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Attitudes and Decisional Conflict Regarding Breast Reconstruction Among Breast Cancer Patients

Manne, Sharon L. PhD; Topham, Neal MD; Kirstein, Laurie MD; Virtue, Shannon Myers PsyD; Brill, Kristin MD; Devine, Katie A. PhD, MPH; Gajda, Tina MA; Frederick, Sara MS; Darabos, Katie MS; Sorice, Kristen MS

doi: 10.1097/NCC.0000000000000320
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Background: The decision to undergo breast reconstruction (BR) surgery after mastectomy is made during stressful circumstances. Many women do not feel well prepared to make this decision.

Objective: Using the Ottawa Decision Support Framework, this study aims to describe women’s reasons to choose or not choose BR, BR knowledge, decisional preparedness, and decisional conflict about BR. Possible demographic, medical, BR knowledge, and attitudinal correlates of decisional conflict about BR were also evaluated.

Methods: Participants were 55 women with early-stage breast cancer drawn from the baseline data of a pilot randomized trial evaluating the efficacy of a BR decision support aid for breast cancer patients considering BR.

Results: The most highly ranked reasons to choose BR were the desire for breasts to be equal in size, the desire to wake up from surgery with a breast in place, and perceived bother of a scar with no breast. The most highly ranked reasons not to choose BR were related to the surgical risks and complications. Regression analyses indicated that decisional conflict was associated with higher number of reasons not to choose BR and lower levels of decisional preparedness.

Conclusions: The results suggest that breast cancer patients considering BR may benefit from decisional support.

Implications for Clinical Practice: Healthcare professionals may facilitate decision making by focusing on reasons for each patient’s uncertainty and unaddressed concerns. All patients, even those who have consulted with a plastic surgeon and remain uncertain about their decision, may benefit from decision support from a health professional.

Author Affiliations: Section of Population Science, Department of Medicine, Robert Wood Johnson Medical School, Rutgers, the Cancer Institute of New Jersey, New Brunswick (Drs Manne, Kirstein, Myers Virtue, and Devine and Mss Gajda, Frederick, and Darabos); Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania (Dr Topham); MD Anderson Cancer Center at Cooper Health Systems, Voorhees Township, New Jersey (Dr Brill); and Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania (Ms Sorice).

This work was supported by an R21 grant awarded to Sharon L. Manne (CA149531).

The authors have no conflicts of interest to disclose.

Correspondence: Sharon Manne, PhD, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903 (sharon.manne@rutgers.edu).

Accepted for publication September 15, 2015.

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