Does a brief surgeon training in negotiation theory principles decrease rates of contralateral prophylactic mastectomy?

Purpose Despite the lack of any oncologic benefit, contralateral prophylactic mastectomy (CPM) use among women with unilateral breast cancer is increasing. This patient-driven trend is influenced by fear of recurrence and desire for peace of mind. Traditional educational strategies have been ineffec...

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Veröffentlicht in:Breast cancer research and treatment Jg. 199; H. 1; S. 119 - 126
Hauptverfasser: Mamtani, Anita, Sjoberg, Daniel D., Vincent, Alain, Ehdaie, Behfar, Malhotra, Deepak, Vickers, Andrew, Morrow, Monica
Format: Journal Article
Sprache:Englisch
Veröffentlicht: New York Springer US 01.05.2023
Springer Nature B.V
Schlagworte:
Breast cancer
Breast Neoplasms - prevention & control
Breast Neoplasms - surgery
Cancer research
Epidemiology
Estrogen receptors
Female
Humans
Mastectomy
Medicine
Medicine & Public Health
Middle Aged
Negotiating
Oncology
Patients
Prophylactic Mastectomy
Self-assessment
Surgeons
Training
Unilateral Breast Neoplasms - surgery
Bilateral mastectomy
Negotiation theory
Contralateral prophylactic mastectomy
ISSN:0167-6806, 1573-7217, 1573-7217
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Zusammenfassung:Purpose Despite the lack of any oncologic benefit, contralateral prophylactic mastectomy (CPM) use among women with unilateral breast cancer is increasing. This patient-driven trend is influenced by fear of recurrence and desire for peace of mind. Traditional educational strategies have been ineffective in reducing CPM rates. Here we employ training in negotiation theory strategies for counseling and determine the effect on CPM rates. Methods In consecutive patients with unilateral breast cancer treated with mastectomy from 05/2017 to 12/2019, we examined CPM rates before and after a brief surgeon training in negotiation skills. This comprised a systematic framework for patient counseling utilizing early setting of the default option, leveraging social proof, and framing. Results Among 2144 patients, 925 (43%) were treated pre-training and 744 (35%) post-training. Those treated in the 6-month transition period were excluded ( n  = 475, 22%). Median patient age was 50 years; most patients had T1–T2 (72%), N0 (73%), and estrogen receptor-positive (80%) tumors of ductal histology (72%). The CPM rate was 47% pre-training versus 48% post-training, with an adjusted difference of −3.7% (95% CI −9.4 to 2.1, p  = 0.2). In a standardized self-assessment survey, all 15 surgeons reported a high baseline use of negotiation skills and no significant change in conversational difficulty with the structured approach. Conclusion Brief surgeon training did not affect self-reported use of negotiation skills or reduce CPM rates. The choice of CPM is a highly individual decision influenced by patient values and decision styles. Further research to identify effective strategies to minimize surgical overtreatment with CPM is needed.
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Anita Mamtani, Daniel D. Sjoberg, Alain Vincent, Behfar Ehdaie, Deepak Malhotra, Andrew Vickers, and Monica Morrow commented on previous versions of the manuscript.
Anita Mamtani, Daniel D. Sjoberg, Alain Vincent, Behfar Ehdaie, Deepak Malhotra, Andrew Vickers, and Monica Morrow contributed to the study conception and design.
Anita Mamtani, Daniel D. Sjoberg, Alain Vincent, Behfar Ehdaie, Deepak Malhotra, Andrew Vickers, and Monica Morrow read and approved the final manuscript.
Material preparation, data collection and analysis were performed by Anita Mamtani, Daniel D. Sjoberg, Alain Vincent, Andrew Vickers, and Monica Morrow.
Author Contributions
The first draft of the manuscript was written by Anita Mamtani and Monica Morrow.
ISSN:0167-6806
1573-7217
1573-7217
DOI:10.1007/s10549-023-06891-6