BMJ 1999;318:1146 ( 24 April )

Letters

Early discharge after surgery for breast cancer

Self selection probably occurred among patients studied

The first 150 words of the full text of this article appear below.

EDITOR---We are pleased that psychological implications of early discharge after surgery for breast cancer are being examined1 but think that some important aspects of the policy have been inappropriately or inadequately researched and warrant further investigation.

There is a drawback to applying randomised controlled trial methodology in situations such as this, where patients are making choices about their care. A self selecting process operates and must be taken into account in the research design; if it is not, a randomised controlled trial will study a biased sample---it will include some patients who might not otherwise have considered earlier discharge and exclude those who are most committed to the idea and do not want to risk being randomised to the control condition. This is not a peripheral issue. The policy framework for commissioning cancer services has emphasised the need to involve both patients and their carers in decisions . . . [Full text of this article]
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