Hester Hill Schnipper, LICSW, OSW-C Program Manager, Oncology Social Work

JANUARY 02, 2018

I have written before about the complexity and difficulty of making treatment decisions. None of us are truly fully informed, and we tend to be in a state of at least some anxiety when faced with these choices, and it can feel that we are not given enough information or direction. There were some advantages to the old days when doctors just told us what to do (please don't read that as a wish to return to that system).

This is almost always an issue when women, newly diagnosed with breast cancer, have to make a surgical decision. Should it be a lumpectomy/wide excision or a mastectomy or bilateral mastectomies? And what about reconstruction? In almost all situations, the lumpectomy vs mastectomy choice will not impact survival; the changes will be equally good in either case (there are exceptions, but not a lot). There are some new online decision making tools that can be helpful. Here is information about one from Medscape:

After Breast Cancer Diagnosis, Web-Based Decision Aid Helps

Liam Davenport

Many women who undergo breast cancer surgery say that they felt they were not completely informed and that they rushed decisions instead of researching all the options. A Web-based decision aid improved both aspects ― by using the aid, women said they felt better informed and realized they could take time to make a decision. The findings come from two studies published online December 12 in the Journal of the American College of Surgery.
In the first study, Sunny Mitchell, MD, a breast surgeon in Stratford, Connecticut, and colleagues conducted a
nationwide survey of women who had undergone breast cancer surgery. Of almost 500 patients, more than half indicated that they had not felt completely informed about their treatment options.
Respondents included women who had undergone lumpectomy only, mastectomy only, or both procedures. Overall, around a third of the women indicated that they felt that making a quick decision was more of a priority than taking time to research all the treatment options.
Dr Mitchell commented that she was "definitely surprised" by the findings. She noted that future studies should focus on determining which formats for the delivery of reliable and consistent information are most effective.
In the second study, led by Heather B. Neuman, MD, Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine and Public Health, Madison, a Web-based decision aid was compared with sending women links to standard websites

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