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BACKGROUND Previous studies have indicated a predominance of passive decision-making styles among women with early-stage breast cancer in the UK offered a choice between breast-conserving surgery (BCS) and mastectomy. The aim of this study was to determine current decision-making styles and establish their association with operation choice and breast unit(More)
BACKGROUND There is interest in interventions that provide support for patients facing challenging decisions, such as the choice between mastectomy and breast conservation surgery for breast cancer. However, it is difficult to implement these interventions. One potential source of resistance is the attitudes of clinicians. OBJECTIVE To examine specialist(More)
BACKGROUND While much is now known about how to assess the competence of medical practitioners in a controlled environment, less is known about how to measure the performance in practice of experienced doctors working in their own environments. The performance of doctors depends increasingly on how well they function in teams and how well the health care(More)
OBJECTIVES To undertake a quantitative evaluation of a theory-based, interactive online decision aid (BresDex) to support women choosing surgery for early breast cancer (Stage I and II), based on observations of its use in practice. METHODS Observational cohort study. Website log-files collected data on the use of BresDex. Online questionnaires assessed(More)
BACKGROUND Some doctors who perform poorly appear not to be aware of how their performance compares with accepted practice. The way that professionals maintain their existing expertise and acquire new knowledge and skills - that is, maintain their 'currency' of practice - requires a capacity to change. This capacity to change probably requires the(More)
Primary endocrine therapy (PET) as an alternative to surgery is widely used in the UK for the treatment of older women with operable breast cancer. For women over 70 it has equivalent overall survival to surgery, although local control rates may be inferior. There are trade-offs to be made in deciding between surgery and PET. There has been little research(More)
BACKGROUND Hospital mastectomy rates vary. This study explores the relationship between mastectomy rates and breast cancer patients' consultation and decision-making experiences with specialist clinicians. METHODS Qualitative semi-structured interviews were conducted with 65 patients from three purposively selected breast units from a single UK region.(More)
INTRODUCTION Little is known regarding cancer clinicians' treatment preferences. AIM Determine the impact of pre-operative variables over specialist breast clinicians' operative preferences using discrete choice experiment methodology. METHODS Cross-sectional survey of operative preferences to hypothetical scenarios based on: patient age, bra cup size,(More)
Wide variation in the surgical management of breast cancer exists at hospital, regional, national and international level. To demonstrate whether variation in surgical practice observed at aggregate level between breast units persists following adjustment for case-mix, individual patient-level data from the Trent Breast Screening Programme Quality Assurance(More)
BACKGROUND Primary endocrine therapy (PET) is a recognised alternative to surgery followed by endocrine therapy for a subset of older, frailer women with breast cancer. Choice of treatment is preference-sensitive and may require decision support. Older patients are often conceptualised as passive decision-makers. The present study used the Coping in(More)