Measures of Appropriateness and Value for Breast Surgeons and Their Patients

The American Society of Breast Surgeons Choosing Wisely ®Initiative

Jeffrey Landercasper, Lisa Bailey, Tiffany S. Berry, Robert R. Buras, Amy C Degnim, Oluwadamilola M. Fayanju, Joshua Froman, Jennifer Gass, Caprice Greenberg, Starr Koslow Mautner, Helen Krontiras, Roshni Rao, Michelle Sowden, Judy A. Tjoe, Barbara Wexelman, Lee Wilke, Steven L. Chen

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Current breast cancer care is based on high-level evidence from randomized, controlled trials. Despite these data, there continues to be variability of breast cancer care, including overutilization of some tests and operations. To reduce overutilization, the American Board of Internal Medicine Choosing Wisely®Campaign recommends that professional organizations provide patients and providers with a list of care practices that may not be necessary. Shared decision making regarding these services is encouraged. Methods: The Patient Safety and Quality Committee of the American Society of Breast Surgeons (ASBrS) solicited candidate measures for the Choosing Wisely®Campaign. The resulting list of “appropriateness” measures of care was ranked by a modified Delphi appropriateness methodology. The highest-ranked measures were submitted to and later approved by the ASBrS Board of Directors. They are listed below. Results: (1) Don’t routinely order breast magnetic resonance imaging in new breast cancer patients. (2) Don’t routinely excise all the lymph nodes beneath the arm in patients having lumpectomy for breast cancer. (3) Don’t routinely order specialized tumor gene testing in all new breast cancer patients. (4) Don’t routinely reoperate on patients with invasive cancer if the cancer is close to the edge of the excised lumpectomy tissue. (5) Don’t routinely perform a double mastectomy in patients who have a single breast with cancer. Conclusions: The ASBrS list for the Choosing Wisely®campaign is easily accessible to breast cancer patients online. These measures provide surgeons and their patients with a starting point for shared decision making regarding potentially unnecessary testing and operations.

Original languageEnglish (US)
Pages (from-to)3112-3118
Number of pages7
JournalAnnals of Surgical Oncology
Volume23
Issue number10
DOIs
StatePublished - Oct 1 2016

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Breast
Breast Neoplasms
Segmental Mastectomy
Decision Making
Neoplasms
Surgeons
Mastectomy
Patient Safety
Internal Medicine
Arm
Randomized Controlled Trials
Lymph Nodes
Magnetic Resonance Imaging
Genes

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Measures of Appropriateness and Value for Breast Surgeons and Their Patients : The American Society of Breast Surgeons Choosing Wisely ®Initiative. / Landercasper, Jeffrey; Bailey, Lisa; Berry, Tiffany S.; Buras, Robert R.; Degnim, Amy C; Fayanju, Oluwadamilola M.; Froman, Joshua; Gass, Jennifer; Greenberg, Caprice; Mautner, Starr Koslow; Krontiras, Helen; Rao, Roshni; Sowden, Michelle; Tjoe, Judy A.; Wexelman, Barbara; Wilke, Lee; Chen, Steven L.

In: Annals of Surgical Oncology, Vol. 23, No. 10, 01.10.2016, p. 3112-3118.

Research output: Contribution to journalArticle

Landercasper, J, Bailey, L, Berry, TS, Buras, RR, Degnim, AC, Fayanju, OM, Froman, J, Gass, J, Greenberg, C, Mautner, SK, Krontiras, H, Rao, R, Sowden, M, Tjoe, JA, Wexelman, B, Wilke, L & Chen, SL 2016, 'Measures of Appropriateness and Value for Breast Surgeons and Their Patients: The American Society of Breast Surgeons Choosing Wisely ®Initiative', Annals of Surgical Oncology, vol. 23, no. 10, pp. 3112-3118. https://doi.org/10.1245/s10434-016-5327-8
Landercasper, Jeffrey ; Bailey, Lisa ; Berry, Tiffany S. ; Buras, Robert R. ; Degnim, Amy C ; Fayanju, Oluwadamilola M. ; Froman, Joshua ; Gass, Jennifer ; Greenberg, Caprice ; Mautner, Starr Koslow ; Krontiras, Helen ; Rao, Roshni ; Sowden, Michelle ; Tjoe, Judy A. ; Wexelman, Barbara ; Wilke, Lee ; Chen, Steven L. / Measures of Appropriateness and Value for Breast Surgeons and Their Patients : The American Society of Breast Surgeons Choosing Wisely ®Initiative. In: Annals of Surgical Oncology. 2016 ; Vol. 23, No. 10. pp. 3112-3118.
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abstract = "Background: Current breast cancer care is based on high-level evidence from randomized, controlled trials. Despite these data, there continues to be variability of breast cancer care, including overutilization of some tests and operations. To reduce overutilization, the American Board of Internal Medicine Choosing Wisely{\circledR}Campaign recommends that professional organizations provide patients and providers with a list of care practices that may not be necessary. Shared decision making regarding these services is encouraged. Methods: The Patient Safety and Quality Committee of the American Society of Breast Surgeons (ASBrS) solicited candidate measures for the Choosing Wisely{\circledR}Campaign. The resulting list of “appropriateness” measures of care was ranked by a modified Delphi appropriateness methodology. The highest-ranked measures were submitted to and later approved by the ASBrS Board of Directors. They are listed below. Results: (1) Don’t routinely order breast magnetic resonance imaging in new breast cancer patients. (2) Don’t routinely excise all the lymph nodes beneath the arm in patients having lumpectomy for breast cancer. (3) Don’t routinely order specialized tumor gene testing in all new breast cancer patients. (4) Don’t routinely reoperate on patients with invasive cancer if the cancer is close to the edge of the excised lumpectomy tissue. (5) Don’t routinely perform a double mastectomy in patients who have a single breast with cancer. Conclusions: The ASBrS list for the Choosing Wisely{\circledR}campaign is easily accessible to breast cancer patients online. These measures provide surgeons and their patients with a starting point for shared decision making regarding potentially unnecessary testing and operations.",
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AU - Bailey, Lisa

AU - Berry, Tiffany S.

AU - Buras, Robert R.

AU - Degnim, Amy C

AU - Fayanju, Oluwadamilola M.

AU - Froman, Joshua

AU - Gass, Jennifer

AU - Greenberg, Caprice

AU - Mautner, Starr Koslow

AU - Krontiras, Helen

AU - Rao, Roshni

AU - Sowden, Michelle

AU - Tjoe, Judy A.

AU - Wexelman, Barbara

AU - Wilke, Lee

AU - Chen, Steven L.

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N2 - Background: Current breast cancer care is based on high-level evidence from randomized, controlled trials. Despite these data, there continues to be variability of breast cancer care, including overutilization of some tests and operations. To reduce overutilization, the American Board of Internal Medicine Choosing Wisely®Campaign recommends that professional organizations provide patients and providers with a list of care practices that may not be necessary. Shared decision making regarding these services is encouraged. Methods: The Patient Safety and Quality Committee of the American Society of Breast Surgeons (ASBrS) solicited candidate measures for the Choosing Wisely®Campaign. The resulting list of “appropriateness” measures of care was ranked by a modified Delphi appropriateness methodology. The highest-ranked measures were submitted to and later approved by the ASBrS Board of Directors. They are listed below. Results: (1) Don’t routinely order breast magnetic resonance imaging in new breast cancer patients. (2) Don’t routinely excise all the lymph nodes beneath the arm in patients having lumpectomy for breast cancer. (3) Don’t routinely order specialized tumor gene testing in all new breast cancer patients. (4) Don’t routinely reoperate on patients with invasive cancer if the cancer is close to the edge of the excised lumpectomy tissue. (5) Don’t routinely perform a double mastectomy in patients who have a single breast with cancer. Conclusions: The ASBrS list for the Choosing Wisely®campaign is easily accessible to breast cancer patients online. These measures provide surgeons and their patients with a starting point for shared decision making regarding potentially unnecessary testing and operations.

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