Is there shared decision making when the provider makes a recommendation?

ObjectiveTo compare the amount of shared decision making in breast cancer surgery interactions when providers do and do not make a treatment recommendation.MethodsWe surveyed breast cancer survivors who were eligible for mastectomy and lumpectomy. Patients reported whether the provider made a recommendation and the recommendation given. They completed items about their interaction including discussion of options, pros, cons, and treatment preference. A total involvement score was calculated with higher scores indicating more shared decision making.ResultsMost patients (85%) reported that their provider made a recommendation. Patients who did not receive a recommendation had higher involvement scores compared to those who did (52% vs. 39.1%, p = 0.004). Type of recommendation was associated with involvement. Patients given different recommendations had the highest total involvement scores followed by those who received mastectomy and lumpectomy recommendations (65.5% vs. 42.5% vs. 33.2%, respectively, p < 0.001).ConclusionProviders were less likely to present a balanced view of the options when they gave a recommendation for surgery. Patients who received a recommendation for lumpectomy had the lowest involvement score.Practice implicationsProviders need to discuss both mastectomy and lumpectomy and elicit patients’ goals and treatment preferences regardless of whether or not a recommendation is given.