Attitudes and Perspectives on Shared Decision Making Among Breast Surgical Oncologists: A Qualitative Study

Shared decision making (SDM) supported by decision aids (DAs) can guide patients with early-stage breast cancer who often face difficulty choosing between lumpectomy and mastectomy. Yet, the use of DAs remains limited in breast surgical oncology practices. In this qualitative study, we sought to assess how breast surgical oncologists perceive SDM/DAs and to identify facilitators and barriers to DA implementation.

Semistructured interviews exploring use of DAs in SDM were conducted with 12 breast surgical oncologists who were recruited from a national breast surgical oncology research group. Interviews were recorded, transcribed, and thematically coded.

Multiple themes emerged around the implementation of SDM and DAs. Participants thought that DAs do not work for every patient and endorsed barriers to implementation, such as time, fear of overwhelming the patient, differences in language/culture, and preference to speak naturally. Participants emphasized the importance of quality of life conversations in SDM but also noted barriers to implementation. Overall, SDM and quality of life conversations were highly regarded by all surgeons.

In this study, breast surgical oncologists reported limited use of DAs but endorsed SDM in their daily practice. Some of the reported barriers to DA use occur at the clinician and the patient level. This study advances the understanding of how physicians perceive SDM tools. As early-stage breast cancer patients navigate surgical options, it is important to facilitate patient-centered decisions.