Attitudes and Decisional Conflict Regarding Breast Reconstruction Among Breast Cancer Patients

Manne, Sharon L.; Topham, Neal S.; Kirstein, Laurie; Virtue, Shannon Myers; Brill, Kristin L.; Devine, Katie A.; Gajda, Tina; Frederick, Sara; Darabos, Katie; Sorice, Kristen

doi:10.1097/ncc.0000000000000320

Cited by 40 publications

(35 citation statements)

References 49 publications

(68 reference statements)

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“…Most studies have examined preferences about involvement, 25,26 and some have examined treatment motivations, 2,27 which are associated with, but not equivalent to, preferences. In one retrospective study, the goals of using one’s own tissue and waking up after mastectomy with reconstruction under way were associated with reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Quality of Patient Decisions About Breast Reconstruction After Mastectomy

et al. 2017

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IMPORTANCE Breast reconstruction has the potential to improve a person’s body image and quality of life but has important risks. Variations in who undergoes breast reconstruction have led to questions about the quality of patient decisions. OBJECTIVE To assess the quality of patient decisions about breast reconstruction. DESIGN, SETTING, AND PARTICIPANTS A prospective, cross-sectional survey study was conducted from June 27, 2012, to February 28, 2014, at a single, academic, multidisciplinary oncology clinic among women planning to undergo mastectomy for stage I to III invasive ductal or lobular breast cancer, ductal carcinoma in situ, or prophylaxis. EXPOSURES Mastectomy only and mastectomy with reconstruction. MAIN OUTCOME AND MEASURES Knowledge, as ascertained using the Decision Quality Instrument; preference concordance, based on rating and ranking of key attributes; and decision quality, defined as having knowledge of 50% or more and preference concordance. RESULTS During the 20-month period, 214 patients were eligible, 182 were approached, and 32 missed. We enrolled 145 patients (79.7% enrollment rate), and received surveys from 131 patients (72.0% participation rate). Five participants became ineligible. The final study population was 126 patients. Among the 126 women in the study (mean [SD] age, 53.2 [12.1] years), the mean (SD) knowledge score was 58.5% (16.2%) and did not differ by treatment group (mastectomy only, 55.2% [15.0%]; mastectomy with reconstruction, 60.5% [16.5%]). A total of 82 of 123 participants (66.7%) had a calculated treatment preference of mastectomy only; 39 of these women (47.6%) underwent mastectomy only. A total of 41 participants (32.5%) had a calculated treatment preference of mastectomy with reconstruction; 36 of these women (87.8%) underwent mastectomy with reconstruction. Overall, 52 of 120 participants (43.3%) made a high-quality decision. In multivariable analysis, white race/ethnicity (odds ratio [OR], 2.72; 95% CI, 1.00–7.38; P = .05), having private insurance (OR, 1.61; 95% CI, 1.35–1.93; P < .001), having a high school education or less (vs some college) (OR, 4.84; 95% CI, 1.22–19.21; P = .02), having a college degree (vs some college) (OR, 1.95; 95% CI, 1.53–2.49; P < .001), and not having a malignant neoplasm (eg, BRCA carriers) (OR, 3.13; 95% CI, 1.25–7.85; P = .01) were independently associated with making a high-quality decision. CONCLUSIONS AND RELEVANCE A minority of patients undergoing mastectomy in a single academic center made a high-quality decision about reconstruction. Shared decision making is needed to support decisions about breast reconstruction.

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Section: Discussionmentioning

confidence: 99%

Quality of Patient Decisions About Breast Reconstruction After Mastectomy

et al. 2017

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“…Overall, women’s knowledge, preparedness, and decision quality related breast reconstruction is relatively low (Lee, Deal, Huh, & et al, 2017; Manne et al, 2016; Pusic et al, 2012; Pusic et al, 2017). For example, although women may view their ability to return to normal activities or avoid complications from surgery as important in their decisions, their actual knowledge of these factors as they relate to reconstruction method appears limited (Lee et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

Met and Unmet Expectations for Breast Reconstruction in Early Posttreatment Breast Cancer Survivors

Steffen

Johnson

Levine

et al. 2017

Plastic Surgical Nursing

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Background The purpose of this study was to evaluate the prevalence of met and unmet expectations after breast reconstruction among breast cancer survivors following mastectomy. A secondary objective was to examine women’s reasons their experiences of reconstructive surgery were better or worse than expected. Methods As part of a larger study of breast cancer survivors, participants completed self-administered questionnaires within 8 months of diagnosis and at 6, 12, and 18 months later. At the 18-month follow-up, women who had breast reconstruction were asked whether their reconstruction was better, the same, or worse than expected. Results The sample consisted of 130 survivors (mean age 48.5 years) who had breast reconstruction following a mastectomy and completed the 18-month follow-up, 42% of whom reported their reconstruction was worse than expected and only 25% reported it was better. Most frequently reported reasons for reconstruction being worse than expected were related to appearance of the reconstructed breast and pain. Conclusions A high percentage of breast cancer patients undergoing breast reconstruction following a mastectomy report the results as worse than expected with the primary reasons for dissatisfaction related to the feel and appearance of the reconstructed breast. Breast cancer patients considering breast reconstruction need better pre-operative education or understanding about what to expect from reconstruction.

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“…Women may not have a sufficient amount of time to make a fully informed decision . Recent data suggest that values and attitudes impact decision‐making . A desire for breast symmetry, wanting to wake up from surgery with a breast in place, and the belief that it would be upsetting to look in the mirror and see a scar with no breast were rated as most frequent reasons to have BR.…”

Section: Introductionmentioning

confidence: 99%