Are patients making high-quality decisions about breast reconstruction after mastectomy? [outcomes article]

• Published in: Plastic and reconstructive surgery (1963) Vol. 127; no. 1; p. 18
• Main Authors: Lee, Clara N, Belkora, Jeff, Chang, Yuchiao, Moy, Beverly, Partridge, Ann, Sepucha, Karen
• Format: Journal Article
• Language: English
• Published: United States 01.01.2011
• Subjects: Breast Neoplasms - surgery; Cross-Sectional Studies; Decision Making; Female; Goals; Health Knowledge, Attitudes, Practice; Humans; Logistic Models; Mammaplasty - methods; Mammaplasty - psychology; Mastectomy; Middle Aged; Patients - psychology
• ISSN: 1529-4242
• DOI: 10.1097/PRS.0b013e3181f958de

Variation in rates of breast reconstruction after mastectomy has raised concerns about the quality of decisions about reconstruction. The authors sought to evaluate patient decision making about reconstruction, using a validated measure of knowledge and preferences related to reconstruction. A cross-sectional survey of early-stage breast cancer survivors from four university medical centers was conducted. The survey included measures of knowledge about specific reconstruction facts, personal goals and concerns, and involvement in decision making. A multivariable linear regression model of characteristics associated with knowledge and a logistic regression model of factors associated with having reconstruction were developed. A total of 84 patients participated (59 percent response rate). Participants answered 37.9 percent of knowledge questions correctly. Higher education (beta, 15 percent; p = 0.003) and having reconstruction (beta, 21 percent; p < 0.0001) were associated with higher knowledge. The goals "use your own tissue to make a breast" (odds ratio, 1.53; 95 percent CI, 1.15, 2.05) and "wake up after mastectomy with reconstruction underway" (odds ratio, 1.66; 95 percent CI, 1.30, 2.12) were associated with reconstruction. The goal "avoid putting foreign material in your body" was associated with no reconstruction (odds ratio, 0.64; 95 percent CI, 0.48, 0.86). Most patients reported they mainly made the decision or made the decision with the doctor equally (93 percent; 95 percent CI, 85 to 97 percent) and that their degree of involvement was about right (85 percent; 95 percent CI, 75 to 91 percent). Women treated with mastectomy in this study were not well-informed about breast reconstruction. Treatments were associated with patients' goals and concerns, however, and patients were highly involved in their decisions. Knowledge deficits suggest that breast cancer patients would benefit from interventions to support their decision making.