Variation in Physician-patient Discussion of Breast Reconstruction

Chen, Judy Y.; Malin, Jennifer L.; Ganz, Patricia A.; Ko, Clifford Y.; Tisnado, Diana M.; Tao, May Lin; Timmer, Martha; Adams, John; Kahn, Katherine L.

doi:10.1007/s11606-008-0855-y

Cited by 41 publications

(32 citation statements)

References 36 publications

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“…More recently, another population-based study of survivors in Los Angeles found that 19% reported no discussion of reconstruction with their provider. 6 Lower-income women in that study were less likely to have discussed reconstruction with their provider.…”

Section: Discussionmentioning

confidence: 76%

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Are Patients Making High-Quality Decisions about Breast Reconstruction after Mastectomy? [Outcomes Article]

Lee

Belkora

Chang

et al. 2011

Plastic and Reconstructive Surgery

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Background Variation in rates of breast reconstruction after mastectomy has raised concerns about the quality of decisions about reconstruction. We sought to evaluate patient decision making about reconstruction, using a validated measure of knowledge and preferences related to reconstruction. Methods 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. Results 84 patients participated (59% response rate). Participants answered 37.9% of knowledge questions correctly. Higher education (beta 15%, p=0.003) and having reconstruction (beta 21%, p<0.0001) were associated with higher knowledge. The goals “use your own tissue to make a breast” (OR 1.53, 95% CI 1.15, 2.05) and “wake up after mastectomy with reconstruction underway” (OR 1.66, 95% CI 1.30, 2.12) were associated with reconstruction. The goal “avoid putting foreign material in your body” was associated with no reconstruction (OR 0.64, 95% CI 0.48, 0.86). Most patients reported they mainly made the decision or made the decision with the doctor equally (93%, 95%CI 85-97%), and that their degree of involvement was about right (85%, 95%CI 75-91%). Conclusion 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.

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Section: Discussionmentioning

confidence: 76%

“…Up to twenty percent of breast cancer survivors have reported they were never told about reconstruction, 6, 7 and ethnic minority women appear to be least informed about reconstruction. 8 Patients who have had reconstruction have expressed regret about having it and the feeling that their goals were not met.…”

Section: Introductionmentioning

confidence: 99%

Are Patients Making High-Quality Decisions about Breast Reconstruction after Mastectomy? [Outcomes Article]

Lee

Belkora

Chang

et al. 2011

Plastic and Reconstructive Surgery

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“…In retrospective studies, approximately 20% of women who had mastectomy reported no discussion about breast reconstruction with their provider. 1, 6, 8 Minority women are less likely to report a discussion about breast reconstruction, 1, 4, 6 and they have lower knowledge about reconstruction. 8 Concern also exists because many women are unsatisfied with their choice to receive or not receive reconstruction.…”

Section: Introductionmentioning

confidence: 99%

How Informed Is the Decision About Breast Reconstruction After Mastectomy?

et al. 2016

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Objective to assess how informed patients are about breast reconstruction, and how involved they are in decision making. Summary Background Data Breast reconstruction is an important treatment option for patients undergoing mastectomy. Wide variations in who gets reconstruction, however, have led to concerns about decision making. Methods We conducted a prospective cross-sectional study of patients planning mastectomy at a single site, over 20 months. Before surgery, patients completed a survey with validated scales to assess knowledge about breast reconstruction and involvement in decision making. Factors associated with knowledge were examined in a multivariable linear regression model. Results 145 patients enrolled (77% enrollment rate), and 126 remained eligible. The overall knowledge score was 58.5% (out of 100%). Knowledge about risk of complications was especially low at 14.3%. Knowledge did not differ by treatment (reconstruction or not). On multivariable analysis, non-white race was independently associated with lower knowledge. Most patients (92.1%) reported some discussion with a provider about reconstruction, and most (90.4%) reported being asked their preference. More patients reported discussing the advantages of reconstruction (57.9%) than the disadvantages (27.8%). Conclusions Women undergoing mastectomy in this sample were highly involved in decision making but had major deficits in knowledge about the procedure. Knowledge about the risk of complications was particularly low. Providers appeared to have discussed the advantages of reconstruction more than its disadvantages.

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“…Patient decision-making should be focused on her values [27]. Comprehension and knowledge retention of breast reconstruction facts may be low [26].…”

Section: Patient Values and Preferences: Weights And U-valuesmentioning

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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Variation in Physician-patient Discussion of Breast Reconstruction

Cited by 41 publications

References 36 publications

Are Patients Making High-Quality Decisions about Breast Reconstruction after Mastectomy? [Outcomes Article]

Are Patients Making High-Quality Decisions about Breast Reconstruction after Mastectomy? [Outcomes Article]

How Informed Is the Decision About Breast Reconstruction After Mastectomy?

Helping Patients Make Choices about Breast Reconstruction

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