Implementing a patient-centered approach to breast cancer care

Implementing a patient-centered approach to your breast cancer care

By Daniel Z. Liu, MD

ASPS urges breast cancer patients and their physicians to advocate for inclusion of a board-certified plastic surgeon on their breast cancer treatment team.

The multidisciplinary team approach to breast cancer care brings together a group of key medical professionals who work together at the inception of a patient’s breast cancer diagnosis to develop and implement a tailored treatment plan based on each patient’s unique needs. The conventional medical team may include a medical oncologist, radiologist, pathologist, radiation oncologist, breast oncologic surgeon, genetic counselor, gynecologist and plastic surgeon. Integrative cancer care then plays a simultaneous role to help patients combat treatment-related side effects. Supportive therapies include oncology rehabilitation (physical therapy), nutritional support, pain management, acupuncture, mind-body practices and spiritual support.

Each step of the breast cancer care journey requires specific medical expertise. Patient outcomes vastly improve when each member of the multidisciplinary team works together to examine every opportunity to provide a unified treatment approach. Breast cancer patients might miss out on a critical conversation that should take place at the time of diagnosis: options for breast reconstruction following partial or total mastectomy.

A board-certified plastic surgeon possesses training and expertise in breast reconstruction, ranging from cutting-edge implant/regenerative medicine technologies to advanced techniques in reconstructive microsurgery. More importantly, an experienced plastic surgeon within a team setting will respectfully communicate with other medical professionals about how the reconstruction plan may affect overall cancer treatment and vice versa.

The multidisciplinary treatment team benefits patients who encounter a complex and serious disease such as breast cancer. When this team includes a variety of specialists – including a board-certified plastic surgeon – it is more likely that these professionals will be knowledgeable on the latest multi-modal treatment options. Patients deserve to be fully informed about their treatment choices including breast reconstruction, and medical professionals should guide patients in a balanced, shared decision-making process. For instance, the three major decisions for women considering a mastectomy with reconstruction involve whether to have reconstruction at all, when to undergo reconstruction and which type of reconstruction to consider.

Shared decision-making

The Institute of Medicine defines patient-centered care as “care that is respectful and responsive to individual patient preferences, needs, and values and [ensures] that patient values guide all clinical decisions.” Shared decisionmaking is a mutual and respectful exchange of information between the physician and patient to reach agreement about a health decision. There is often no “best” option for a health condition, and the choice depends on a patient’s values and preferences.

Although this is important for all aspects of breast cancer care, patient preferences and expectations are especially crucial for informed decisions around breast reconstruction, an area where the patient’s satisfaction is central. In the field of breast reconstruction, the surgeon’s goal is directed toward a restoration or improvement in the appearance and feel of the breasts as perceived by the patient. Beyond a surgeon’s technical proficiency, shared decision-making requires a physician’s commitment to listen to patients and adapt recommendations to medical conditions, personalities, fears, perception of outcomes, family member engagement and cultural differences.

Establishing trust

By understanding patient expectations and assimilating surgical expertise, the physician and patient become equal team players in designing the optimal path for breast reconstruction. The patient learns about the benefits and possible complications of each procedural step, including the expected healing process, and provides input on their personal goals and preferences.

The physician is responsible for delivering pertinent technical information to a level of detail that is comfortable for each patient and recommending procedures that minimize morbidity and mortality. The patient is responsible for disclosing all aspects of their medical health including habits (e.g., smoking) and honestly describing their optimal aesthetic outcomes. An experienced plastic surgeon will be able to provide realistic expectations (including photographs representing a range of outcomes) for breast reconstruction based on the patient’s body type and reconstructive modality. Patients might have preexisting notions to expect higher satisfaction with specific types