This study highlights the need for clinicians to take into account the indication for surgery as a major psychological factor in patients' perception of self and experience of surgery. It demonstrates that bilateral immediate reconstruction patients report similar physical symptoms irrespective of indication for mastectomy, but the decision-making process in terms of risk-balancing and diagnosis influences satisfaction with self and surgery. It underlines the importance of preoperative management of expectations for patients undergoing risk-reducing procedures.

IntroductionMaximizing response rates in questionnaires can improve their validity and quality by reducing non-response bias. A comprehensive analysis is essential for producing reasonable conclusions in patient-reported outcome research particularly for topics of a sensitive nature. This often makes long (≥7 pages) questionnaires necessary but these have been shown to reduce response rates in mail surveys. Our work adapted the “Total Design Method,” initially produced for commercial markets, to raise response rates in a long (total: 11 pages, 116 questions), non-incentivized, very personal postal survey sent to almost 350 women.Patients and methodsA total of 346 women who had undergone mastectomy and immediate breast reconstruction from 2008–2014 (inclusive) at Addenbrooke’s University Hospital were sent our study pack (Breast-Q satisfaction questionnaire and support documents) using our modified “Total Design Method.” Participants were sent packs and reminders according to our designed schedule.ResultsOf the 346 participants, we received 258 responses, an overall response rate of 74.5% with a useable response rate of 72.3%. One hundred and six responses were received before the week 1 reminder (30.6%), 120 before week 3 (34.6%), 225 before the week 7 reminder (64.6%) and the remainder within 3 weeks of the final pack being sent. The median age of patients that the survey was sent to, and the median age of the respondents, was 54 years.ConclusionIn this study, we have demonstrated the successful implementation of a novel approach to postal surveys. Despite the length of the questionnaire (nine pages, 116 questions) and limitations of expenses to mail a survey to ~350 women, we were able to attain a response rate of 74.6%.

the hospital charity. The winning climber climbed two thirds the height of Mount Everest (2,595 flights) and the winning team twice the height of Mount Kilimanjaro (5,615 flights). 4 Post-survey data demonstrated the most enjoyable aspects were teamwork and bonding, improved fitness and the fun nature of this challenge. 100% of responders reported feeling their mood improve during this challenge. ConclusionThis challenge demonstrated that key aspects of medical professionalism, such as teamwork and communication, can be challenged and encouraged in a non-clinical environment across all members of the multidisciplinary team. Additional benefits also include contributing to trust sustainability, benefiting staff fitness and wellbeing, and funding for the hospital charity, ultimately providing improved care for patients at Southmead. As we learn to live with the pandemic and fluctuating stressors in our hospital environment, it is key to devise innovative ways to encourage comradery and wellbeing to improve workforce resilience across all levels of the multidisciplinary team. The North Bristol NHS Trust stair climb challenge achieved just that.

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