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A Randomized Controlled Trial Evaluating the BREASTChoice Tool for Personalized Decision Support About Breast Reconstruction After Mastectomy

Politi, Mary C. PhD*; Lee, Clara N. MD, MPP†,‡,§; Philpott-Streiff, Sydney E. MPH*; Foraker, Randi E. PhD, MA; Olsen, Margaret A. PhD, MPH*,||; Merrill, Corinne BSN, RN**; Tao, Yu MS*; Myckatyn, Terence M. MD**

doi: 10.1097/SLA.0000000000003444
Randomized Controlled Trial: PDF Only
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Objective: 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.

Methods: 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).

Results: 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.

Conclusions: BREASTChoice 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.

*Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri

Department of Plastic and Reconstructive Surgery, College of Medicine, The Ohio State University, Columbus, Ohio

Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio

§The James Comprehensive Cancer Center-Solove Research Institute, The Ohio State University, Columbus, Ohio

Division of General Medical Sciences, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri

||Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri

**Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.

mpoliti@wustl.edu.

This work was supported by Siteman Cancer Center through a Siteman Investment Program Pre-R01 Award, funded by the Cancer Frontier Fund through the foundation for Barnes-Jewish Hospital and Siteman Cancer Center, to Drs TMM and MCP. MCP has a research contract (2017–2019) from Merck & Co. on a topic unrelated to the content of this article. MAO has grant funding from Pfizer, Merck, and Sanofi Pasteur, and is a consultant for Pfizer on topics unrelated to the content of this article. TMM is a consultant for, received advisory board remuneration, and received investigator-initiated grant funding from Allergan Medical and RTI Surgical, on topics unrelated to the content of this article.

The authors report no additional conflicts of interest.

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