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Helping Patients Make Choices about Breast Reconstruction: A Decision Analysis Approach

Sun, Clement S. M.S.; Cantor, Scott B. Ph.D.; Reece, Gregory P. M.D.; Fingeret, Michelle C. Ph.D.; Crosby, Melissa A. M.D.; Markey, Mia K. Ph.D.

Plastic and Reconstructive Surgery: October 2014 - Volume 134 - Issue 4 - p 597–608
doi: 10.1097/PRS.0000000000000514
Breast: Special Topic
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Summary: Decision analysis can help breast reconstruction patients and their surgeons to methodically evaluate clinical alternatives and make hard decisions. The purpose of this article is to help plastic surgeons guide patients in making decisions though a case study in breast reconstruction. By making good decisions, patient outcomes may be improved. This article aims to illustrate decision analysis techniques from the patient perspective, with an emphasis on her values and preferences. The authors introduce normative decision-making through a fictional breast reconstruction patient and systematically build the decision basis to help her make a good decision. The authors broadly identify alternatives of breast reconstruction, propose types of outcomes that the patient should consider, discuss sources of probabilistic information and outcome values, and demonstrate how to make a good decision. The concepts presented here may be extended to other shared decision-making problems in plastic and reconstructive surgery. In addition, the authors discuss how sensitivity analysis may test the robustness of the decision and how to evaluate the quality of decisions. The authors also present tools to help implement these concepts in practice. Finally, the authors examine limitations that hamper adoption of patient decision analysis in reconstructive surgery and health care in general. In particular, the authors emphasize the need for routine collection of quality-of-life information, out-of-pocket expense, and recovery time.

Supplemental Digital Content is available in the text.Video Discussion by Samuel J. Lin, M.D., is available online for this article.

Austin, Texas

From the Department of Biomedical Engineering, The University of Texas at Austin; and the Departments of Plastic Surgery, Behavioral Science, Health Services Research, and Imaging Physics, The University of Texas M. D. Anderson Cancer Center.

Received for publication December 15, 2013; accepted April 23, 2014.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s Web site (www.PRSJournal.com).

A Video Discussion by Samuel J. Lin, M.D., accompanies this article. Go to PRSJournal.com and click on “Video Discussions” in the “Videos” tab to watch.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Mia K. Markey, Ph.D., The University of Texas at Austin, 107 West Dean Keeton, Stop C0800, BME 3.314, Austin, Texas 78712-1801, mia.markey@utexas.edu

©2014American Society of Plastic Surgeons