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To enhance shared decision-making for patients with breast cancer, we developed an evidence-based educational breast cancer video (BCV) providing an overview of breast cancer biology, prognostic indicators, and surgical treatment options while introducing health care choice. By providing patients access to a BCV with information necessary to make i...
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Citations
... Shared decision making is considered a standard of care in breast cancer. Literature focusing on patients' experience of shared decision making within breast cancer treatment has described reduced levels of stress, improved knowledge and a preference for a personalized decision-making approach 4,5 . Shared decision making has recently been adopted by the General Medical Council as a formal recommendation within the decision-making and consent guidelines published in September 2020 6 . ...
Introduction
Over half of women with surgically managed breast cancer in the UK undergo breast-conserving treatment (BCT). While photographs are shown prior to reconstructive surgery or complex oncoplastic procedures, standard practice prior to breast conservation is to simply describe the likely aesthetic changes. Patients have expressed the desire for more personalized information about likely appearance after surgery. The hypothesis was that viewing a three-dimensional (3D) simulation improves patients’ confidence in knowing their likely aesthetic outcome after surgery.
Methods
A randomized, controlled trial of 117 women planning unilateral BCT was undertaken. The randomization was three-way: standard of care (verbal description alone, control group), viewing two-dimensional (2D) photographs, or viewing a 3D simulation before surgery. The primary endpoint was the comparison between groups’ median answer on a visual analogue scale (VAS) for the question administered before surgery: ‘How confident are you that you know how your breasts are likely to look after treatment?’
Results
The median VAS in the control group was 5.2 (i.q.r. 2.6–7.8); 8.0 (i.q.r. 5.7–8.7) for 2D photography, and 8.9 (i.q.r. 8.2–9.5) for 3D simulation. There was a significant difference between groups (P < 0.010) with post-hoc pairwise comparisons demonstrating a statistically significant difference between 3D simulation and both standard care and viewing 2D photographs (P < 0.010 and P = 0.012, respectively).
Conclusions
This RCT has demonstrated that women who viewed an individualized 3D simulation of likely aesthetic outcome for BCT were more confident going into surgery than those who received standard care or who were shown 2D photographs of other women. The impact on longer-term satisfaction with outcome remains to be determined.
Registration number: NCT03250260 (http://www.clinicaltrials.gov).
... While our approach incorporated a web-based educational tool that was reviewed after the initial consultation, an alternative or complementary approach is provision of education materials prior to the initial consultation with the aim of preparing the patient for discussion at the first visit. The feasibility of pre-visit educational videos in patients with breast cancer has been demonstrated elsewhere with favorable patient attitudes [23]. We are currently piloting the approach of a series of concise pre-visit videos in our clinic as an adjunct to the application. ...
Background:
Every case of breast cancer is unique, and treatment must be personalized to incorporate a woman's values and preferences. We developed an individually-tailored mobile patient education application for women with breast cancer.
Methods:
Pre-post surveys were completed by 255 women who used the tool.
Results:
Patients thought the application included helpful information (N = 184, 72%) and was easy to navigate (N = 156, 61%). Most patients thought the amount of information in the tool was "about right" (N = 193, 87%). Decision making confidence increased by an average of 0.8 points (10-point scale) following a consultation and use of the tool (p < 0.001).
Conclusions:
Tailored mobile applications may optimize care by facilitating shared decision making and knowledge transfer, and they may also enhance the experience of patients as they navigate through their breast cancer journey.
... However, different parameters of genetic assays have unique implications, along with various correlations with clinical or pathological features of BC. Therefore, the combination of different genetic assays benefits diagnosis and prognostic prediction of BC. 18 HER2 gene encodes proteins, which are specifically coupled with ligands to form heterodimers, which cause conformational change of HER2 proteins, and autophosphorylation of tyrosine kinase inside the cytoplasm to activate signal pathways. The activity of this heterodimer is advantageous over heterodimers that are formed by other members in EGFR family, causing a cascade reaction. ...
Objective:
Breast cancer (BC) is a common malignant tumor in females. The combined assay of multiple molecular markers benefits the diagnosis and prognostic prediction. Human epidermal growth factor receptor 2 (HER2) facilitates the proliferation and differentiation of cancer cells through ligand binding. Ki67 is a tumor proliferation-related gene, whereas GSTP1 is a DNA repair-related gene. This study thus investigated the significance of HER2 and Ki67/GSTP1 gene combined assay in the diagnosis and prognosis of BC.
Materials and methods:
A total of 86 breast tumor tissues and adjacent tissues were collected. Gene expression and protein levels of HER2 and Ki67 were quantified by real-time polymerase chain reaction (PCR) and Western blot, respectively. Methylation frequency of GSTP1 was analyzed by methylation-specific PCR. The correlation between HER2 and Ki67/GSTP1 and clinical/pathological features of BC was analyzed.
Results:
Gene and protein expression levels of HER2 and Ki67 in tumor tissues were increased (p < 0.05 compared with adjacent tissues). Methylation frequency of GSTP1 gene was 37.2%, which was significantly higher in breast tumor tissues than in adjacent tissues (12.79%, p < 0.05). HER2 expression was positively correlated with TNM stage, tumor size, and lymph node metastasis, and negatively correlated with tissue grade and estrogen receptor (ER)/progesterone receptor (PR) expression (p < 0.05). GSTP1 methylation was positively correlated with TNM stage and tumor size, and negatively correlated with ER/PR expression (p < 0.05).
Conclusions:
HER2, Ki67, and GSTP1 methylation were correlated with clinical and pathological features of BC. The combined assay benefits the early diagnosis and prognostic prediction of cancer.
... Studies in the breast literature have demonstrated the importance of patient understanding and the discrepancy between perceived patient understanding and actual retained knowledge [23,24]. The use of adjunctive educational resources can increase patient understanding of medical conditions and their treatments in addition to improving patient satisfaction [25,26]. ...
Purpose of Review
The review is aimed at determining critical factors in the preoperative and postoperative care of transgender patients undergoing gender-affirming surgery. General and procedure-specific considerations are summarized to improve the longitudinal perioperative care of transgender patients.
Recent Findings
Surgical providers should follow World Professional Association for Transgender Health (WPATH) guidelines regarding eligibility for surgery. Important elements in preoperative evaluation include mental health screening, fertility discussion, and adjustment of hormone replacement therapy. Postoperative considerations include proper cancer screening, mental health support, appropriate outcomes assessment, and awareness of potential procedure specific complications.
Summary
Proper perioperative care for transgender patients undergoing gender-affirming surgery involves a multidisciplinary approach to healthcare to create a comprehensive treatment environment at an institutional level.
... Previous studies have shown that most breast cancer patients feel more informed than they actually are. 19,23,43 So, consistent with past research 18,19,23,[43][44][45] and the Institute of Medicine special report, 21 there appears to be a substantial deficiency in the informing of women about their breast cancer treatment options. Some patients (and therefore some doctors too) might feel that being "somewhat informed" is sufficient and satisfactory. ...
... We also found that the vast majority of women were turning to other sources for information about treatment options (Table 2), consistent with past research. 19,44,45 Another large survey, conducted a decade ago with women in Los Angeles, CA and Detroit, MI, who had mostly undergone breast-conserving operations, also asked about what sources of information the women used. 19 Despite somewhat lower education levels, that survey's sample reported higher use rates of books (60%), scientific journal papers (52%), and magazines (51%) compared with our survey's lumpectomy-only patients' use of books or magazines (28%), and slightly lower rates of internet use (48% vs 58%), probably all due to the shift from print to digital during the past decade, and perhaps also due to culturally declining interest in reading. ...
... 44 Whatever the reasons might be, the use of those other sources of information might not always be beneficial because some of those sources might be providing misinformation or otherwise be confusing and counterproductive (Table 3). 19,45,46 In addition, most patients lack sufficient research skills to locate all of the best information available and lack sufficient medical knowledge to evaluate the quality of the information they find. Therefore, healthcare providers should be prepared to provide vetted, medically reliable information in a variety of formats. ...
Background:
Women diagnosed with breast cancer often describe the process of treatment decision making as bewildering and worrisome. Patients who do not feel completely informed about their surgical options might make choices that are suboptimal or regretted later. The Institute of Medicine has called for more research on why breast cancer patients are inadequately informed about treatment options. The aims of the study were to explore how women become informed about their breast cancer surgery treatment options and to identify improvement opportunities.
Study design:
A nationwide internet survey was conducted among women who reported being surgically treated by lumpectomy only (n = 215), mastectomy only (n = 140), or by both procedures (n = 132) for breast cancer. To improve generalizability, Census-based enrollment quotas were applied for geographic region, health insurance, and income.
Results:
Only 47% (95% CI 41% to 54%) of lumpectomy-only patients, 67% (95% CI 59% to 75%) of mastectomy-only patients, and 28% (95% CI 21% to 35%) of patients having both procedures said they felt "completely informed" about treatment options before their operations. "Making a quick decision" was more important than "thoroughly researching all options" for 35% of lumpectomy-only patients, 31% of mastectomy-only patients, and 22% of patients having both procedures. Nearly all women used some other source of information to research treatment options. Lumpectomy-only and mastectomy-only patients who relied on their surgeon's recommendation without additional research were significantly less likely to report feeling "completely informed" (odds ratio 0.6; 95% CI 0.4 to 0.9; p < 0.02).
Conclusions:
Many women who had surgery for breast cancer did not feel completely informed about their surgical options. This appears to be due, in part, to a false sense of urgency and perhaps insufficient or misdirected information gathering by patients. The responsibility for fully informing patients about their treatment options must be better fulfilled by surgeons.
Eighty percent of children diagnosed with cancer in childhood survive into adulthood. Fertility preservation (FP) is an important consideration, and procedures are available to reduce the risk of infertility following gonadotoxic therapies. Discussing FP options eases decision-making and minimizes regret; however, poor comprehension of these topics remains a challenge. This study evaluates if video-based educational tools increase understanding of FP options among pediatric patients and families. Videos were first tested among participants not at risk of infertility to ensure objective utility and optimize quality. In part 1, parents of pediatric surgical patients were randomized to view 2 publicly available educational videos on FP in differing orders. Each group completed pre-surveys and post-surveys assessing the comprehension and perception of video quality. In part 2, the parent and patient participants completed a comprehension assessment before and after viewing our institution-specific educational video, designed based on participant feedback from part 1. Part 1 results demonstrated a significant increase in participant knowledge and perceived understanding after viewing the videos (P<0.001), regardless of order. In part 2, the post-test comprehension scores were significantly improved for all participants and all subgroups, P<0.01. Results suggest that video-based educational tools may help to reduce barriers to FP in pediatric oncology.
Background:
Shared decision making (SDM) is a popular care paradigm between patients and clinicians to facilitate treatment agreement by building consensus and sharing information. Decisional aids (DAs) are tools frequently used in SDM for improving knowledge sharing and facilitating the decision process. The use and outcomes of decisional aids in surgery, however, have not been investigated. This study investigates whether SDM in surgery benefits any type of surgical patient compared with non-SDM treatment using patient-defined outcomes, such as an increase in knowledge and decisional satisfaction, as well as decreased decisional regret and anxiety.
Methods:
The search strategy was developed with a medical librarian to address the question of whether SDM in surgery benefits any type of surgical patient compared with non-SDM treatment using patient-defined outcomes. Seven databases (Medline [Ovid], Embase [Ovid], Cochrane [Wiley], Africa-Wide [EBSCO], Global Health [Ovid], Global Index Medicus (WHO), Web of Science [Clarivate Analytics]) were searched from inception until September 9th, 2019, with no language restriction. A two-person title and abstract screen was performed, followed by a full-text publication review. A DerSimonian-Laird random effects model was used for the meta-analysis, with heterogeneity established. Mean and standard deviation were collected for all study outcomes. Study eligibility was determined with strict inclusion and exclusion criteria. Study quality was assessed using the Cochrane Bias Risk Assessment Tool.
Results:
In total, 6060 studies were retrieved. After duplicates were removed, 5303 titles and abstracts were screened, and of 356 full texts reviewed, 42 studies were included in the analysis. Heterogeneity was high in three of six variables (surgery chosen, decisional conflict, and knowledge gained), moderate in two (decisional anxiety and decisional satisfaction), and low in one (decisional regret). For all except the rates of surgical intervention, the results for decisional conflict, knowledge gained, decisional satisfaction, and decisional anxiety were significant at a 95% confidence interval. Decisional conflict decreased in 20/24 of the papers that recorded it; rates of choosing surgery decreased in 8 of the 11; and patient knowledge increased in 19 of the 22 that recorded it. The majority of papers had risk of bias, however, with the evidence of generally low quality.
Conclusion:
The results suggest that SDM in surgery is associated with greater quality of patient satisfaction and value agreement, leading to decreased conflict and anxiety, and increased knowledge and translation. This data is useful in guiding the development of SDM protocols for use in surgical disciplines.
Review registration:
Registered on PROSPERO-ID: CRD42018097286 [13].
