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Patient choice in the treatment of breast cancer

BMJ 2011; 343 doi: (Published 18 October 2011) Cite this as: BMJ 2011;343:d5965
  1. Natasha Louise Turley, final year medical student
  1. 1Leicester Medical School, Leicester, UK

Joint decision making can have negative psychological consequences

Many patients would find it reassuring if they felt that they were doing what the doctor considers best rather than using their lay person’s knowledge.

Doctors and health professionals have recognised the need to move from compliance towards concordance when considering patient care. A patient is no longer regarded as someone who should simply “follow doctor’s orders,” and it is now acknowledged that patients are often experts in their own care and that a consultation should be seen as a partnership of equals.

The Right Care Shared Decision Making Programme is run by the National Health Service in the East Midlands and allows “a more empowering, adult-adult relationship which helps give patients the care they need and no less, the care they want and no more.”1 The programme states that this will improve both clinical outcomes and safety and increase adherence to the agreed management plan.

Clinical scenario

An older woman presented at the one stop breast clinic with tenderness and skin tethering over her left breast of three weeks’ duration. The patient had never had any problems with her breasts, which had been “clear” on a mammogram 18 months previously. Imaging and histology showed a high grade invasive ductal carcinoma with no lymph node involvement. When the case was discussed at the weekly multidisciplinary team meeting, the team decided that the patient had two options: the first was to have wide local excision and radiotherapy, and the second was to have a mastectomy.

The way in which bad news is broken has a major impact on patients, and it is important for doctors to make that experience as easy as possible. In this clinical scenario, a vast amount of information was given in small chunks and explained …

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