Decisional conflict in breast cancer patients considering immediate breast reconstruction

Abstract

Background: Breast cancer (BC) patients who are treated with mastectomy are frequently offered immediate breast reconstruction. This study aimed to assess decisional conflict in patients considering immediate breast reconstruction, and to identify factors associated with clinically significant decisional conflict (CSDC). Methods: Baseline data of a multicenter randomized controlled trial evaluating the impact of an online decision aid for BC patients considering immediate breast reconstruction after mastectomy were analyzed. Participants completed questionnaires assessing sociodemographic and clinical characteristics, decisional conflict and other patient-reported outcomes related to decision-making such as breast reconstruction preference, knowledge, information resources used, preferred involvement in decisionmaking, information coping style, and anxiety. Multivariable logistic regression analysis was performed to identify factors associated with CSDC (score > 37.5 on decisional conflict). Results: Of the 250 participants, 68% experienced CSDC. Patients with a slight preference for breast reconstruction (odds ratio (OR) ¼ 6.19, p < .01), with no preference for or against breast reconstruction (OR ¼ 11.84, p < .01), and with a strong preference for no breast reconstruction (OR ¼ 5.20, p < .05) were more likely to experience CSDC than patients with a strong preference for breast reconstruction. Furthermore, patients with more anxiety were more likely to experience CSDC (OR ¼ 1.03, p ¼ .01). Conclusion: A majority of BC patients who consider immediate breast reconstruction after mastectomy experience clinically significant decisional conflict. The findings emphasize the need for decision support, especially for patients who do not have a strong preference for breast reconstruction.

Decisional conflict is associated with quality of life and mental health in patients with inflammatory bowel disease

“…Interestingly, the study found that after adjusting for various factors, disease knowledge did not show a signi cant correlation with decision con ict. This nding is consistent with a study on the con ict of decision-making in breast reconstruction among breast cancer patients 29 , suggesting that making a treatment decision for IBD may create uncertainty for the patient regardless of their prior knowledge. Decisional con ict may be more closely related to the perceived knowledge of patients rather than their actual knowledge.…”

“…Previous research has shown that decisional con ict can be exacerbated by anxiety and depression, and vice versa 29,33 . When patients are uncertain and regret existing decisions, anxiety, and depression may be exacerbated.…”

Effect of patient decision aids on choice between sugammadex and neostigmine in surgeries under general anesthesia: a multicenter randomized controlled trial

“…PtDAs have shown to be significantly beneficial to patients in various medical topics, such as choice of medication for type 2 diabetes mellitus [12], surgical intervention for breast cancer [19], paediatric vaccination of rotavirus [20], and clinical care of lumbar degenerative diseases [21]. The use of PtDAs in shared clinical decision-making encourages patients and decision-makers to ask questions, thereby making them better informed to make proper medical decisions for themselves or their family.…”

Breast reconstruction during the COVID-19 pandemic in resource-limited settings

“…There has been an increase in the incidence with a rate of up to 3.5% over the preceding decade [ 13 ]. Surgery remains the foundation of treatment for breast cancer worldwide, and current current trends in surgical care including breast conservation surgery, mastectomy and reconstruction [ 14 ], [ 15 ], [ 16 ], [ 17 ], [ 18 ], [ 19 ]. There has been a paradigm shift in the management of breast cancer and the advent of oncoplastic breast surgery has revolutionised the concept of breast preservation, utilising limited tissue resection as opposed to a mastectomy [ 20 ], [ 21 ], [ 22 ], [ 23 ], [ 24 ], [ 25 ], [ 26 ], [ 27 ].…”

“…At most breast centres, the majority of reconstructions is performed immediately, in a joint procedure between the breast surgeon, who performs the mastectomy, and the plastic surgeon [ 15 ], [ 19 ], [ 31 ], [ 34 ], [ 35 ], [ 36 ], [ 37 ]. Pre-operatively, this allows for mastectomy skin sparing incisions to be discussed between the two teams which can then be incorporated in the final decision on the optimal reconstruction to best suit the patient.…”