Research article summary (published 30 May 2005):

Satisfaction with surgery outcomes and the decision process in a population-based sample of women with breast cancer.

Full Abstract

OBJECTIVE: To better understand medical decision making in the context of "preference sensitive care," we investigated factors associated with breast cancer patients' satisfaction with the type of surgery received and with the decision process. DATA SOURCES/DATA COLLECTION: For a population-based sample of recently diagnosed breast cancer patients in the Detroit and Los Angeles metropolitan areas (N=1,633), demographic and clinical data were obtained from the Surveillance, Epidemiology, and End Results tumor registry, and self-reported psychosocial and satisfaction data were obtained through a mailed survey (78.4 percent response rate). STUDY DESIGN: Cross-sectional design in which multivariable logistic regression was used to identify sociodemographic and clinical factors associated with three satisfaction measures: low satisfaction with surgery type, low satisfaction with the decision process, and decision regret. PRINCIPAL FINDINGS: Overall, there were high levels of satisfaction with both surgery and the decision process, and low rates of decision regret. Ethnic minority women and those with low incomes were more likely to have low satisfaction or decision regret. In addition, the match between patient preferences regarding decision involvement and their actual level of involvement was a strong indicator of satisfaction and decision regret/ambivalence. While having less involvement than preferred was a significant indicator of low satisfaction and regret, having more involvement than preferred was also a risk factor. Women who received mastectomy without reconstruction were more likely to report low satisfaction with surgery (odds ratio [OR]=1.54, p<.05), low satisfaction with the process (OR=1.37, p<.05), and decision regret (OR=1.55, p<.05) compared with those receiving breast conserving surgery (BCS). An additional finding was that as patients' level of involvement in the decision process increased, the rate of mastectomy also increased (p<.001). CONCLUSIONS: A significant proportion of breast cancer patients experience a decision process that matches their preferences for participation, and report satisfaction with both the process and the outcome. However, women who report more involvement in the decision process are significantly less likely to receive a lumpectomy. Thus, increasing patient involvement in the decision process will not necessarily increase use of BCS or lead to greater satisfaction. The most salient aspect for satisfaction with the decision making process is the match between patients' preferences and experiences regarding participation.

Author information

Author/s: Lantz, Paula M (PM); Janz, Nancy K (NK); Fagerlin, Angela (A); Schwartz, Kendra (K); Liu, Lihua (L); Lakhani, Indu (I); Salem, Barbara (B); Katz, Steven J (SJ);

Affiliation: 109 Observatory, Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, 48109-2029, USA.

Journal and publication information

Publication Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.

Journal: Health services research (Health Serv Res), published in United States. (Language: eng)

Reference: 2005-Jun; vol 40 (issue 3) : pp 745-67

Dates: Created 2005/06/17; Completed 2005/08/04; Revised 2008/11/20;

PMID: 15960689, status: MEDLINE (last retrieved date: 2/18/2009)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Health Serv Res. 2005 Jun;40(3):769-79. (PMID: 15960690)

External Links for this article
(including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MeSH Headings (categories) shown below.

Aged Breast Neoplasms - ethnology; surgery Cross-Sectional Studies Decision Making Female Health Care Surveys Humans Logistic Models Los Angeles

Los Angeles Mastectomy - psychology; utilization Mastectomy, Segmental - psychology; utilization Michigan Middle Aged Patient Participation Patient Satisfaction - ethnology; statistics & numerical data SEER Program Treatment Outcome

Note: Bold headings indicate primary MeSH headings or qualifiers.

Related articles

These are the most related articles currently in our database:

• [Interactive cd-rom on the choice between breast-sparing treatment and mastectomy: positive responses from patients and surgeons] 24 May 2001
• Treatment of early stage breast cancer: do surgeons and patients agree regarding whether treatment alternatives were discussed? 29 Apr 2003
• Taking responsibility for cancer treatment. 30 Aug 2001
• The effect of race/ethnicity, sex, and social circumstances on coronary revascularization preferences: a vignette comparison. 30 Aug 2006
• Correlates of surgical treatment type for women with noninvasive and invasive breast cancer. 30 Aug 2001
• Patient satisfaction with rheumatology practitioner clinics: can we achieve concordance by meeting patients' information needs and encouraging participatory decision making? 30 Jan 2007
• Women's perspectives on maternity services in Sweden: processes, problems, and solutions. 27 Feb 2007
• Self-direction in home care for older people: a consumer's perspective. 30 Dec 1996
• A paradigm shift in patient satisfaction assessment. 30 Aug 2003
• The development and validation of the primary care satisfaction survey for women. 28 Feb 2004

See 100+ related articles.

Related Article Map

Legend: - FREE Full text Article. - Abstract only. - Title only. More help.

See a larger map of 100+ related articles.