• This case study was supplied by Newcastle upon Tyne NHS Foundation Trust.
  • It is an example of shared decision making from the Newcastle breast care team.
  • The aim of the intervention was to help a patient to come to a shared decision that was right for her.
  • The clinician carefully explained the patient's options, gave her time to think about them, and then explored her decision to clarify her understanding of the options.

Faced with a difficult decision about whether to have a mastectomy or the wide local excision of a breast lump, a patient was struggling to make up her mind. After providing her with explanations about each procedure using an Option Grid, she was given an appointment a week later. When she asked who else she might consult for guidance, it was suggested she could speak with her GP.

A week later, the patient said she had decided to have a mastectomy. The consultant asked her to explain the reasons for this decision. The patient responded that her GP advised that if she had a mastectomy, the cancer would be gone and she would have nothing to worry about.

To clarify that this choice was based on accurate knowledge and understanding of the options, and on what was most important to her, the surgeon went through the options again.

After discussing this information with her husband, including risks of recurrence for the two treatment options, the patient asked whether this meant that she didn’t need to lose the whole of her breast. It wasn’t until then that she fully understood the options and their consequences, that she had a choice, and could consider the pros and cons based upon her own personal values.

Had the surgeon not asked her to explain her initial choice, she would have gone through with the mastectomy without question. In the end, she chose to have wide local excision. 

Further reading