An absence of equipoise: Examining surgeons' decision talk during encounters with women considering breast cancer surgery

Shared decision-making is recommended for decisions with multiple reasonable options, yet clinicians often subtly or explicitly guide choices. Using purposive sampling, we performed a secondary analysis of 142 audio-recorded encounters between 13 surgeons and women eligible for breast-conserving sur...

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Bibliographic Details
Published in:PloS one 2021-12, Vol.16 (12), p.e0260704-e0260704
Main Authors: Politi, Mary C, Saunders, Catherine H, Grabinski, Victoria F, Yen, Renata W, Cyr, Amy E, Durand, Marie-Anne, Elwyn, Glyn
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Analysis
Auroral kilometric radiation
Biology and Life Sciences
Breast cancer
Breast Neoplasms - psychology
Breast Neoplasms - radiotherapy
Breast Neoplasms - surgery
Cancer surgery
Care and treatment
Clinical medicine
Collaboration
Decision making
Decision Making, Shared
Diagnosis
Female
Humans
Intervention
Life Sciences
Lumpectomy
Mastectomy
Mastectomy, Segmental
Medicine
Medicine and Health Sciences
Methods
Middle Aged
Patient outcomes
Patients
People and Places
Physician and patient
Physician-Patient Relations
Practice
Proposals
Radiation
Secondary analysis
Social Sciences
Surgeons
Surgeons - psychology
Surgery
Taxonomy
Transgender persons
Verbal communication
Womens health
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Summary:Shared decision-making is recommended for decisions with multiple reasonable options, yet clinicians often subtly or explicitly guide choices. Using purposive sampling, we performed a secondary analysis of 142 audio-recorded encounters between 13 surgeons and women eligible for breast-conserving surgery with radiation or mastectomy. We trained 9 surgeons in shared decision-making and provided them one of two conversation aids; 4 surgeons practiced as usual. Based on a published taxonomy of treatment recommendations (pronouncements, suggestions, proposals, offers, assertions), we examined how surgeons framed choices with patients. Many surgeons made assertions providing information and advice (usual care 71% vs. intervention 66%; p = 0.54). Some made strong pronouncements (usual care 51% vs. intervention 36%; p = .09). Few made proposals and offers, leaving the door open for deliberation (proposals usual care 21% vs. intervention 26%; p = 0.51; offers usual care 40% vs. intervention 40%; p = 0.98). Surgeons were significantly more likely to describe options as comparable when using a conversation aid, mentioning this in all intervention group encounters (usual care 64% vs. intervention 100%; p
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0260704