Breast Surgery Decision Guide: a shared decision-making aid

Overview

Patients newly diagnosed with breast cancer face complex, time-sensitive decisions about surgical treatment — primarily lumpectomy versus mastectomy — and, if mastectomy is chosen, whether to pursue reconstruction. The choice is shaped not only by clinical factors (oncologic safety, anatomy, comorbidities) but also by deeply personal values: body image, recovery time, fear of recurrence, and quality of life.

The Breast Surgery Decision Guide structures this conversation through shared decision-making (SDM). It pairs side-by-side evidence comparisons with a guided values-clarification exercise, so patients arrive at their consultation with a clearer sense of what matters to them — and the care team has a shared frame for the discussion.

What the Digital Trails team is doing

• Decision-aid architecture — structuring content around the balance-sheet framework so patients can compare options on the dimensions that matter to them.
• Values-clarification module — interactive exercises that surface patient priorities (recurrence risk, recovery, appearance, ongoing surveillance) before the surgical consult.
• Clinical workflow fit — designing the aid to slot into the existing UVA Breast Cancer Care Team workflow without adding friction for patients or providers.

Methodology

The guide uses a balance-sheet framework, presenting each option with a parallel structure: what it involves, expected recovery, oncologic equivalence where it applies, cosmetic and reconstructive implications, and surveillance requirements after surgery. The values-clarification exercise then translates abstract trade-offs into concrete preferences — for example, weighing radiation as part of breast-conservation therapy against the longer recovery and surveillance pattern of mastectomy with reconstruction.

Outcomes & current status

The decision guide is in active development with the UVA Breast Cancer Care Team. Once piloted in clinic, the project will assess whether structured SDM and values clarification improve patient-reported decision quality, decisional conflict, and satisfaction with the surgical choice — outcomes that matter for both initial recovery and long-term well-being.