A Breast Reconstruction Needs Assessment: How does Self-Efficacy Affect Information Access and Preferences?

Abstract

Background Breast cancer patients requiring mastectomy do not consistently receive information about post-mastectomy breast reconstruction (PMBR) surgery from the treatment team. Patients have varying levels of self-efficacy, defined as one's confidence in their ability to gather information and make health-related decisions. The present preliminary study was designed to evaluate the relationship between self-efficacy and access to PMBR information. Methods A qualitative interview study was conducted on a convenience sample of 10 breast cancer patients considering or having already undergone PMBR and six key health care provider informants. The modified six-item Stanford Self-Efficacy Scale for managing chronic disease was administered. Results Patient self-efficacy scores ranged from 5 to 9.3 (out of 10). Two main access to information themes were identified from the patient qualitative data: theme A – difficulty initiating the PMBR discussion; and theme B – perceived lack of access to PMBR information with the sub-themes of timing, modality, quantity and content of resources. All respondents expressed their concern over the absence of a standardized process for initiating the dialogue of PMBR. Patients also reported that credible and easily accessible information was not routinely available and expressed a desire to hear about their PMBR options early in the decision-making process. Conclusions Health care providers may need to assume more responsibility in standardizing information dissemination on PMBR. This information should be distributed early in the consultation process, the content should be complete, and there may be a role for individualizing the delivery of information based on a patient's level of self-efficacy.

A prospective study of mastectomy patients with and without delayed breast reconstruction: Long‐term psychosocial functioning in the breast cancer survivorship period

“…These higher levels of distress at one-year post breast cancer diagnosis (prior to DBR) may have put women with DBR at higher risk of experiencing distress in the long-term. Previous qualitative research has reported that fear of breast cancer recurrence under a reconstructed breast is a major recurring theme [33].…”

Shared decision-making: Applying a person-centered approach to tailored breast reconstruction information provides high satisfaction across a variety of breast reconstruction options

“…This high degree of satisfaction, independent of the type of reconstruction, is felt to be largely due to the high level of patient engagement in co-decision-making. When women were given adequate information and were actively involved using a decision aid tool, satisfaction with their decision was higher peri-operatively and 10 months post-surgery than women who did not receive information and tools to make an informed choice [14]. Zhong et al [5] identified that decision regret was diminished when women were satisfied with preoperative information, whereas women dissatisfied with the information they received showed increased levels of stress, anxiety, and depression [6].…”

“…Though there are technical complexities in the surgical execution of each particular reconstruction option, we hypothesize that the main determinate of successful breast reconstruction occurs before any surgery is performed, vis-à-vis the provision of accurate, interpreted information that assists a woman to frame her choices based on her individual circumstances, and make the right choice for her. Satisfaction with preoperative information and active involvement in the decisionmaking process not only affects long term quality of life but also increases satisfaction with surgery regardless of choice made [4,[13][14][15].…”

Preconsultation Educational Group Intervention Can Address the Knowledge Gap in Postmastectomy Breast Reconstruction

“…The content, format, and mode of delivery for the PEGI were based on the results of a formal needs assessment with breast cancer survivors and key informants led by Zhong. 27 The PEGI composed of presentations from a plastic surgeon and breast reconstruction nurse, a value clarification exercise, and shared experiences from patients who had undergone PMBR. The PEGI is centered on a conceptual framework based in the Ottawa Decision Framework consolidating theoretical concepts in general and social psychology, decision analysis, values, social support, and self-efficacy, to rectify decisional conflict.…”