Decision-making context of women who have undergone surgical treatment for breast cancer: a qualitative exploration of patient perspectives

Background: Mastectomy (MT) rates are higher in Newfoundland and Labrador (NL) than in any other province in Canada, even in women diagnosed with early-stage breast cancer. In this article, we present qualitative data from women who made a surgical breast cancer treatment decision to better understand the decision-making environment and process. Methods: A descriptive, qualitative design was employed. Semi-structured interviews and focus groups were held with women in NL who underwent surgical treatment for breast cancer, including breast-conserving surgery (BCS) or mastectomy (MT). Results: Thirty-five women participated. 74.3% had MT, whereas only 11.4% had BCS. Additionally, 14.3% had BCS initially followed by MT. The surgical treatment decision-making context was heterogeneous. Women reported varying levels of time they had to make a surgical decision, diverse perceptions of decisional choice, opinions on the adequacy of information provided to inform a decision, and different levels of available formal and informal supports. Most reported they were satisfied with their surgical decision, although the context in which these decisions were made was clearly a challenging one. Conclusions: Although most women were pleased with the surgical care they received, adequate time and thorough pre-surgical discussion were noted as necessary but not always available. Women explained the importance of thinking through their personal circumstances and values so as to make informed surgical decisions. Postsurgical care and discussion of available psychosocial supports were proposed as areas that could be improved.