Surgeons’ preferences for using sentinel lymph node biopsy in patients with ductal carcinoma in situ

Background There is a large variation between Dutch hospitals in the use of Sentinel Lymph Node Biopsy (SLNB) in patients with a biopsy diagnosis of Ductal Carcinoma in Situ. The aim of our study was to investigate whether this variation might be explained by preferences of surgeons, organisational factors or the influence of patients preferences. Methods A cross-sectional web survey was conducted among 260 Dutch oncological/breast surgeons. Preferences of surgeons and the influence of the patients’ preferences were determined by means of best-worst scaling (BWS) of profile case scenarios and by ranking risk factors. The survey also explored organisational questions, the reported use of diagnostic techniques and influences on the decision. Results The BWS scenarios were completed by 57 surgeons. The most important reasons for performing SLNB were a suspected invasive component and DCIS grade 3. In the ranking, these were also the first and second most important factor, followed by the size of the lesion and a mass on mammogram. In 58% to 70% of the scenarios, the surgeons would not change their decisions on the use of SLNB if the patient’s chose differed. No organisational factor was significantly associated with the reported use of SLNB. Conclusion The inter-hospital variation in the use of SLNB could not be attributed to organisational factors or surgeons’ preferences for risk factors. The risk factors that most surgeons reported as reasons for performing SLNB are consistent with the factors described in the Dutch treatment guideline for the use of SLNB.

This question is asked in order to be able to make a decision at hospital level. During the analysis, the data is coded (the hospitals are numbered) so that your data remains anonymous but a statement can be made at hospital level.

Organizational Factors
The following questions are about organizational factors regarding the sentinel lymph node biopsy. These questions are asked to gain insight into the diagnosis and performing the sentinel lymph node biopsy for patients with biopsy-proven DCIS. You can enter comments and apply nuances in the text box at the bottom of the page. Surgeons' preferences for using sentinel lymph node biopsy in patients with ductal carcinoma in situ -S1 -3 Plos One

Scenarios
This part of the survey will consist of 16 scenarios. The scenarios consist of six patient and tumour characteristics. Some of these characteristics change with each scenario. For each scenario, state the most important and the least important factor for you to perform a sentinel lymph node biopsy. Please note: after each scenario a question follows whether you are actually would perform a sentinel lymph node biopsy. You can select one item as the most important factor and one item as the least important factor. We are aware that not every scenario is clinically realistic. This cannot be remedied due to the chosen methodology. Note: a distinction has been made in the scenarios between patients undergoing breast conserving surgery and patients undergoing mastectomy. There will first be eight breast conserving surgery scenarios and then eight mastectomy scenarios.
Respondents are automatically assigned to version 1, 2, 3 or 4 of set of scenario's, Version 1: These first 8 scenarios are about patients undergoing breast-conserving surgery What do you consider to be the most and least important factor in performing a sentinel lymph node procedure, given the fact that breast conserving surgery is going to take place?
Scenario Surgeons' preferences for using sentinel lymph node biopsy in patients with ductal carcinoma in situ -S1 -6 Plos One The next eight scenarios will be about patients undergoing a mastectomy. For each scenario, state the most important and the least important factor for you to perform a sentinel lymph node biopsy given that a mastectomy is performed. Please note: after each scenario a question follows whether you are actually would perform a sentinel lymph node biopsy. You can select one item as the most important factor and one item as the least important factor. We are aware that not every scenario is clinically realistic. This cannot be remedied due to the chosen methodology.
The following eight scenarios are about patients undergoing a mastectomy. At the end of the eight scenarios, one ranking question is asked. The intention is that you rank the various factors that influence the decision on performing the sentinel lymph node biopsy. Surgeons' preferences for using sentinel lymph node biopsy in patients with ductal carcinoma in situ -S1 -9 Plos One 11. Below are 12 factors that can influence the decision whether or not to perform sentinel lymph node biopsy. You will be asked to rank the factors by importance. The answers must be different and must be ranked.

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Surgeons' preferences for using sentinel lymph node biopsy in patients with ductal carcinoma in situ -S1 -10 Plos One
Surgeons' preferences for using sentinel lymph node biopsy in patients with ductal carcinoma in situ -S1 -16 Plos One