Importance of Shared Decision-Making for Vulnerable Populations: Examples from Postmastectomy Breast Reconstruction

Abstract

Shared decision-making (SDM) is a process through which patients and providers collaborate to select a treatment option that aligns with patients' preferences and clinical context. SDM can improve patients' decision quality and satisfaction. However, vulnerable populations face barriers to participation in SDM, which exacerbates disparities in decision quality. This perspective article discusses SDM with vulnerable patients, using examples from patients who made decisions about postmastectomy breast reconstruction. We offer several strategies for clinical practice, medical education, and research to ensure that movements to engage patients in SDM do not exclude already marginalized groups.

Do socio-economically disadvantaged patients prefer shared decision-making?

“…9 The fact that nearly half of all patients wanted to play an active role in SDM is in contrast to perceptions that socioeconomically disadvantaged patients do not want to participate in SDM. 21,22 This perception is likely caused by patients not clearly articulating their preference for SDM. Factors such as the language barrier, lack of time per consultation, and a power imbalance between patients and clinician may impede the patients' ability to clearly communicate their preferences, and will be discussed in more detail.…”

Oncoplastic breast surgery: A guide to good practice

“…Decisions about OPBS are often complex and every effort must be made to give all patients sufficient time and support to consider their options with the operating surgeon(s) and reach a shared decision [30]. A clinical nurse specialist should be available for discussions about surgical options.…”

Post-mastectomy Breast Reconstruction with Autologous Tissue: Current Methods and Techniques

“…Shared decision-making between the patient and surgeon ensures that the patient has a good understanding of the reconstructive options and yields higher patient satisfaction. 1 , 43 Once the surgeon and patient are comfortable with operative plan and agree that autologous tissue reconstruction is the best option for the patient, there are several techniques that can be employed to increase the volume of the reconstructed breast. Beveling at the perimeter of the flap dissection can maximize the volume obtained from any donor site.…”

“…Long-term data are not available in the literature, but published studies in the short term reveal favorable results. 52 For the best possible outcomes, extensive preoperative discussions with the patient and having a shared decision-making approach will optimize patient satisfaction 1 , 43 (Figs. 7 – 8 ).…”