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

Abstract

Background Whether to undergo postmastectomy breast reconstruction (PMBR) is a challenging, preference-sensitive decision. It is therefore paramount to optimize decision quality through ensuring patients' knowledge and aligning treatments with their personal preferences. This study assessed the effects of a preconsultation educational group intervention (PEGI) on patient knowledge, state-trait anxiety, and decisional conflict (patient uncertainty in decision making) during the decision-making process. Methods This phase 3 randomized controlled trial assessed effects of a PEGI in women without active breast cancer undergoing delayed PMBR, or prophylactic mastectomy with immediate PMBR. Both groups underwent routine education before consultation. In addition, the intervention group underwent a PEGI composed of presentations from a plastic surgeon and nurse, a value clarification exercise, and shared experiences from PMBR patients before the consultation with the plastic surgeon. Before and 1-week after consultation, outcome measures were assessed using the Decisional Conflict Scale, State-Trait Anxiety Inventory, and the BREAST-Q. Results Of the 219 women deemed eligible, a total of 156 women were recruited and randomized. Treatment fidelity was 96% and retention was 88%. At baseline, there were no significant differences in terms of demographic or clinical status, knowledge, state-trait anxiety, and decisional conflict. Patient knowledge about PMBR improved in both groups; however, the degree of knowledge attainment was significantly greater in the PEGI group (24.5% improvement in the intervention group compared with 13.5% in the routine education group, P < 0.001). The reduction in decisional conflict from baseline to follow-up was greater in the intervention group compared with the routine education; however, the difference only approached significance ( P = 0.09). Conclusions The provision of a preconsultation educational group intervention has been shown to significantly close the knowledge gap on PMBR in patients seeking delayed breast reconstruction or prophylactic mastectomy with immediate breast reconstruction compared with routine education alone.

Effects of decision aids on breast reconstruction: A systematic review and meta‐analysis of randomised controlled trials

“…Six studies (Heller et al, 2008; Lam et al, 2013; Manne et al, 2015; Varelas et al, 2020; Wang et al, 2020; Zhong et al, 2021) assessed women's anxiety after the intervention. These studies had a high level of heterogeneity ( I 2 = 71%, p = .008); thus, a random‐effects model was chosen.…”

“…The characteristics of the twelve studies were summarised in Table 1. All the included studies were published between 2008 and 2021: six studies (Heller et al, 2008; Klifto et al, 2021; Luan et al, 2016; Manne et al, 2015; Politi et al, 2020; Varelas et al, 2020) were conducted in America, two (Causarano et al, 2015; Zhong et al, 2021) in Canada and two (Sherman et al, 2016, 2017) in Australian and two (Lam et al, 2013; Wang et al, 2020) in China. There were a total of 1204 participants, sample size varied from 16 (Luan et al, 2016) to 276 (Lam et al, 2013).…”

“…A random-effects model was used because these studies showed a high level of heterogeneity (I 2 = 97%, p < .0001). The meta-analysis of five studies (Manne et al, 2015;Sherman et al, 2016Sherman et al, , 2017Varelas et al, 2020;Zhong et al, 2021) showed that there was a significant difference in satisfaction (SMD, 0.94; 95% CI −0.08 to1.96; p = .07; Figure 6a). The results of another three studies that reported satisfaction showed that most women were satisfied with the content of DAs and using DAs increased their decision satisfaction.…”

“…We identified five formats of DAs: four studies used brochure (Klifto et al, 2021;Lam et al, 2013;Luan et al, 2016;Wang et al, 2020), four used a menu-driven modular format (Heller et al, 2008;Politi et al, 2020;Sherman et al, 2016Sherman et al, , 2017, two used pre-consultation educational group (Causarano et al, 2015;Zhong et al, 2021), one used a virtual form (Varelas et al, 2020) and one was Web-based (Manne et al, 2015). Except for one study (Varelas et al, 2020) that did not explain how the DA design process was conducted, the other studies detailed the DAs design process, which analysed the needs and recommendations of breast cancer patients regarding BR.…”

“…Except for one study (Varelas et al, 2020) that did not explain how the DA design process was conducted, the other studies detailed the DAs design process, which analysed the needs and recommendations of breast cancer patients regarding BR. Some authors reported using International Patient Decision Aids Standards (IPDAS) criteria when developing DAs (Lam et al, 2013;Politi et al, 2020;Sherman et al, 2016Sherman et al, , 2017 and some DAs were developed using an Ottawa Decision Support Framework (ODSF) (Causarano et al, 2015;Wang et al, 2020;Zhong et al, 2021). Meanwhile, other studies did not use the IPDAS or ODSF (Heller et al, 2008;Luan et al, 2016;Manne et al, 2015;Varelas et al, 2020), which are developed based on clinical guidelines or recommendations from a multidisciplinary team that includes doctors, nurses and patients except for one study (Varelas et al, 2020) that did not explain how it was developed.…”