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  • br Factors associated with not following doctor s

    2020-03-24

    
    Factors associated with not following doctor’s advice
    Of the 39 patients whose doctors recommended either CPM or UM, eight chose not to follow their doctor’s recommendation (20.5%). Seven of these patients were initially recommended UM (and subsequently underwent CPM), and one of these patients was recommended CPM (and subsequently under-went UM). There were no differences in patient age, race, education, insurance type, or income between patients who STA-21 followed their doctor’s advice versus those who did not (P > 0.05; Table 2).
    Table 2 e Factors associated with following doctor’s initial advice.
    Factor Did not follow advice (n ¼ 8) Followed advice (n ¼ 31) P-value
    Race
    Education
    Insurance type
    Income
    Active participation in decision-making
    Compared to patients who did not engage in active partici-pation in decision-making, patients who engaged in active participation chose to undergo CPM more often (68.3% versus 30.8%, P < 0.001). Patients who actively participated in decision-making with their doctors tended to be younger at the time of surgery than those who did not (median age 46 versus 55, P ¼ 0.001); aside from age, there were no other sig-nificant sociodemographic differences between the two groups (Table 3). On multivariate analysis controlling for age, however, active participation in decision-making remained an independent predictor of the patient ultimately choosing to undergo CPM (OR 3.507, 95% CI 1.268-9.700, P ¼ 0.016).
    Effect of physicianepatient communication on satisfaction with surgical decision
    The mean SWD score of the entire cohort was 4.80 of 5.00 (range 3.17-5.00), with similarly high satisfaction reported in patients who had CPM and UM (mean SWD score 4.72 versus 4.85, respectively, P ¼ 0.078). Among patients who received a recommendation from their doctor, satisfaction was similar regardless of whether the physician recommended UM or CPM (mean SWD score 4.80 versus 4.64, respectively, P ¼ 0.894). Those who did not follow their doctor’s initial recommenda-tion were as satisfied with their decision as those who did follow their doctor’s recommendation (mean SWD 4.88 versus 
    Patient-reported preferred communication strategies
    When asked their preferences, 12 patients (12%) stated that first law of thermodynamics (conservation) preferred for the doctor to provide a recommendation (either CPM or UM), seven (7%) preferred to make the decision on their own, and 81 (81%) preferred to engage in active participation in decision-making with their doctors; there was one patient who did not provide a response to preferred communication style. Age, race, education, insurance type, and income did not differ between patients reporting different preferred communication strategies (P > 0.05).
    Discussion
    This study of 101 mastectomy patients sought to explore the dynamics of physicianepatient communication in the context of choosing between CPM and UM. We found that when physicians provide recommendations, nearly 80% of patients tend to follow them. These findings are echoed in other studies as well. For example, in an SEER-based survey study, Katz et al. found that recommendation against CPM was highly associated with lower rates of CPM, compared to no
    Table 3 e Factors associated with active participation in decision-making with doctor.
    Factor No active participation (n ¼ 39) Active participation (n ¼ 61) P-value
    Median age (y)
    Race
    Education
    Insurance type
    Income
    recommendation against CPM.19 Jagsi et al. also found that 58.9% of patients who stated that their surgeon recommended CPM followed this recommendation, whereas only 2.1% of patients whose surgeon recommended against CPM opted to undergo CPM regardless.20 Indeed, one study that asked pa-tients about factors affecting their decisions in terms of breast surgery, surgeon recommendation was one of the most important factors patients considered.21