Shared Decision-Making in Breast Reconstruction for Breast Cancer Patients: A Scoping Review

Abstract

For most breast cancer (BC) patients who have undergone a mastectomy, the decision whether to proceed with breast reconstruction (BR) is complicated and requires deliberation. Shared decision-making (SDM) helps to address those needs and promote informed value-based decisions. However, little is known about the SDM status for BR in BC patients. This scoping review describes: 1) basic characteristics of studies on BR SDM in BC patients; 2) factors influencing BR SDM in BC patients; 3) experience and perception of BR SDM in BC patients; and 4) outcome measures reported. This review was performed in accordance with the Arksey and O’Malley methodology. A total of 5 English and 4 Chinese databases were searched, as well as different sources from grey literature. The data extraction form was developed by referring to the objectives and the Ottawa Decision Support Framework (ODSF). Data was analyzed using thematic analysis, framework analysis and descriptive statistics, with findings presented in the tables and diagrams. A total of 1481 records were retrieved and 42 of these included after screening. In 21 (21/42, 50%) of the studies, patient decision aids (PDAs) were utilized, and in 17 (17/42, 40.48%) of the studies, the factors influencing the implementation of SDM were explored. Of these 17 studies, the factors influencing the implementation of SDM were categorized into the following: the patient level (17/17, 100%), the healthcare level (2/17, 11.76%) and the organizational and system level (7/17, 41.18%). A total of 8 (19.05%) of the 42 studies focused on patients’ experiences and perceptions of SDM, and all studies used qualitative research methods. Of these 8 studies, a total of 7 (7/8, 87.50%) focused on patients’ experiences of SDM participation, and 4 (4/8, 50.00%) focused on patients’ perceptions of SDM. A total of 24 studies (24/42, 57.14%) involved quantitative outcome measures, where 49 items were divided into three classifications according to the outcomes of ODSF: the quality of the decision (17/24, 70.83%), the quality of the decision-making process (20/24, 83.33%), and impact (13/24, 54.17%). Although researchers have paid less attention to other research points in the field of SDM, compared to the design and application of SDM interventional tools, the research team still presents some equally noteworthy points through scoping review. For instance, the various factors influencing BC patients’ participation in SDM for BR (especially at the healthcare provider level and at the organizational system level), patients’ experiences and perceptions. Systematic reviews (SRs) should be conducted to quantify the impact of these different factors on BR SDM. Implementation of scientific theories and methods can inform the exploration and integration of these factors.

Braxon®-assisted prepectoral breast reconstruction: A decade later

“…On the other hand, minimal postoperative pain, avoidance of animation deformity, and maintenance of pectoralis muscle functional integrity are among the most important reported benefits ( 47 , 48 , 50 , 85 ). Overall, a shared decision-making process, which must also seek low rates of postoperative complications and a natural esthetic outcome, increases patient satisfaction and postoperative quality of life ( 30 , 43 , 45 , 86 ).…”

Breast Reconstructive Options

“…The plan must be individualized to each patient based on these factors. Furthermore, the decision process of reconstructive procedure must entail a collaborative approach between the plastic surgeon and the affected patient [17]. More specifically, the reconstructive plastic surgeon presents the available options based on the above mentioned factors, while the patient states her desires to finally arrive at the optimal breast reconstructive plan.…”

Influence of Tamoxifen on Different Biological Pathways in Tumorigenesis and Transformation in Adipose-Derived Stem Cells, Mammary Cells and Mammary Carcinoma Cell Lines—An In Vitro Study

“…Due to the diversity of reconstructive options and the patient’s individual risk profile, a joint decision regarding the surgical procedure should be made after a detailed consultation [ 9 ]. In addition to surgical treatment options, neo-adjuvant or adjuvant radiation is of great importance for locoregional tumor control and the prevention of local recurrence [ 10 ].…”