RESUMEN
BACKGROUND: Hospital mastectomy rates vary. This study explores the relationship between mastectomy rates and breast cancer patients' consultation and decision-making experiences with specialist clinicians. METHODS: Qualitative semi-structured interviews were conducted with 65 patients from three purposively selected breast units from a single UK region. Patients provided with a choice of breast cancer surgery (breast conservation therapy (BCT) or mastectomy) were purposively recruited from high, medium and low case-mix-adjusted mastectomy rate units. RESULTS: Low mastectomy rate unit patients' consultation and decision-making experiences were markedly different to those of the medium and high mastectomy rate breast units. Treatment variation was associated with patients' perception of the most reassuring and least disruptive treatment; the content and style of information provision (equipoise or directed); level of patient participation in decision making; the time and process of decision making and patient autonomy in decision making. The provision of more comprehensive less directive information and greater autonomy, time and support of independent decision making were associated with a lower uptake of BCT. CONCLUSION: Variation in hospital mastectomy rates was associated with differences in the consultation and decision-making experiences of breast cancer patients. Higher mastectomy rates were associated with the facilitation of more informed autonomous patient decision making.
Asunto(s)
Neoplasias de la Mama/cirugía , Toma de Decisiones , Mastectomía/estadística & datos numéricos , Adulto , Anciano , Femenino , Hospitales , Humanos , Persona de Mediana Edad , Participación del Paciente , Satisfacción del Paciente , Derivación y ConsultaRESUMEN
The following article by Donna J. Wilde, MPA, RRA, is the first in a series of brief articles aimed at focusing members' attention on the vital importance of recruiting students to medical record programs. If our profession is to grow in numbers and in high level performers, we must begin attracting students to the challenging world of healthcare information management. Wilde discusses the topic from the educator's viewpoint.
