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Table 2 Themes and exemplar quotes by PCC domain [34]

From: Identifying opportunities to support patient-centred care for ductal carcinoma in situ: qualitative interviews with clinicians

PCC domainsThemesExemplar quotes
Fostering healing relationshipBuilding rapportYou have to you know take the time to get to know the patient well enough to be able to tailor your approach to them. (06 gen surg)
You have to have the ability as a physician to say, you have all the time you need and I’m here, I always sit down with the patient and give them the correct idea that I’m listening, that I do have time. (05 surg onc)
Exchanging informationLabel for DCISSome people talk about DCIS as being a pre-cancer and patients often come in from the surgeons saying that, but I don’t agree with that particular term. So, if that’s the case I clarify that it is breast cancer, but it’s very early (04 rad onc)
Achieving patient understandingThe main barrier honestly for the most part is a patient just having the capacity to understand the notion of a non-invasive breast cancer and the potential for it to develop into an invasive breast cancer and that it’s not currently a threat; patients have a hard time wrapping their head around that notion. (07 rad onc)
I see my patients at 6-month follow-up following surgery … and when I see them again, sometimes patients are still asking me whether or not they actually had cancer or whether it was DCIS or not. (04 gen sx)
You end up spending a lot of time explaining to them the difference between DCIS and invasive breast cancer because they don’t necessarily understand that often when they come. They know they have breast cancer and that’s all they understand. (04 med onc)
Justifying treatment despite good prognosisThey find it harder to understand why they need a mastectomy for pre-invasive disease … it’s not that serious but you need a mastectomy. That can be a difficult discussion (03 surg onc)
Providing supplemental informationI have my own personal website which has a whole bunch of websites on it. So I kind of refer them to that to look at if they’re of that … wanting more information. So like I said, I have a personal website. It has lists of places you can go. Like the Cancer Society and the NIH and places they can search for reputable information (01 gen surg)
I refer patients to information from randomized trials because with DCIS there are many randomized trials; and very consistent information from the randomized trials. So I like to use that information (04 rad onc)
If they want more information … I’m not sure where or who I’d send them too? if they have questions along those lines, like someone else ends up dealing with them more than me. (10 surg onc)
I’ll often times draw a sketch or show diagrammatically you know how … how for instance DCIS hasn’t invaded through base membrane. So I draw a picture of what a milk duct looks like and show how cancer cells populate and multiply. (05 gen surg)
Addressing EmotionsEmphasizing good prognosisI usually try to explain to the patients that it represents the best form of breast cancer if they were ever going to get problem of this nature. (05 gen surg)
Referring to supportive careThese are high maintenance emotional needs patients. So having somebody that they can access after the consultation is over just alleviates a lot of their psychological consternation. (09 surg onc)
Managing UncertaintyDescribing uncertaintyI tell them that not all ductal carcinoma in situ will progress to cancer. We don’t know exactly which ones will and which ones won’t. (03 gen surg)
The surgery is more as a precaution to prevent further development of invasive disease but more also to make sure that that’s all that there is there. (07 surg onc)
Making DecisionsInvolving women in decision makingI make sure I know before I go in with the patient whether or not it is amenable to do breast conserving surgery. I’ll make sure they have no contraindications of radiation … then I can present to them the options. But I don’t want to present options that are inappropriate. Then it’s at the patient choice, which they prefer. (08 surg onc)
Some women choose to have a mastectomy for this condition but I certainly make it very clear that for that woman that is not necessary and it could be completely addressed without a mastectomy with a much lesser surgery, less invasive, fewer complications, etc., and then I would encourage that. (09 surg onc)
If the area looks readily resectable I don’t even mention the word mastectomy. I just say we’re gonna, we’ll get this area out. (04 surg onc)
Enabling Self-ManagementPaucity of DCIS-specific resources and supportI don’t think there’s anything that’s specific to DCIS. A lot of it is kind of it is around the surgery and what to expect at the time of surgery and if they need a wire localization procedure. What that involves and that kind of stuff.. (02 surg onc)
I don’t think there are ones [support groups] for DCIS specifically. I think they’re all breast … that’s the problem, breast cancer patients. So these people are going to support groups with cancer people which is not ideally the best way. (07 surg onc)