Annals of Surgical Oncology

, Volume 20, Issue 1, pp 7–14

Surgeon-Level Variation in Patients’ Appraisals of Their Breast Cancer Treatment Experiences

  • Sarah T. Hawley
  • Sarah E. Lillie
  • Arden Morris
  • John J. Graff
  • Ann Hamilton
  • Steven J. Katz
Health Policy

DOI: 10.1245/s10434-012-2582-1

Cite this article as:
Hawley, S.T., Lillie, S.E., Morris, A. et al. Ann Surg Oncol (2013) 20: 7. doi:10.1245/s10434-012-2582-1


Background and Purpose

While variation in breast cancer quality indicators has been studied, to date there have been no studies examining the degree of surgeon-level variation in patient-reported outcomes. The purpose of this study is to examine surgeon-level variation in patient appraisals of their breast cancer care experiences.


Survey responses and clinical data from breast cancer patients reported to Detroit and Los Angeles Surveillance, Epidemiology and End Results registries from 6/2005 to 2/2007 were merged with attending surgeon surveys (1,780 patients, 291 surgeons). Primary outcomes were patient reports of access to care, care coordination, and decision satisfaction. Random-effects models examined variation due to individual surgeons for these three outcomes.


Mean values on each patient-reported outcome scale were high. The amount of variation attributable to individual surgeons in the unconditional models was low to modest: 5.4 % for access to care, 3.3 % for care coordination, and 7.5 % for decision satisfaction. Few factors were independently associated with patient reports of better access to or coordination of care, but less-acculturated Latina patients had lower decision satisfaction.


Patients reported generally positive experiences with their breast cancer treatment, though we found disparities in decision satisfaction. Individual surgeons did not substantively explain the variation in any of the patient-reported outcomes.

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Sarah T. Hawley
    • 1
  • Sarah E. Lillie
    • 2
  • Arden Morris
    • 3
  • John J. Graff
    • 4
  • Ann Hamilton
    • 5
  • Steven J. Katz
    • 6
  1. 1.Division of General Medicine, University of Michigan Health SystemCenter for Clinical Management Research, Ann Arbor VA Medical CenterAnn ArborUSA
  2. 2.Department of Health Behavior and Health EducationUniversity of Michigan School of Public HealthAnn ArborUSA
  3. 3.Department of SurgeryUniversity of Michigan Health SystemAnn ArborUSA
  4. 4.Cancer Institute of New JerseyNew Jersey State Cancer RegistryNew BrunswickUSA
  5. 5.Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  6. 6.Division of General MedicineUniversity of Michigan Health SystemAnn ArborUSA

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