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Article Title

Ductal Carcinoma in Situ Treatment Decision-Making and Patient-Reported Outcomes: A Review of the Literature

Publication Date

4-30-2015

Keywords

DCIS, treatment, decision-making

Abstract

Background/Aims: The treatment for ductal carcinoma in situ (DCIS) is similar to invasive breast cancer despite evidence of low 10-year recurrence rates and mortality. Patient preferences and involvement with decision-making should play a key role in treatment decisions; however, little are known about how decision-making about the type of treatment influences patient-reported outcomes. The objective is to review the recent literature to determine how decision-making for treatment of DCIS influences patient-reported outcomes and to make recommendations on future studies to improve decision-making practices.

Methods: A search of PubMed database was conducted for manuscripts published 2009–2014. Search terms included “ductal carcinoma in situ” and “satisfaction with treatment” (n=33), “decisional conflict” (n=1) or “patient decision making” (n=137). Only articles that included patient-reported decision-making were included in the review. Articles were excluded if they aggregated patients with invasive or metastatic breast cancer.

Results: There were a total of 11 articles included in the review. We found that decisional conflict among patients was common. Physicians play an important role in women understanding the disease; however, there is controversy about treatment of DCIS among experts. Decisional conflict was related to a lack of knowledge about the disease, which led to confusion, anxiety, fear and depression. The studies showed that conflicting messages from health care professionals negatively impacted patient’s abilities to make informed treatment decisions and patient-reported outcomes. In terms of health disparities, one study found that a lack of understanding about DCIS was greater in women from non-English speaking backgrounds. Recommendations for future research include: 1) improve knowledge of DCIS and its complexities among health care professionals and patients, 2) address knowledge gaps by developing and testing the efficacy of “decision aids” to improve patients comfort in making informed treatment choices, 3) evaluate why various messages about DCIS exist among health care professionals, and 4) address the need to establish consensus on guidelines.

Discussion: The literature suggests that patients often have a lack of knowledge and experience adverse psychological outcomes associated with a diagnosis of DCIS. More research is needed to improve informed treatment decisions about the disease for patients diagnosed with DCIS.

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