Abstract:
Introduction: Shared decision-making (SDM) refers to clinicians and patients collaboratively making decisions based on the best available evidence. SDM encourages patients
to consider the options, their benefits and risks, and communicate their preferences to
clinicians. SDM has been associated with better adherence to treatment, less unwarranted
intervention, and greater satisfaction with cancer care. This study explores the role of SDM
in the treatment choices of women with early breast cancer who underwent mastectomy
while eligible for breast-conserving surgery (BCS) in northern Sri Lanka.
Method: An exploratory descriptive qualitative study was carried out among 15 women
who underwent mastectomy for early breast cancer. Patients referred to Tellippalai Trail
Cancer Hospital for adjuvant therapy after mastectomy and matched the study criteria
were recruited. Data were collected through in-depth semi-structured interviews, which
were transcribed in Tamil, translated into English, coded using QDA Miner Lite software,
and analysed thematically.
Results: Of 15 participants, three were not informed of BCS as a treatment option before
mastectomy. The remainder were aware, but six women did not know they were eligible
for BCS, while another five were steered towards mastectomy by treating teams who conveyed possibilities of spread or recurrence following BCS. Only one participant had selected mastectomy despite the surgeon recommending BCS. All but two women ‘shared’ decision-making with their spouses, children, siblings and others, who viewed mastectomy as
the safer option. Pre-surgical counselling was often too brief; the complications following
mastectomy were conveyed, but the possibility of needing adjuvant therapy was frequently not communicated. Neither the survival rates nor risks/benefits of the two surgical options were discussed. Despite the information gaps, many believed they received sufficient
information.
Conclusions: Patient narratives suggest that SDM may not be widely practiced in the surgical treatment of breast cancer in northern Sri Lanka. High patient-to-staff ratios and the
unavailability of supportive care teams pose significant barriers to practicing SDM in the
local setting.
