CRYSTAL CHU: When women are diagnosed with breast cancer
and they're considering surgical options,
a lot of them just naturally think,
if I'm going to remove one breast, why not the other?
That's the first natural thought that comes to mind.
It's really important for them to understand
that a mastectomy alone is hard to get through,
but removing both is a little more complicated.
I'm Crystal Chu, and I'm a PhD student at the School
of Nursing here at UVA.
I've been an oncology nurse for almost 10 years
and was working mostly with patients
diagnosed with breast cancer.
Hearing them have those "if I had
known this" or "if I had thought about that,"
that maybe things would have been different for them-- just
digging deeper to say, what can we do to make sure that they're
making the best choices through their care
and ensuring that when they enter survivorship,
that they have the best quality of life possible.
LYNN DENGEL: So a contralateral prophylactic mastectomy
is when a patient comes in with a diagnosis of breast
cancer in one breast and is considering
having the opposite side removed for prevention
of future cancers.
When a woman needs breast surgery for primary breast
cancer, adding a contralateral or an opposite-side procedure
increases the risk.
It just increases the time in the operating room
and increases the rate of infection, bleeding.
All the complications that we see with the primary surgery,
we're then seeing almost twice as many
because you're doing both sides.
CRYSTAL CHU: My research really focuses on that decision point
and creating this decision aid to make sure that they have
the clinical background that they need to understand
and really bringing forth their own values and goals.
First part goes into clinical background.
I make sure to just emphasize what they've already
heard from the clinical team, pros
and cons of this procedure, risk involved,
potential complications.
And then we go into, what are your goals?
What's influencing you?
The second balance sheet talks about benefits to them
and consideration of others.
We rarely make a decision on our own.
Is someone else afraid that I'm going to have a cancer again?
Is my partner worried about what I'm going to look like later?
Once they've gone through the whole exercise,
say what their preference is.
LYNN DENGEL: Many times, there is a choice
for the patient to make.
And it's not always crystal clear
which side they should end up on.
And so the decision aids really add a way for this
to be more formalized, more thorough, and for the patient,
I think, to drive more of the conversation.
It gives them time to go away from me
and take time with Crystal or another wonderful nurse
to think through this and then come back to me
with more understanding and probably in a better place
to make the best decision for them.
CRYSTAL CHU: When they have the decision aid
to really make their points clear
and bring that back to the surgeon,
it's a more productive conversation.
And it doesn't feel like they're arguing.
It feels like they can articulate their needs
and goals in a way that the surgeon can
hear and understand.
And this just gave them their voice to say,
this is what I want and why.
Going through this doesn't necessarily change their mind,
but it makes them feel more solid, more confident
in that choice.
And to me, that's really the goal.
I want people to feel like they're making a choice
and that they're not going to look back and regret it,
that you know that these are potential complications.
And even if those occur, I'm still OK with my choice.