Regret associated with the decision for breast reconstruction: The association of negative body image, distress and surgery characteristics with decision regret

Abstract

This study investigated the influence of psychosocial and surgical factors on decision regret among 123 women diagnosed with breast cancer who had undergone immediate (58%) or delayed (42%) breast reconstruction following mastectomy. The majority of participants (52.8%, n = 65) experienced no decision regret, 27.6% experienced mild regret and 19.5% moderate to strong regret. Bivariate analyses indicated that decision regret was associated with negative body image and psychological distress - intrusion and avoidance. There were no differences in decision regret either with respect to methods or timing patterns of reconstructive surgery. Multinominal logistic regression analysis showed that, when controlling for mood state and time since last reconstructive procedure, increases in negative body image were associated with increased likelihood of experiencing decision regret. These findings highlight the need for optimal input from surgeons and therapists in order to promote realistic expectations regarding the outcome of breast reconstruction and to reduce the likelihood of women experiencing decision regret.

Decision Regret following Breast Reconstruction

“…Psychometric evaluation of the scale has shown high levels of internal consistency (Cronbach α = 0.86), and it has been previously validated in breast cancer and breast reconstruction patients. 11,30,31 …”

Exploratory and Confirmatory Factor Analysis of the Decision Regret Scale in Recipients of Internal Cardioverter Defibrillators

“…In comparison, there were no differences in the internal reliability consistency or discriminant validity of the DRS among men faced with a prostate treatment decision. Based on the initial validation study, several studies report the DRS as a reliable measure in oncology patients faced with treatment decisions and participation in clinical trials (Sheehan, Sherman, Lam, & Boyages, 2007a; Sheehan, Sherman, Lam, & Boyages, 2007b; Stryker, Wray, Emmons, Winer, & Demetri, 2006; Whalen, Shin, Somerville, & McLean, 2002).…”

Attitudes and Decisional Conflict Regarding Breast Reconstruction Among Breast Cancer Patients

“…27 Women who report body image concerns are more likely to experience decisional regret. 26 Other studies have reported no differences in perceived body image between women choosing BR and women who don’t choose BR, 28 or reported mixed psychological outcomes. These studies indicate no differences with regard to some psychological outcomes (e.g., anxiety), but significant differences on other psychological outcomes (e.g., lower depressive symptoms among women undergoing mastectomy without BR as compared to women undergoing mastectomy with BR.…”

“…17,24–25 About half of women undergoing BR report some decisional regret. 26 Women who have post-operative complications experience elevated anxiety, depression, and cancer-specific distress. 27 Women who report body image concerns are more likely to experience decisional regret.…”