Surgical oncology · 2026
Empowering women in breast cancer surgery: A systematic review of shared decision-making between mastectomy and breast conservation.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
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Maes-Carballo Marta, Gómez-Fandiño Yolanda, Martínez-Martínez Carmen, Sampol-Ramírez Laura, de-la-Puente-Mota Natalia, Bueno-Cavanillas Aurora
Аннотация
BACKGROUND: As survival improves, attention in breast cancer (BC) has shifted from purely oncologic outcomes to quality of life, body image, and value-concordant decision-making. In this context, shared decision-making (SDM) has emerged as a cornerstone of patient-centered BC care, particularly in guiding choices between breast-conserving surgery (BCS) and mastectomy. However, its implementation and impact on patient outcomes remain inconsistently documented.
METHODS: Following PRISMA guidelines, a systematic review was conducted across six databases (PubMed, Embase, Web of Science, Scopus, Cochrane Library, and Trip) up to April 2025 (OSF registration: osf. io/fr8ka). Original studies examining SDM in surgical decision-making between BCS and mastectomy were included. Data extraction and quality assessment (using the QualSyst tool) were performed independently by four reviewers. Evidence was synthesized thematically across five SDM domains: determinants of surgical choice, patient perception and outcomes, decision aids, structured SDM models, and barriers and facilitators.
RESULTS: Twenty-two studies met the inclusion criteria. Most were observational (59%), with 95% of quantitative studies rated as strong (QualSyst ≥0.80). SDM consistently enhanced patient knowledge, involvement, and satisfaction, significantly reducing decisional conflict (mean reduction 6-10 points, p < 0.01) and improving congruence between treatment choice and personal values. Decision aids, particularly 3D visual and conversational tools, increased observed SDM scores by 24-32 points (OPTION-5 (Observing Patient Involvement-5), p = 0.01) and mitigated knowledge disparities among lower-socioeconomic status patients. While SDM rarely altered overall surgical distributions (BCS approximately 70%, mastectomy 30%), it refined the decision-making process and increased confidence. Implementation barriers included clinician resistance, time constraints, and systemic inequities, whereas structured frameworks and institutional support facilitated success.
CONCLUSIONS: SDM in BC surgery strengthens the ethical and psychological integrity of surgical decisions by ensuring that choices between BCS and mastectomy reflect informed, deliberative, and value-concordant preferences. Though its influence on surgical distribution is limited, SDM enhances satisfaction, decisional quality, and equity. Integrating structured SDM frameworks and clinician training into standard breast surgery practice is essential to advance truly patient-centered care.
METHODS: Following PRISMA guidelines, a systematic review was conducted across six databases (PubMed, Embase, Web of Science, Scopus, Cochrane Library, and Trip) up to April 2025 (OSF registration: osf. io/fr8ka). Original studies examining SDM in surgical decision-making between BCS and mastectomy were included. Data extraction and quality assessment (using the QualSyst tool) were performed independently by four reviewers. Evidence was synthesized thematically across five SDM domains: determinants of surgical choice, patient perception and outcomes, decision aids, structured SDM models, and barriers and facilitators.
RESULTS: Twenty-two studies met the inclusion criteria. Most were observational (59%), with 95% of quantitative studies rated as strong (QualSyst ≥0.80). SDM consistently enhanced patient knowledge, involvement, and satisfaction, significantly reducing decisional conflict (mean reduction 6-10 points, p < 0.01) and improving congruence between treatment choice and personal values. Decision aids, particularly 3D visual and conversational tools, increased observed SDM scores by 24-32 points (OPTION-5 (Observing Patient Involvement-5), p = 0.01) and mitigated knowledge disparities among lower-socioeconomic status patients. While SDM rarely altered overall surgical distributions (BCS approximately 70%, mastectomy 30%), it refined the decision-making process and increased confidence. Implementation barriers included clinician resistance, time constraints, and systemic inequities, whereas structured frameworks and institutional support facilitated success.
CONCLUSIONS: SDM in BC surgery strengthens the ethical and psychological integrity of surgical decisions by ensuring that choices between BCS and mastectomy reflect informed, deliberative, and value-concordant preferences. Though its influence on surgical distribution is limited, SDM enhances satisfaction, decisional quality, and equity. Integrating structured SDM frameworks and clinician training into standard breast surgery practice is essential to advance truly patient-centered care.