To evaluate a web-based breast reconstruction
decision aid, BREASTChoice
Summary and Background Data:
Although postmastectomy breast reconstruction
can restore quality of life and body image, its morbidity remains substantial. Many patients lack adequate knowledge to make informed choices. Decisions are often discordant with patients’ preferences.
Adult women with stages 0–III breast cancer considering postmastectomy breast reconstruction
with no previous reconstruction were randomized to BREASTChoice
or enhanced usual care (EUC).
Three hundred seventy-six patients were screened; 120 of 172 (69.8%) eligible patients enrolled. Mean age = 50.7 years (range 25–77). Most were Non-Hispanic White (86.3%) and had a college degree (64.3%). Controlling for health literacy and provider seen, BREASTChoice
users had higher knowledge than those in EUC (84.6% vs. 58.2% questions correct; P
< 0.001). Those using BREASTChoice
were more likely to know that reconstruction typically requires more than 1 surgery, delayed reconstruction lowers one's risk, and implants may need replacement over time (all ps < 0.002). BREASTChoice
compared to EUC participants also felt more confident understanding reconstruction information (P
= 0.009). There were no differences between groups in decisional conflict, decision process quality, shared decision-making, quality of life, or preferences (all ps > 0.05). There were no differences in consultation length between BREASTChoice
and EUC groups (mean = 29.7 vs. 30.0 minutes; P
> 0.05). BREASTChoice
had high usability (mean score = 6.3/7). Participants completed BREASTChoice
in about 27 minutes.
can improve breast reconstruction
decision quality by improving patients’ knowledge and providing them with personalized risk estimates. More research is needed to facilitate point-of-care decision support and examine BREASTChoice's
impact on patients’ decisions over time.