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

Patient Educ Couns. 2013 Jan;90(1):69-73. doi: 10.1016/j.pec.2012.08.016. Epub 2012 Sep 20.


Objective: To compare the amount of shared decision making in breast cancer surgery interactions when providers do and do not make a treatment recommendation.

Methods: We 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.

Results: Most 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).

Conclusion: Providers 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 implications: Providers need to discuss both mastectomy and lumpectomy and elicit patients' goals and treatment preferences regardless of whether or not a recommendation is given.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / psychology
  • Breast Neoplasms / surgery*
  • Communication*
  • Decision Making*
  • Directive Counseling*
  • Female
  • Health Care Surveys
  • Humans
  • Mastectomy / psychology
  • Middle Aged
  • Patient Participation
  • Physician-Patient Relations*
  • Practice Patterns, Physicians'
  • Quality of Health Care
  • Socioeconomic Factors
  • Survivors / psychology
  • Survivors / statistics & numerical data
  • Treatment Outcome