Following the Patient’s Lead
Wednesday, December 28, 2011
The old adage “the doctor knows best” affirms patients’ trust in a physician’s impartial and expert opinion in matters of health, but can physicians continue to be solo managers of patient care? At Newton Medical Center in Newton, NJ, Renee C. Comizio, M.D., M.S., board-certified plastic and reconstructive surgeon, is providing an avenue for breast cancer patients to take an active role in defining their own treatments through shared decision-making.
Photo: L-R: Michelle Baisley, medical assistant; Renee Comizio, M.D., M.S.; and Danielle Bedotto, office assistant
The shared decision-making program is founded in the belief that each patient has the right to choose the most appropriate medical treatment for his or her life and medical concern. An informed medical decision ensures safety and personalized care while reducing the chance of treatment being tailored to the physician’s preference rather than the patient’s needs and desires.
Support for Breast Cancer
As Dr. Comizio explains, the Dartmouth Atlas Project — a research initiative to clearly illustrate the delivery and distribution of health care in America — has revealed regional variations when it comes to breast reconstruction procedures. This data suggests that physicians’ personal preferences rather than patient choices may be dictating the kinds of surgeries selected and performed in certain areas of the country.
The Stoeckle Center at Massachusetts General Hospital - Harvard Medical School is currently studying shared decision-making. The investigation covers 23 different medical areas, from routine screenings to acute treatment, in an effort to measure the impact of visual aids in the decision-making process. Patients receive a DVD and a booklet specific to their medical concerns and answer surgery questions before and after they review the informational aids. For Dr. Comizio, who completed her specialized training at Dartmouth-Hitchcock Medical Center — where shared decision-making is a standard of patient care — the application of these aids to breast cancer cases is particularly relevant.
“Women with breast cancer are faced with the decision to treat part or all of the breast and whether to participate in countless other options,” says Dr. Comizio. “The patient has to make the decision rather than being told what the decision should be.”
Opening the Discussion
When a patient is referred to Dr. Comizio’s office for a consultation, she receives a DVD on breast reconstructive surgery, which details the various options available and how these options relate to the curative procedures she may be considering, as well as an accompanying booklet. The patient can screen the DVD according to her schedule — rather than being rushed in an appointment setting — and prepare any questions she has before meeting with Dr. Comizio.
“Understanding a breast cancer diagnosis and the available treatment and reconstruction options is like learning a new language,” says Dr. Comizio. “With the DVD, patients can watch it with loved ones whenever they want and as many times as they want to get as much information as possible.”
This spaced-out schedule eliminates information overload and allows the patient to take an active role in her conversation with Dr. Comizio. The two can have an informed discussion about how certain curative therapies will impact the potential cosmetic outcomes. For example, radiation can permanently affect the breast skin in unpredictable ways, and lumpectomies may create irregular contours in the breast shape. While Dr. Comizio does not deter patients from necessary curative procedures, she does present the possible outcomes of each and how reconstructive surgery can fit into a patient’s total treatment plan.
“I feel strongly that all breast cancer patients would benefit from meeting with a plastic surgeon as part of the treatment discussion, even if they choose not to have reconstructive surgery,” says Dr. Comizio. “There are ramifications for choices they make that are not dictated by their tumor pathologies.”
The Immediate Approach
Dr. Comizio partners with breast surgeons at Newton Medical Center and Morristown Medical Center to offer patients immediate breast reconstruction performed in the same operating room following a mastectomy or lumpectomy. After the surgeon has removed the cancerous tissue, Dr. Comizio begins the patient-chosen reconstruction, always tailoring her technique to utilize the incision location selected by the breast surgeon.
Dr. Comizio performs saline and silicone implant and tissue expander procedures, as well as natural reconstructions, which create breasts with tissue from a patient’s abdomen or back. After the surgery, the breast surgeon completes follow-up care with the patient from a cancer perspective, while Dr. Comizio provides follow-up care concerning the reconstruction.
For more information about plastic and reconstructive surgery at Newton Medical Center, visit www.atlantichealth.org/newton.
MD News November/December 2011, Eastern Pennsylvania