAG 12, CA 15-3 and MCA. PG - 1439-42 AB - The aim of the present study was to evaluate the clinical value of the preoperative serum tumour markers TAG 12, CA 15-3 and MCA in predicting a recurrence of breast cancer patients. The sensitivity of the TAG 12 test was 54%, that of the CA 15-3 test 15% and that of the MCA test 15% in predicting a recurrence of breast cancer. The most important predictor of breast cancer recurrence was TAG 12. In order to evaluate the contributions of different tumour marker serum test, a stepwise discriminant analysis was carried out. The discriminant function (DF) is DF = TAG 12 x 0.061 - CA 15-3 x 0.1336 - 0.396. The sensitivity of the DF in detecting recurrence of breast cancer was 63% with a specificity of 90% and an efficiency of 75%. In conclusion, the results indicate that a new tumour marker TAG 12 is superior to CA 15-3 and MCA in predicting breast cancer recurrence. In this study the discriminant function including TAG 12 and CA 15-3 was superior to single preoperative tumour marker tests. The results speak for the use of a decision support system to aid in predicting a recurrence of breast cancer. FAU - Eskelinen, M AU - Eskelinen M AD - Department of Surgery, University of Kuopio, Finland. FAU - Hippelainen, M AU - Hippelainen M FAU - Carlsson, L AU - Carlsson L FAU - Jonsson, P AU - Jonsson P FAU - Alhava, E AU - Alhava E LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - Greece TA - Anticancer Res JT - Anticancer research JID - 8102988 RN - 0 (Antigens, Neoplasm) RN - 0 (Antigens, Tumor-Associated, Carbohydrate) RN - 0 (Biomarkers, Tumor) RN - 0 (TAG 12) RN - 0 (mucinous carcinoma-associated antigen) SB - IM MH - Antigens, Neoplasm/*blood MH - Antigens, Tumor-Associated, Carbohydrate/*blood MH - Biomarkers, Tumor/*blood MH - Breast Neoplasms/*blood/pathology/surgery MH - Female MH - Humans MH - Lymphatic Metastasis MH - Mastectomy MH - Mastectomy, Segmental MH - Middle Aged MH - Neoplasm Metastasis MH - Prognosis MH - Prospective Studies MH - Recurrence EDAT- 1992/09/01 MHDA- 1992/09/01 00:01 CRDT- 1992/09/01 00:00 PST - ppublish SO - Anticancer Res. 1992 Sep-Oct;12(5):1439-42. PMID- 1913500 OWN - NLM STAT- MEDLINE DA - 19911108 DCOM- 19911108 LR - 20071115 IS - 0008-543X (Print) IS - 0008-543X (Linking) VI - 68 IP - 5 Suppl DP - 1991 Sep 01 TI - Patient issues in breast reconstruction. PG - 1167-9 AB - Breast reconstruction is not a new idea. Techniques have been developing since the late 1800s. The state of the art is such that the knowledge of its availability and success has significant effect on the willingness of women to seek earlier diagnosis and treatment. However, reconstruction is not for everyone. This paper examines the issues about knowledge, attitudes, and practices that either result in electing for or against reconstruction. Some issues involved are financial, others have to do with cosmetic appearance, and still others involve the medical and psychological affects. Identifying and understanding the issues from the point of view of the patient is important in providing support for the patient with breast cancer. FAU - Brown, H G AU - Brown HG AD - Jonsson Comprehensive Cancer Center, Division of Cancer Control, Los Angeles, California 90024. LA - eng PT - Journal Article PT - Review PL - United States TA - Cancer JT - Cancer JID - 0374236 SB - AIM SB - IM MH - Breast Neoplasms/*psychology/surgery MH - *Choice Behavior MH - Female MH - *Health Knowledge, Attitudes, Practice MH - Humans MH - Mammaplasty/*psychology/standards MH - Patient Education as Topic/methods MH - Teaching Materials RF - 6 EDAT- 1991/09/01 MHDA- 1991/09/01 00:01 CRDT- 1991/09/01 00:00 PST - ppublish SO - Cancer. 1991 Sep 1;68(5 Suppl):1167-9. PMID- 1835623 OWN - NLM STAT- MEDLINE DA - 19920109 DCOM- 19920109 LR - 20061115 IS - 0959-8049 (Print) IS - 0959-8049 (Linking) VI - 27 IP - 9 DP - 1991 TI - Breast-conserving treatment or mastectomy in early breast cancer: a clinical decision analysis with special reference to the risk of local recurrence. PG - 1132-7 AB - A clinical decision analysis was performed to judge the impact of local recurrences after breast-conserving treatment (BCT) on the (quality-adjusted) life expectancy of breast cancer patients. A life-long follow-up of two patient groups, one of which had undergone mastectomy and one BCT, was simulated by a Markov model of medical prognosis. Data used in the model originated from the literature. Since results in the source papers were not split according to stage, we performed two analyses: one with data from all source studies (T1 and T2) and one with data from source studies, concerning only T1 patients. In both analyses, the conclusion was that BCT yields better quality-adjusted life expectancy than mastectomy. Sensitivity analysis, however, identified subgroups of patients who should preferably undergo mastectomy. These subgroups are: patients preferring mastectomy to BCT, patients with a high risk of local recurrence, young patients and patients at high age, if they also have a high local recurrence risk. For these groups, patient preferences should play a major role in recommending treatment. FAU - Verhoef, L C AU - Verhoef LC AD - Institute for Radiotherapy, Radboud University Hospital, Nijmegen, The Netherlands. FAU - Stalpers, L J AU - Stalpers LJ FAU - Verbeek, A L AU - Verbeek AL FAU - Wobbes, T AU - Wobbes T FAU - van Daal, W A AU - van Daal WA LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Eur J Cancer JT - European journal of cancer (Oxford, England : 1990) JID - 9005373 SB - IM MH - Adult MH - Age Factors MH - Aged MH - Breast/surgery MH - Breast Neoplasms/*mortality/surgery MH - *Decision Support Techniques MH - Female MH - Humans MH - Mastectomy/methods/*mortality MH - Middle Aged MH - Neoplasm Recurrence, Local/*mortality MH - Postoperative Period MH - Prognosis MH - Quality of Life MH - Risk Factors MH - Sensitivity and Specificity EDAT- 1991/01/01 MHDA- 1991/01/01 00:01 CRDT- 1991/01/01 00:00 PST - ppublish SO - Eur J Cancer. 1991;27(9):1132-7. PMID- 2361056 OWN - NLM STAT- MEDLINE DA - 19900806 DCOM- 19900806 LR - 20151119 IS - 0786-5686 (Print) IS - 0786-5686 (Linking) VI - 2 IP - 2 DP - 1990 TI - [Women's experience of care following breast surgery]. PG - 146-51 AB - The purpose of this study was women's readiness and possibility of self-care after breast operation, and experiences and expectations which they had about their guidance with knowledge and skills and support during the care. A questionnaire was developed and sent to the subjects. The sample consisted of 109 women with breast cancer within the last three years. The statistical analysis of data was based on percentual distributions with correlations, cross tabulation and log-linear models. The patients described that they have good readiness to take part in their own care, but at all stages of care they got support and information insufficiently. Relatives were not supported enough. The action organised by cancer association was mainly considered positive. FAU - Suominen, T AU - Suominen T LA - fin PT - English Abstract PT - Journal Article TT - Rintaleikattujen naisten hoitokokemuksia. PL - Finland TA - Hoitotiede JT - Hoitotiede JID - 9104138 SB - N MH - *Adaptation, Psychological MH - Adult MH - Aged MH - Consumer Behavior MH - Data Interpretation, Statistical MH - Family/psychology MH - Female MH - Humans MH - Mastectomy/nursing/*psychology MH - Middle Aged MH - *Self Care MH - Social Support MH - Surveys and Questionnaires EDAT- 1990/01/01 MHDA- 1990/01/01 00:01 CRDT- 1990/01/01 00:00 PST - ppublish SO - Hoitotiede. 1990;2(2):146-51. PMID- 2693454 OWN - NLM STAT- MEDLINE DA - 19900306 DCOM- 19900306 LR - 20061115 IS - 0021-9304 (Print) IS - 0021-9304 (Linking) VI - 23 IP - A3 Suppl DP - 1989 Dec TI - Nondestructive investigations on ninety-seven surgically excised mammary prostheses. PG - 285-98 AB - The information contained in the medical files of 68 patients having undergone surgical excision of a total of 97 internal mammary prostheses allowed us to define a typical patient profile at time of first implantation. Age: 33 years 11 months, height: 1.59 m, weight: 51.5 kg, two children. Twenty-one percent of these patients had the operation done subsequent to a mastectomy, while 79% requested it for cosmetic reasons. The duration of implantation was less than 55 months for 76% of the prostheses received after excision. The most frequent evolutive complications were the formation of a fibrous capsule followed by silicone bleeding, as well as mineralization. Macroscopic examination of the 97 explanted prostheses provided information on their integrity (38.1% of prostheses ruptured), gel differentiation (24.7%), sticky surfaces (26.8%), surface deposits (33%), memory folds (54.6%), and Dacron fixation patches (20.6%). According to the medical files, a fibrous capsule was found in association with 69.8% of the breast implants. We received only 46 capsules. The average thickness was 1.4 mm. Mineralizations were present on 15 capsules (32.6%). Two zinc phosphates were identified, for the first time, in human body: parascholzite and hopeite. Statistical examination showed that Heyer-Schulte prostheses stayed in place for a longer time. Integrity and gel differentiation depended on the duration of the implantation. Presence of mineralization was model-related (Dow Corning prostheses were associated with deposits) and depended on the presence of fixation patches. FAU - Rolland, C AU - Rolland C AD - Biomaterials Unit, St-Francois d'Assise Hospital, Quebec City, Canada. FAU - Guidoin, R AU - Guidoin R FAU - Marceau, D AU - Marceau D FAU - Ledoux, R AU - Ledoux R LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - United States TA - J Biomed Mater Res JT - Journal of biomedical materials research JID - 0112726 RN - 0 (Biocompatible Materials) RN - 0 (Minerals) RN - 0 (Silicones) SB - IM MH - Adult MH - *Biocompatible Materials MH - Breast/*surgery MH - Data Interpretation, Statistical MH - Electron Probe Microanalysis MH - Female MH - Foreign-Body Reaction/etiology/metabolism/pathology MH - Humans MH - Medical Records MH - Microscopy, Electron, Scanning MH - Minerals/analysis MH - *Prostheses and Implants/adverse effects MH - Prosthesis Failure MH - *Silicones MH - Spectrophotometry, Infrared MH - Surface Properties MH - X-Ray Diffraction EDAT- 1989/12/01 MHDA- 1989/12/01 00:01 CRDT- 1989/12/01 00:00 PST - ppublish SO - J Biomed Mater Res. 1989 Dec;23(A3 Suppl):285-98. PMID- 2696036 OWN - NLM STAT- MEDLINE DA - 19900320 DCOM- 19900320 LR - 20150828 IS - 0080-0015 (Print) IS - 0080-0015 (Linking) VI - 115 DP - 1989 TI - Overview of adjuvant radiotherapy for breast cancer. PG - 220-5 FAU - Cuzick, J AU - Cuzick J AD - Imperial Cancer Research Fund, Lincoln's Inn Fields, London, Great Britain. LA - eng PT - Clinical Trial PT - Journal Article PT - Randomized Controlled Trial PL - Germany TA - Recent Results Cancer Res JT - Recent results in cancer research. Fortschritte der Krebsforschung. Progres dans les recherches sur le cancer JID - 0044671 SB - IM MH - Breast Neoplasms/mortality/*radiotherapy/surgery MH - Combined Modality Therapy MH - Data Collection/standards MH - Data Interpretation, Statistical MH - Humans MH - Mastectomy MH - Meta-Analysis as Topic MH - Randomized Controlled Trials as Topic MH - Survival Rate EDAT- 1989/01/01 MHDA- 1989/01/01 00:01 CRDT- 1989/01/01 00:00 PST - ppublish SO - Recent Results Cancer Res. 1989;115:220-5. PMID- 6877163 OWN - NLM STAT- MEDLINE DA - 19830920 DCOM- 19830920 LR - 20071115 IS - 0025-729X (Print) IS - 0025-729X (Linking) VI - 2 IP - 4 DP - 1983 Aug 20 TI - Patients' perceptions of breast reconstruction after mastectomy. PG - 173-6 AB - Members of the Victorian section of Plastic and Reconstructive Surgery of the Royal Australasian College of Surgeons participated in a review of the benefits and problems associated with breast reconstruction after mastectomy from the patient's perspective. Fifty-four patients completed anonymous, open-ended questionnaires designed to elicit their frank thoughts and feelings about their breast reconstruction. The most commonly mentioned benefits and problems of reconstruction are reported. The benefits vastly outweighed any problems experienced by these women and none expressed any regret at having undergone breast reconstruction. Breast reconstruction can be a valuable aid to psychological adjustment after mastectomy. We believe that patients who may benefit from breast reconstruction should be identified and offered this option. FAU - Rassaby, J AU - Rassaby J FAU - Hill, D AU - Hill D LA - eng PT - Comparative Study PT - Journal Article PL - Australia TA - Med J Aust JT - The Medical journal of Australia JID - 0400714 SB - IM MH - Breast/*surgery MH - Decision Making MH - Female MH - Humans MH - *Mastectomy/psychology MH - Patient Education as Topic MH - Postoperative Complications MH - Retrospective Studies MH - *Self Concept MH - *Surgery, Plastic MH - Time Factors EDAT- 1983/08/20 MHDA- 1983/08/20 00:01 CRDT- 1983/08/20 00:00 PST - ppublish SO - Med J Aust. 1983 Aug 20;2(4):173-6.