WEBVTT

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CRYSTAL CHU: When women are
diagnosed with breast cancer

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and they're considering
surgical options,

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a lot of them just
naturally think,

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if I'm going to remove one
breast, why not the other?

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That's the first natural
thought that comes to mind.

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It's really important
for them to understand

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that a mastectomy alone
is hard to get through,

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but removing both is a
little more complicated.

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I'm Crystal Chu, and I'm a
PhD student at the School

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of Nursing here at UVA.

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I've been an oncology
nurse for almost 10 years

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and was working
mostly with patients

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diagnosed with breast cancer.

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Hearing them have
those "if I had

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known this" or "if I
had thought about that,"

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that maybe things would have
been different for them-- just

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digging deeper to say, what can
we do to make sure that they're

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making the best choices
through their care

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and ensuring that when
they enter survivorship,

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that they have the best
quality of life possible.

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LYNN DENGEL: So a contralateral
prophylactic mastectomy

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is when a patient comes in
with a diagnosis of breast

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cancer in one breast
and is considering

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having the opposite side
removed for prevention

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of future cancers.

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When a woman needs breast
surgery for primary breast

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cancer, adding a contralateral
or an opposite-side procedure

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increases the risk.

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It just increases the
time in the operating room

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and increases the rate
of infection, bleeding.

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All the complications that we
see with the primary surgery,

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we're then seeing
almost twice as many

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because you're doing both sides.

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CRYSTAL CHU: My research really
focuses on that decision point

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and creating this decision aid
to make sure that they have

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the clinical background
that they need to understand

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and really bringing forth
their own values and goals.

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First part goes into
clinical background.

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I make sure to just emphasize
what they've already

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heard from the
clinical team, pros

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and cons of this
procedure, risk involved,

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potential complications.

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And then we go into,
what are your goals?

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What's influencing you?

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The second balance sheet
talks about benefits to them

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and consideration of others.

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We rarely make a
decision on our own.

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Is someone else afraid that I'm
going to have a cancer again?

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Is my partner worried about what
I'm going to look like later?

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Once they've gone through
the whole exercise,

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say what their preference is.

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LYNN DENGEL: Many
times, there is a choice

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for the patient to make.

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And it's not always
crystal clear

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which side they
should end up on.

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And so the decision aids
really add a way for this

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to be more formalized, more
thorough, and for the patient,

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I think, to drive more
of the conversation.

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It gives them time
to go away from me

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and take time with Crystal
or another wonderful nurse

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to think through this
and then come back to me

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with more understanding and
probably in a better place

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to make the best
decision for them.

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CRYSTAL CHU: When they
have the decision aid

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to really make
their points clear

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and bring that back
to the surgeon,

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it's a more productive
conversation.

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And it doesn't feel
like they're arguing.

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It feels like they can
articulate their needs

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and goals in a way
that the surgeon can

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hear and understand.

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And this just gave them
their voice to say,

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this is what I want and why.

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Going through this doesn't
necessarily change their mind,

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but it makes them feel
more solid, more confident

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in that choice.

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And to me, that's
really the goal.

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I want people to feel like
they're making a choice

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and that they're not going
to look back and regret it,

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that you know that these
are potential complications.

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And even if those occur,
I'm still OK with my choice.

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