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Does a brief surgeon training in negotiation theory principles decrease rates of contralateral prophylactic mastectomy?

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Despite the lack of any oncologic benefit, contralateral prophylactic mastectomy (CPM) use among women with unilateral breast cancer is increasing. This patient-driven trend is influenced by fear of recurrence and desire for peace of mind. Traditional educational strategies have been ineffective in reducing CPM rates. Here we employ training in negotiation theory strategies for counseling and determine the effect on CPM rates.

Methods

In consecutive patients with unilateral breast cancer treated with mastectomy from 05/2017 to 12/2019, we examined CPM rates before and after a brief surgeon training in negotiation skills. This comprised a systematic framework for patient counseling utilizing early setting of the default option, leveraging social proof, and framing.

Results

Among 2144 patients, 925 (43%) were treated pre-training and 744 (35%) post-training. Those treated in the 6-month transition period were excluded (n = 475, 22%). Median patient age was 50 years; most patients had T1–T2 (72%), N0 (73%), and estrogen receptor-positive (80%) tumors of ductal histology (72%). The CPM rate was 47% pre-training versus 48% post-training, with an adjusted difference of −3.7% (95% CI −9.4 to 2.1, p = 0.2). In a standardized self-assessment survey, all 15 surgeons reported a high baseline use of negotiation skills and no significant change in conversational difficulty with the structured approach.

Conclusion

Brief surgeon training did not affect self-reported use of negotiation skills or reduce CPM rates. The choice of CPM is a highly individual decision influenced by patient values and decision styles. Further research to identify effective strategies to minimize surgical overtreatment with CPM is needed.

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Data availability

Research data are stored in an institutional repository and will be shared upon request to the corresponding author.

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Acknowledgements

The preparation of this study was supported in part by NIH/NCI Cancer Center Support Grant P30 CA008748 to Memorial Sloan Kettering Cancer Center.

Funding

The preparation of this study was supported in part by the NIH/NCI Cancer Center Support Grant P30 CA008748 to Memorial Sloan Kettering Cancer Center.

Author information

Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA

    Anita Mamtani, Alain Vincent & Monica Morrow

  2. Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Daniel D. Sjoberg & Andrew Vickers

  3. Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Daniel D. Sjoberg, Behfar Ehdaie & Andrew Vickers

  4. Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Behfar Ehdaie

  5. Negotiation, Organizations, and Markets Unit, Harvard Business School, Boston, MA, USA

    Deepak Malhotra

Authors
  1. Anita Mamtani
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Contributions

AM, DDS, AVin, BE, DM, AVic, and MM contributed to the study conception and design. Material preparation, data collection, and analysis were performed by AM, DDS, AVin, AVic, and MM. The first draft of the manuscript was written by AM and MM. AM, DDS, AVin, BE, DM, AVic, and MM commented on previous versions of the manuscript. AM, DDS, AVin, BE, DM, AVic, and MM read and approved the final manuscript.

Corresponding author

Correspondence to Anita Mamtani.

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Competing interests

All authors have no conflict of interests or commercial interests to disclose.

Ethical approval

This study was approved by the Memorial Sloan Kettering Cancer Center (New York, NY, USA) Institutional Review Board.

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Mamtani, A., Sjoberg, D.D., Vincent, A. et al. Does a brief surgeon training in negotiation theory principles decrease rates of contralateral prophylactic mastectomy?. Breast Cancer Res Treat 199, 119–126 (2023). https://doi.org/10.1007/s10549-023-06891-6

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