As with any cancer diagnosis, patients who are told they have breast cancer are frightened and need information. The best person to provide this information is their doctor. The patient's doctor must educate the patient about their condition and available treatment options including surgery. After all, informed consent must be more than signature on a consent form the day of surgery. However, according to a recent study published in the Journal of the American College of Surgeons, half of early-stage breast cancer survivors lacked basic information about their disease and treatment options. As a result, the study concluded many doctors fail to provide their breast cancer patients valuable information necessary for them to make an informed decision about their treatment options. As a medical malpractice lawyer, I have handled my share of informed consent cases. However, I was even surprised by the results of this study showing that many doctors, perhaps close to half, fail to provide their patients critical information they need to make an informed decision about their breast cancer treatment options.
Lead by lead researcher, Dr. Clara N. Lee of the University of North Carolina School of Medicine, Chapel Hill, the retrospective study evaluated the decision making process of early stage breast cancer patients regarding surgical treatment. Surveys were mailed out to adult women with a history of early-stage invasive breast cancer treated at one of four academic medical centers: The Dana-Farber Cancer Institute, Boston; Massachusetts General Hospital, Boston; University of California, San Francisco; and University of North Carolina, Chapel Hill. Based on answers to basic questions about their disease and treatment options, patients answered only half their questions right (52%), demonstrating these patients had a large knowledge gap regarding their disease and treatment choices.
Because study data was collected an average of 2 ½ years after the patient's surgical procedure, researchers recognized that some patients are likely to forget some information over time. However, the information that was forgotten was simply too basic, according to researchers, to be simply forgotten. For example, only half of breast cancer survivors from the study knew the survival rate was the same for breast-conservation therapy and mastectomy. Likewise, breast cancer survivors who underwent a partial mastectomy routinely did not know the local recurrence rates (compared to women who had a mastectomy).
According to Dr. Lee, "patients and providers need to have transparent conversations about treatment options, risks and goals in order to make fully informed decisions." Dr. Lee's remarks are fully supported by the American Medical Association stated beliefs on informed consent. According to the AMA, "[i]nformed consent is more than just getting a patient to sign a consent form." The AMA acknowledges the communication process requires the physician to provide the patient: their diagnosis (if known); nature and purpose of the proposed treatment or procedure; the risks and benefits of the treatment or procedure; alternative treatment, along with the risks and benefits of the alternative treatment; and the risks of benefits of not receiving treatment. In addition, doctors must give the patient the opportunity to ask questions about any of this information in order to better understand of their options. As the AMA recognizes, informed consent is more than just a legal obligation necessary to defend against medical malpractice claims. It is an ethical obligation. Unfortunately, as this most recent study illustrates, some doctors often fail to honor either obligation.