Assessing the role of oncologist type in shared decision-making for patients with metastatic breast cancer.

Abstract

e13085 Background: Metastatic breast cancer (MBC) involves complex treatment plans, as patients and their oncologists must balance extending life with maintaining quality of life, within a landscape of rapidly increasing therapeutic options. Shared Decision-making (SDM), a collaborative approach between clinician and patient, underscores the importance of patient engagement in their treatment decisions. This patient-led study examined the relationship between seeing a breast specialist and perceptions of shared decision-making for people with MBC. Methods: We collected data using a self-administered survey developed by the Patient-Centered Dosing Initiative, a patient-led nonprofit working to bring real-life experience into cancer treatment decisions. Eligible participants were aged ≥18 years, US residents, with a self-reported history of MBC. Participants were asked whether their primary oncologist treated exclusively breast cancer patients (yes/no/I don’t know). They also rated their level of agreement on a 6-point (0 to 5) scale using the validated 9-item SDM-Q-9 instrument. We calculated the median (Med) and standard deviation (SD) of the summed SDM score (Min:0, Max: 45) and of individual SDM-Q-9 items (Min: 0, Max: 5), where higher scores indicated having a greater sense of SDM. We used Mann-Whitney U tests to compare medians between respondents who saw a breast specialist and those who did not. P values less than 0.05 were considered statistically significant. Results: There were 501 respondents with MBC with complete survey data. Participants had a mean age of 55 and 62.9% (n = 315) reported seeing a breast specialist. The overall median summed SDM-Q-9 was 40 (SD:15.2) and was statistically different (p = 0.043) between respondents who saw a breast specialist (Med: 42, SD: 15.7) and those who did not (Med: 37, SD: 14.2). For the specific SDM item “My doctor and I selected a treatment option together,” respondents who saw a breast specialist had significantly higher median SDM scores (Med: 5.0, SD: 1.6) than those who did not (Med: 4.0, SD: 1.5), (p = 0.011). For the SDM item “My doctor precisely explained the advantages and disadvantages of treatment options,” respondents who saw a breast specialist had significantly higher median SDM scores (Med: 5.0, SD: 1.4) than those who did not (Med: 4.0, SD: 1.4), (p = 0.008). Conclusions: Patients with MBC reported high levels of shared decision-making overall; however, patients treated by breast specialists reported significantly greater overall shared decision-making. The differences across several subdomains indicate that patients seeing breast specialists may be more involved in treatment selection and communication about treatment trade-offs. These differences identify potential system-level targets across different types of oncology practices to improve patient-centered, preference-concordant care in MBC.