Assessing Women’s Preferences and Preference Modeling for Breast Reconstruction Decision Making

Sun, Clement S.; Cantor, Scott B.; Reece, Greg P; Crosby, Melissa A.; Fingeret, Michelle Cororve; Markey, Mia K.

doi:10.1097/gox.0000000000000062

Cited by 7 publications

(6 citation statements)

References 19 publications

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“…Large-scale studies such as those highlighted above will continue to produce generalizable PROs that clinicians and patients can utilize in future decision making. 30 …”

Section: Discussionmentioning

confidence: 99%

The BREAST-Q in surgical research: A review of the literature 2009–2015

Cohen

Mundy

Ballard

et al. 2016

Journal of Plastic, Reconstructive & Aesthetic Surgery

291

176

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Introduction Health outcomes research has gained considerable traction over the past decade as the medical community attempts to move beyond traditional outcome measures such as morbidity and mortality. Since its inception in 2009, the BREAST-Q has provided meaningful and reliable information regarding health related – quality of life (HR-QOL) and patient satisfaction for use in both clinical practice and research. Now five years from its initial publication, we review how researchers have utilized the BREAST-Q and how it has enhanced our understanding and practice of plastic and reconstructive breast surgery. Methods An electronic literature review was performed to identify publications that used the BREAST-Q to assess patient outcomes. Studies developing and/or validating the BREAST-Q or an alternate patient reported outcome measure (PROM), review papers, conference abstracts, discussions, comments and/or responses to previously published papers, studies that modified a version of BREAST-Q, and studies not published in English were excluded. Results Our literature review yielded 214 unique articles, 49 of which met our inclusion criteria. Important trends and highlights were further examined. Discussion The BREAST-Q has provided important insights in breast surgery highlighted by literature concerning autologous reconstruction, implant type, fat grafting, and patient education. The BREAST-Q has increased the use of PROMs in breast surgery and provided numerous important insights in its brief existence. The increased interest in PROMs as well as the under utilized potential of the BREAST-Q should permit its continued use and ability to foster new innovations and improve quality of care.

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“…Large-scale studies such as those highlighted above will continue to produce generalizable PROs that clinicians and patients can utilize in future decision making. 30 …”

Section: Discussionmentioning

confidence: 99%

The BREAST-Q in surgical research: A review of the literature 2009–2015

Cohen

Mundy

Ballard

et al. 2016

Journal of Plastic, Reconstructive & Aesthetic Surgery

291

176

View full text Add to dashboard Cite

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“…33 Second, beneficial appearance expectations and positive psychosocial expectations including the desire to feel normal and feminine, the expectation of improved quality of life, and wanting to “move on,” are cited as common reasons for choosing BR, 17,25,34–36 and fear of complications and anxiety are cited as reasons not to choose BR. 25 However, with few exceptions, 37 research has used qualitative methods or assessed effects of BR on patient-reported outcomes after surgery, rather than a standardized assessment to evaluate reasons for choosing or not choosing BR. Third, other factors that contribute to decisions, such as satisfaction with preparation for the decision and decisional conflict, have not been examined during the time period when women are making the decision using standard instruments.…”

Section: Introductionmentioning

confidence: 99%

Attitudes and Decisional Conflict Regarding Breast Reconstruction Among Breast Cancer Patients

et al. 2016

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Background The decision to undergo breast reconstruction (BR) surgery following mastectomy is made during stressful circumstances. Many women do not feel well-prepared to make this decision. Objective Using the Ottawa Decision Support Framework, this study aimed to describe women’s reasons to choose or not choose BR, BR knowledge, decisional preparedness, and decisional conflict about BR. Possible demographic, medical, BR knowledge, and attitudinal correlates of decisional conflict about BR were also evaluated. Methods Participants were 55 women with early stage breast cancer drawn from the baseline data of a pilot randomized trial evaluating the efficacy of a breast reconstruction decision support aid for breast cancer patients considering BR. Results The most highly-ranked reasons to choose BR were the desire for breasts to be equal in size, the desire to wake up from surgery with a breast in place, and perceived bother of a scar with no breast. The most highly-ranked reasons not to choose BR were related to the surgical risks and complications. Regression analyses indicated that decisional conflict was associated with higher number of reasons not to choose BR and lower levels of decisional preparedness. Conclusions The results suggest that breast cancer patients considering BR may benefit from decisional support.

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“…There are a number of candidate multiattribute utility functions (MAUFs) that may be used. We have shown that they perform equally well [36]. Let us assume that the additive MAUF is consistent with Jenn’s preferences.…”

Section: The Breast Reconstruction Decision: a Fictional Case Studymentioning

confidence: 99%

Helping Patients Make Choices about Breast Reconstruction

Sun

Cantor

Reece

et al. 2014

Plastic and Reconstructive Surgery

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Decision analysis can help breast reconstruction patients and their surgeons to methodically evaluate clinical alternatives and make hard decisions. The purpose of this paper is to help plastic surgeons guide patients in making decisions though a case study in breast reconstruction. By making good decisions, patient outcomes may be improved. This paper aims to illustrate decision analysis techniques from the patient perspective with an emphasis on her values and preferences. We introduce normative decision-making through a fictional breast reconstruction patient and systematically build the decision basis to help her make a good decision. We broadly identify alternatives of breast reconstruction, propose types of outcomes that the patient should consider, discuss sources of probabilistic information and outcome values, and demonstrate how to make a good decision. The concepts presented here may be extended to other shared decision-making problems in plastic and reconstructive surgery. In addition, we discuss how sensitivity analysis may test the robustness of the decision and how to evaluate the quality of decisions. We also present tools to help implement these concepts in practice. Finally, we examine limitations that hamper adoption of patient decision analysis in reconstructive surgery and healthcare in general. In particular, we emphasize the need for routine collection of quality of life information, out-of-pocket expense, and recovery time.

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Assessing Women’s Preferences and Preference Modeling for Breast Reconstruction Decision Making

Cited by 7 publications

References 19 publications

The BREAST-Q in surgical research: A review of the literature 2009–2015

The BREAST-Q in surgical research: A review of the literature 2009–2015

Attitudes and Decisional Conflict Regarding Breast Reconstruction Among Breast Cancer Patients

Helping Patients Make Choices about Breast Reconstruction

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