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Psychosurgery01:30

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Psychosurgery, the surgical alteration or permanent removal of brain tissue to alleviate severe psychological conditions, stands as one of the most radical and controversial treatments in the history of mental health care. Its development and application have evolved significantly, marked by dramatic shifts in scientific understanding and ethical perspectives.
Historical Development of Psychosurgery
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Does a brief surgeon training in negotiation theory principles decrease rates of contralateral prophylactic

Anita Mamtani1, Daniel D Sjoberg2,3, Alain Vincent4

  • 1Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. mamtana1@mskcc.org.

Breast Cancer Research and Treatment
|March 7, 2023
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Summary
This summary is machine-generated.

Surgeon training in negotiation skills did not reduce rates of contralateral prophylactic mastectomy (CPM) for unilateral breast cancer. Patient values, not training, appear to drive the decision for CPM.

Keywords:
Bilateral mastectomyContralateral prophylactic mastectomyNegotiation theory

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Health Services Research

Background:

  • Contralateral prophylactic mastectomy (CPM) use is increasing despite lacking oncologic benefit for unilateral breast cancer.
  • Patient-driven trends in CPM are linked to fear of recurrence and desire for peace of mind.
  • Traditional educational strategies have not effectively reduced CPM rates.

Purpose of the Study:

  • To evaluate the impact of surgeon training in negotiation theory on CPM rates.
  • To determine if a systematic counseling framework influences patient decisions regarding CPM.

Main Methods:

  • A cohort study examined CPM rates before and after surgeon training in negotiation skills.
  • The training focused on a systematic counseling framework including default options, social proof, and framing.
  • Data were collected from patients with unilateral breast cancer undergoing mastectomy between May 2017 and December 2019.

Main Results:

  • The CPM rate was 47% pre-training and 48% post-training, with no statistically significant difference (-3.7% adjusted difference; p=0.2).
  • Surgeons reported high baseline use of negotiation skills and no change in conversational difficulty after training.
  • The study included 2144 patients with unilateral breast cancer.

Conclusions:

  • Brief surgeon training in negotiation skills did not alter CPM rates.
  • CPM decisions are highly individualized, influenced by patient values and decision-making styles.
  • Further research is needed to identify effective strategies for minimizing overtreatment with CPM.