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Striving to Do No Harm and Yet Respect Patient Autonomy: Plastic Surgeons’ Perspectives of the Consultation for Breast Reconstruction with Women Who Have Early-Stage Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Rates of contralateral prophylactic mastectomy (CPM) have doubled over the last decade among women considered low risk for developing contralateral breast cancer. Despite the strong association between CPM and breast reconstruction, little is known about the clinical encounter between patients and plastic surgeons. A qualitative study was performed to understand how plastic surgeons describe their roles in the treatment decision-making process through their consultations with women who have unilateral early-stage breast cancer.

Methods

Semi-structured interviews with Ontario plastic surgeons were conducted. An inductive and interpretive thematic approach was initially used to analyze the data. The four principles of biomedical ethics then served as the conceptual lens to interpret the findings.

Results

The participants in this study were 18 plastic surgeons, and data saturation was reached. Four themes were identified: maintaining non-maleficence, supporting patient autonomy, delivering (un)equal health care, and providing care to enhance well-being. The ongoing push-pull between competing ethical principles was the overarching theme, specifically, striving to balance parallel responsibilities to do no harm while also respecting patients’ rights to make their own healthcare decisions.

Conclusions

In this patient-centric climate, it is important to acknowledge that patients may value outcomes such as achieving greater peace of mind above other clinical factors and are willing to incur additional risks to achieve these goals. Shared decision-making will help to reveal the rationale underlying each individual’s treatment choice, which in turn will allow physicians to appropriately weigh patient requests with the best available medical evidence when counseling women on decision-making for breast cancer care.

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Author information

Authors and Affiliations

  1. Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, M5T 3L9, Canada

    Selina Schmocker MSc & Erin D. Kennedy MD, PhD

  2. Evaluative Clinical Sciences and the Tory Trauma Research Program, Sunnybrook Research Institute, Toronto, ON, Canada

    Lesley Gotlib Conn PhD

  3. Division of General Surgery, Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada

    Erin D. Kennedy MD, PhD

  4. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

    Erin D. Kennedy MD, PhD & Frances C. Wright MD, MEd

  5. Department of Surgery, University Health Network, Toronto General Hospital, Toronto, ON, Canada

    Toni Zhong MD, MHS

  6. Department of Surgical Oncology, University of Toronto, University Health Network, Toronto General Hospital, Toronto, ON, Canada

    Toni Zhong MD, MHS

  7. Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Frances C. Wright MD, MEd

Authors
  1. Selina Schmocker MSc
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  2. Lesley Gotlib Conn PhD
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  3. Erin D. Kennedy MD, PhD
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  4. Toni Zhong MD, MHS
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  5. Frances C. Wright MD, MEd
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Correspondence to Selina Schmocker MSc.

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Schmocker, S., Gotlib Conn, L., Kennedy, E.D. et al. Striving to Do No Harm and Yet Respect Patient Autonomy: Plastic Surgeons’ Perspectives of the Consultation for Breast Reconstruction with Women Who Have Early-Stage Breast Cancer. Ann Surg Oncol 26, 3380–3388 (2019). https://doi.org/10.1245/s10434-019-07541-2

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  • DOI: https://doi.org/10.1245/s10434-019-07541-2

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