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How Informed Is the Decision About Breast Reconstruction After Mastectomy?: A Prospective, Cross-sectional Study

Lee, Clara Nan-hi MD, MPP; Ubel, Peter Anthony MD; Deal, Allison M. MS; Blizard, Lillian Burdick BA; Sepucha, Karen R. PhD; Ollila, David W. MD; Pignone, Michael Patrick

doi: 10.1097/SLA.0000000000001561
ORIGINAL ARTICLES
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Objective: To assess how informed patients are about breast reconstruction, and how involved they are in decision making.

Summary Background Data: Breast reconstruction is an important treatment option for patients undergoing mastectomy. Wide variations in who gets reconstruction, however, have led to concerns about decision making.

Methods: We conducted a prospective cross-sectional study of patients planning mastectomy at a single site, over 20 months. Before surgery, patients completed a survey with validated scales to assess knowledge about breast reconstruction and involvement in decision making. Factors associated with knowledge were examined in a multivariable linear regression model.

Results: A total of 145 patients enrolled (77% enrollment rate), and 126 remained eligible. The overall knowledge score was 58.5% (out of 100%). Knowledge about risk of complications was especially low at 14.3%. Knowledge did not differ by treatment (reconstruction or not). On multivariable analysis, non-white race was independently associated with lower knowledge. Most patients (92.1%) reported some discussion with a provider about reconstruction, and most (90.4%) reported being asked their preference. More patients reported discussing the advantages of reconstruction (57.9%) than the disadvantages (27.8%).

Conclusions: Women undergoing mastectomy in this sample were highly involved in decision making, but had major deficits in knowledge about the procedure. Knowledge about the risk of complications was particularly low. Providers seemed to have discussed the advantages of reconstruction more than its disadvantages.

*Department of Surgery, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC

Department of Health Policy and Management, School of Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC

Lineberger Comprehensive Cancer Center, University of North Carolina Chapel Hill, Chapel Hill, NC

§Department of Marketing, Fuqua School of Business, Duke University, Durham, NC

Lineberger Comprehensive Cancer Center Biostatistics Core Facility, University of North Carolina Chapel Hill, Chapel Hill, NC

||Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA

**Department of Medicine, Massachusetts General Hospital, Boston, MA

††Department of Medicine, Harvard Medical School, Boston, MA

‡‡Department of Medicine, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC.

Reprints: Clara Nan-hi Lee, MD, MPP, UNC Plastic Surgery, CB 7195, Chapel Hill, NC 27599-7195. E-mail: cnlee@med.unc.edu.

National Institutes of Health 1K07CA154850-01A1 Cancer Prevention, Control, Behavioral, and Population Sciences Career Development Award (National Cancer Institute); Lineberger Comprehensive Cancer Center Population Sciences Cancer Research Award; North Carolina Translational and Clinical Sciences Institute Pilot Award.

Disclosure: The authors declare no conflict of interests.

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