Factors influencing surgical decision-making in breast cancer: A multicenter study in Japan.

[BACKGROUND] Recent advances in cancer treatment and improvements in prognosis have led to increasing recognition of the critical role of shared decision-making (SDM) between patients and healthcare providers in determining treatment strategies. SDM requires not only information on surgery-related outcomes and health-related quality of life, but also consideration of patient-specific factors such as the social background. However, determinants of surgical choice among Japanese patients remain unclear, and this study aimed to identify the influencing factors.

[METHODS] This multicenter, cross-sectional study evaluated patient-reported outcomes in 577 Japanese patients who underwent mastectomy (MT), breast-conserving surgery (BCS), or immediate breast reconstruction (IBR). Participants completed questionnaires to assess the factors influencing surgical decision-making, including sociodemographic, psychosocial, and healthcare provider-related factors. Clinical data were obtained from the medical records, and multivariate analyses were conducted to identify the factors associated with the selection of surgical procedures.

[RESULTS] The most frequently cited factor was the surgeon's opinion (92.2%), followed by fear of recurrence (43.8%) and partner's opinion (35.5%). Partner's opinion was significantly more influential in BCS and IBR selection than in MT selection (P = 0.012), whereas concern about recurrence was the main factor influencing MT selection (P = 0.002). Multivariate analysis suggested the nurse's opinion was significantly associated with IBR, while concern about recurrence was inversely related.

[CONCLUSIONS] Considering that the factors influencing decision-making vary by surgical procedure, it is essential to tailor surgical choices to each patient's values and lifestyle. Strengthening decision-support systems by involving the entire healthcare team will be an important priority moving forward.