Breast Reconstruction Decision Aids Decrease Decisional Conflict and Improve Decisional Satisfaction: A Randomized Controlled Trial

Abstract

Several complex decisions face women considering breast reconstruction, such as whether or not to undergo reconstruction, type of reconstruction, and timing of reconstruction (immediate versus delayed). Unlike many other aspects of breast cancer therapy, the patient's preferences play a central role in reconstructive decisions. Although choice may offer a woman a sense of control at a time when such opportunities may feel scarce, the decisions can be challenging to make. [1][2][3] Background: Decision aids are useful adjuncts to clinical consultations for women considering breast reconstruction. This study compared the impact of two online decision aids, the Breast RECONstruction Decision Aid (BRECONDA) and the Alberta Health Services (AHS) decision aid, on decisional conflict, decisional satisfaction, and decisional regret. Methods: This randomized controlled trial included 60 women considering whether or not to undergo breast reconstruction. Two online decision aids, the AHS and the BRECONDA, were compared using randomized two-arm equal allocation. Participants responded to questionnaires at baseline, after the first and second consultations, and at 6 weeks and 6 months after deciding to, or not to, undergo reconstruction. Change in decisional conflict scores was compared between the BRECONDA and the AHS decision aid. Secondary outcomes included decisional regret and decisional satisfaction. Results: Both groups were similar in demographic, clinical, and behavioral characteristics. Women spent more time consulting the BRECONDA in comparison to women using the AHS decision aid (56.7 ± 53.8 minutes versus 28.4 ± 27.2 minutes; P < 0.05). Decisional conflict decreased (P < 0.05), and decisional satisfaction improved over time in both groups (P < 0.05). However, there were no differences based on the type of decision aid used (P > 0.05). Both decision aids had a similar reduction in decisional regret (P > 0.05). Conclusions: Decision aids decrease decisional conflict and improve decisional satisfaction among women considering breast reconstruction. Physicians should therefore offer patients access to decision aids as an adjunct to breast reconstruction consultations to help patients make an informed decision. (Plast.

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

“…Therefore, further elucidation of the correlations between decision con ict and psychological distress as well as the quality of life of IBD patients might help in understanding the sources of decisional con ict. Our results also show the importance of improving decision con ict, and the use of decision AIDS may be an effective means, which has been validated in multiple high-quality studies [40][41][42] .…”

Information needs in breast reconstruction after mastectomy: a qualitative analysis of free-text responses from 2077 women

“…Whilst an Australian decision aid exists [ 45 , 46 ], there is limited information regarding its use. As decision aids for BR have been shown to reduce decision regret and improve decision satisfaction [ 46 , 47 ], work is needed to develop strategies to ensure women access these resources.…”

Patient Preferences for Postmastectomy Breast Reconstruction

“…Shared decision-making has been described as the criterion standard in health care, with existing literature demonstrating reduced decisional conflict and improved decision quality with the use of decision aids . In the context of breast reconstruction, decision support tools have made promising strides, helping to inform patient choice, improve patient satisfaction, and mitigate decisional regret . The Institute of Medicine Committee on Quality of Health Care in America Crossing the Quality Chasm: A New Health System for the 21st Century report emphasized that patients should have enough information to choose among treatment options, and the US Preventive Services Task Force has repeatedly encouraged SDM about health care services, leading to growing interest in the development and implementation of patient decision aids to facilitate SDM .…”

“…43 In the context of breast reconstruction, decision support tools have made promising strides, helping to inform patient choice, improve patient satisfaction, and mitigate decisional regret. 14,44 The Institute of Medicine Committee on Quality of Health Care in America Crossing the Quality Chasm: A New Health System for the 21st Century report 45 emphasized that patients should have enough information to choose among treatment options, and the US Preventive Services Task Force has repeatedly encouraged SDM about health care services, leading to growing interest in the development and implementation of patient decision aids to facilitate SDM. 46 As the Center for Medicare & Medicaid Services continues to accelerate toward alternative payment models, high-cost and highvolume procedures, such as breast reconstruction, may begin to be considered for bundled reimbursement, with the expectation that clinicians meet quality performance targets, such as evidence that patient preferences are incorporated into the treatment decision.…”