• Megan C Saucke, Nora Jacobson, Selina Chow, Grace McKinney, and Heather B Neuman.
• Wisconsin Surgical Outcomes Research Program, University of Wisconsin, Madison, WI.
• Ann. Surg. 2025 Jan 31.

ObjectiveTo understand how breast cancer patients experience the surgical decision process and identify strategies surgeons can employ to empower patients to engage in decision-making.BackgroundPatient engagement in decision-making is associated with improved patient outcomes. Although, some patients prefer that their healthcare provider drive the decision, the benefits of engaging in decision-making hold true even for patients who prefer to defer to their provider.MethodsWe performed semi-structured interviews with patients that experienced low engagement in clinical trial A231701CD (n=30). We used qualitative content analysis to analyze data and organize it into overarching themes that represent experiences with decision-making.ResultsPatients could be grouped based on their experiences with the decision process into those that wanted to defer, share, or drive the decision. Three domains differentiated patients between groups: (1) overall disposition toward the surgeon, (2) tendency to exchange information and ask questions, and (3) attitudes toward how their preferences should shape the treatment decision. We identified surgeon behaviors that could optimize patient engagement. These opportunities were observed across all patients, regardless of their experience with the decision process.ConclusionSurgeons can empower patients to engage in decision-making by getting to know patients as individuals, ensuring all treatment options are presented, and integrating patient preferences into the decision process. Through these actions, surgeons can help patients with varied preferences for decision-making engage in making high quality decisions that reflect patients' priorities. These suggestions may have the greatest impact on socially disadvantaged patients and help to reduce disparities in care.Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.

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