Purpose: To assess the quality of breast cancer patients’ decisions about reconstruction by measuring their knowledge and the degree to which their treatment decisions reflect their goals.
Method: A convenience sample of breast cancer survivors who had undergone mastectomy in the past 3 years completed a mailed survey, as part of a larger study to validate decision quality instruments. The survey contained questions on important facts about reconstruction and questions about personal goals and concerns related to reconstruction. Characteristics associated with knowledge were identified using chi-squared analysis. Goals/concerns associated with reconstruction were identified using chi-squared analysis and multivariate logistic regression. A model for predicting receipt of reconstruction was developed, incorporating demographic and clinical variables, whether the provider mentioned reconstruction, and goals/concerns that were significant on bivariate analysis. Treatment was considered concordant with preferences if the model predicted probability was >0.50.
Result: The larger study recruited 456 patients, 91 of whom completed the reconstruction module (overall response rate 59%). Generally, patient knowledge was poor (mean=32.9, SD=19). 41% understood that reconstruction has little effect on surveillance. 54% understood that recovery after implant surgery is easier than after flap surgery. 3.3% knew that about 1/3 of patients have a major complication after surgery. Women who had reconstruction had higher knowledge compared to those who did not (43.3 vs. 32.6, p=0.053). Having a college degree (43.4 vs. 26.2, p<0.01) and being married (40.9 vs. 29, p=0.04) were also associated with higher knowledge. The following goals were associated with having reconstruction: “use your own tissue to make a breast” (OR 1.309, CI 1.028, 1.605), “avoid using a prosthesis” (OR 1.254, CI 1.039, 1.512), and “wake up after mastectomy with reconstruction underway” (OR 1.254, CI 1.057, 1.487). Patients who felt it was important to “avoid putting foreign material in your body” were less likely to have reconstruction (OR 0.682, CI 0.518, 0.899). The majority of patients (81%) had treatment that was concordant with preferences.
Conclusion: Women undergoing mastectomy for breast cancer have important knowledge deficits about reconstruction. Some women do not receive the treatment they would prefer. Providers should consider how patients feel about using their own tissue, having foreign material in the body, wearing a prosthesis, and beginning reconstruction at the time of mastectomy, in order to personalize care.
Candidate for the Lee B. Lusted Student Prize Competition