Background: Measuring patient-reported outcomes has become increasingly important in cosmetic and reconstructive breast surgery. The objective of this study was to develop a new patient-reported outcome measure to assess the unique outcomes of breast surgery patients.
Methods: Patient interviews, focus groups, expert panels, and a literature review were used to develop a conceptual framework and a list of questionnaire items. Three procedure-specific questionnaires (augmentation, reduction, and reconstruction) were developed and cognitive debriefing interviews used to pilot each questionnaire. Revised questionnaires were field tested with 1950 women at five centers in the United States and Canada (response rate, 72 percent); 491 patients also completed a test-retest questionnaire. Rasch measurement methods were used to construct scales, and traditional psychometric analyses, following currently recommended procedures and criteria, were performed to allow for comparison with existing measures.
Results: The conceptual framework included six domains: satisfaction with breasts, overall outcome, and process of care, and psychosocial, physical, and sexual well-being. Independent scales were constructed for these domains. This new patient-reported outcome measure “system” (the BREAST-Q) contains three modules (augmentation, reconstruction, and reduction), each with a preoperative and postoperative version. Each scale fulfilled Rasch and traditional psychometric criteria (including person separation index 0.76 to 0.95; Cronbach’s alpha 0.81 to 0.96; and test-retest reproducibility 0.73 to 0.96).
Conclusions: The BREAST-Q can be used to study the impact and effectiveness of breast surgery from the patient’s perspective. By quantifying satisfaction and important aspects of health-related quality of life, the BREAST-Q has the potential to support advocacy, quality metrics, and an evidence-based approach to surgical practice.
New York, N.Y.; Hamilton and Vancouver, Canada; and London, United Kingdom
From the Memorial Sloan-Kettering Cancer Center, McMaster University, University of British Columbia, and University College London.
Received for publication November 24, 2008; accepted February 9, 2009.
Presented at the International Society for Quality of Life Research Meeting, in Toronto, Ontario, Canada, October of 2007, and at the American Society of Plastic Surgeons Annual Meeting, in Chicago, Illinois, October of 2008.
Disclosures: The BREAST-Q is jointly owned by Memorial Sloan-Kettering Cancer Center and the University of British Columbia. Drs. Pusic, Klassen, and Cano are codevelopers of the BREAST-Q and, as such, receive a share of any license revenues based on the inventor sharing policies of these two institutions.
Andrea L. Pusic, M.D., Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, Room MRI-1007, 1275 York Avenue, New York, N.Y. 10065, firstname.lastname@example.org