National study of the impact of patient information and involvement in decision-making on immediate breast reconstruction rates

Frisell, A; Lagergren, Jesper; Boniface, Jana de

doi:10.1002/bjs.10286

Cited by 25 publications

(41 citation statements)

References 33 publications

(35 reference statements)

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“…Some existing studies suggested that hospitals and/or surgeons act as gatekeepers to BR access and that inter‐hospital variations may not be ‘purely resource‐driven’ . In NSW, surgeons must be accredited by a hospital in order to be granted operating privileges and lists at that particular hospital.…”

Section: Discussionmentioning

confidence: 99%

Patterns of immediate breast reconstruction in New South Wales, Australia: a population‐based study

Feng

Flitcroft

Leeuwen

et al. 2019

ANZ Journal of Surgery

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BackgroundThe rate of immediate breast reconstruction (IBR) following mastectomy for breast cancer in Australia is low and varies between regions. To date, no previous Australian studies have examined IBR rates between all hospitals within a particular jurisdiction, despite hospitals being an important known contributor to variation in IBR rates in other countries.MethodsWe used cross‐classified random‐effects logistic regression models to examine the inter‐hospital variation in IBR rates by using data on 7961 women who underwent therapeutic mastectomy procedures in New South Wales (NSW) between January 2012 and June 2015. We derived IBR rates by patient‐, residential neighbourhood‐ and hospital‐related factors and investigated the underlying drivers for the variation in IBR.ResultsWe estimated the mean IBR rate across all hospitals performing mastectomy to be 17.1% (95% Bayesian credible interval (CrI) 12.1–23.1%) and observed wide inter‐hospital variation in IBR (variance 4.337, CrI 2.634–6.889). Older women, those born in Asian countries (odds ratio (OR) 0.5, CrI 0.4–0.6), residing in neighbourhoods with lower socioeconomic status (OR 0.7, CrI 0.5–0.8 for the most disadvantaged), and who underwent surgery in public hospitals (OR 0.4, CrI 0.1–1.0) were significantly less likely to have IBR. Women residing in non‐metropolitan areas and attending non‐metropolitan hospitals were significantly less likely to undergo IBR than their metropolitan counterparts attending metropolitan hospitals.ConclusionWide inter‐hospital variation raises concerns about potential inequities in access to IBR services and unmet demand in certain areas of NSW. Explaining the underlying drivers for IBR variation is the first step in identifying policy solutions to redress the issue.

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Section: Discussionmentioning

confidence: 99%

Patterns of immediate breast reconstruction in New South Wales, Australia: a population‐based study

Feng

Flitcroft

Leeuwen

et al. 2019

ANZ Journal of Surgery

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“…In the previously reported study of a similar cohort, younger age, non‐invasive tumours, no clinically involved lymph nodes and residence in the Stockholm/Gotland region were independent predictors of undergoing IBR, as well as the availability of in‐house plastic surgery services, patient information and involvement in decision‐making. This raised the question of whether the observed regional differences could be associated with differences in socioeconomic factors.…”

Section: Resultsmentioning

confidence: 69%

“…Significant regional differences in IBR rates in Sweden have been reported previously 19 , and were not explained by regional differences in tumour or patient characteristics, but by disparities in patient information, availability of plastic surgery services and patient involvement in decision-making. As socioeconomic factors were not taken into account at that time, the aim of the present study was to determine their potential association with IBR rates, as well as with patient-reported information and involvement in the surgical decision-making process.…”

Section: Introductionmentioning

confidence: 54%

Influence of socioeconomic status on immediate breast reconstruction rate, patient information and involvement in surgical decision-making

et al. 2020

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Background Immediate breast reconstruction (IBR) rates in breast cancer differ between healthcare regions in Sweden. This is not explained by regional differences in patient age distribution or tumour characteristics, but by differences in patient‐reported information and patient involvement in the decision‐making process. As socioeconomic status may play a significant role in surgical decision‐making, its potential associations with IBR rates were analysed. Methods Women who had undergone therapeutic mastectomy for primary breast cancer in Sweden in 2013 were included in the analysis. Tumour and treatment data were retrieved from the Swedish National Breast Cancer Register, and socioeconomic background data from the Central Bureau of Statistics Sweden. Postal questionnaires regarding information about reconstruction and perceived involvement in the preoperative decision‐making process had been sent out in a previous survey. Results In addition to regional differences, lower tumour and nodal category, independent factors increasing the likelihood of having IBR for the 3131 women in the study were living without a registered partner, having current employment and high income per household. Patient‐reported perceived preoperative information (odds ratio (OR) 12·73, 95 per cent c.i. 6·03 to 26·89) and the feeling of being involved in the decision‐making process (OR 2·56, 1·14 to 5·76) remained strong independent predictors of IBR despite adjustment for socioeconomic factors. Importantly, responders to the survey represented a relatively young and wealthy population with a lower tumour burden. Conclusion Several socioeconomic factors independently influence IBR rates; however, patient‐reported information and involvement in the surgical decision‐making process remain independent predictors for the likelihood of having IBR.

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“…Post‐mastectomy reconstruction has been shown to improve satisfaction and psychological outcomes for women following mastectomy, yet due to the elective nature of the procedure, it is particularly susceptive to disparities in uptake . Most of the previous research regarding the unequal rates of uptake of reconstruction has focused on racial/ethnic disparities, but there is an increasing focus on patient needs for reliable information and engagement in the shared decision‐making process . Patients with LHL represent a unique population that require tailored interventions specific to their health literacy level and preferred learning style.…”

Section: Discussionmentioning

confidence: 99%

Impact of patient health literacy on surgical treatment of breast cancer

et al. 2018

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Little is known about the role of low health literacy (LHL) among breast surgical oncology patients. We initiated a prospective health literacy assessment to determine the relationship between health literacy and surgical treatment. Among 512 patients, univariate analysis revealed no statistical significance in the relationship of health literacy to breast surgery type, contralateral prophylactic mastectomy, or reconstruction following mastectomy. In a multivariate analysis, women with LHL were less likely to undergo reconstruction (aOR 0.81, 95% CI 0.69-0.94, P value = .006). Tailored interventions are needed to combat disparities in cancer treatment associated with LHL, with focus on reconstruction following mastectomy.

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National study of the impact of patient information and involvement in decision-making on immediate breast reconstruction rates

Cited by 25 publications

References 33 publications

Patterns of immediate breast reconstruction in New South Wales, Australia: a population‐based study

Patterns of immediate breast reconstruction in New South Wales, Australia: a population‐based study

Influence of socioeconomic status on immediate breast reconstruction rate, patient information and involvement in surgical decision-making

Impact of patient health literacy on surgical treatment of breast cancer

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