DO PATIENTS MIS-PREDICT FUTURE WELL-BEING IN DECISIONS ABOUT BREAST RECONSTRUCTION AFTER MASTECTOMY?

Purpose:

Making a good decision about surgery requires a patient to predict how she will feel in the future, with or without the procedure. However, people often mis-predict how they will feel, tending to overestimate the impact of life events. We hypothesized that breast cancer patients undergoing mastectomy would overestimate the negative impact of mastectomy and the positive impact of reconstruction on well-being. We also hypothesized that prediction accuracy would be associated with satisfaction with decisions.

Method:

Adult women undergoing mastectomy for stage I-III breast cancer, DCIS, or prophylaxis were enrolled at a single site. Before surgery, participants were asked to predict their 12-month happiness, quality of life (QOL), body image, sexual attractiveness, physical sensations, and pain. 12 months after surgery, actual scores and satisfaction with decisions were measured. Prediction accuracy was calculated as the difference in predicted and actual 12 month scores, and compared between groups using t-tests. Associations of prediction accuracy with satisfaction with decisions were evaluated by linear regression.

 

Result:

131 patients completed the baseline survey (72% participation rate) and 111 completed the 12 month survey (88% participation rate). 15 patients were excluded due to delayed reconstruction, leaving 54 who had mastectomy-only and 42 who had mastectomy-with-reconstruction. Mastectomy-only patients generally predicted poorer outcomes than they actually experienced, and mastectomy-with-reconstruction patients generally predicted better outcomes than they actually experienced (Figure 1). Prediction accuracy differed by treatment for QOL (6.3 v -2.3, p=0.01), satisfaction with breast clothed (0.4 v -0.1, p=0.04) and unclothed (0.1 v -0.5, p=0.02), sexual attractiveness clothed (0.2 v -0.4, p=0.03) and unclothed (-0.3 v -1.0, p=0.01) (Table 1). Both groups predicted poorer outcomes after mastectomy-only than after mastectomy-with-reconstruction, with the mastectomy-with-reconstruction group predicting significantly larger differences, for all but the physical sensation and pain items. Prediction accuracy was not associated with satisfaction with decisions (all p≥0.10).

Conclusion:

Women undergoing mastectomy made mis-predictions about their future well-being after surgery. On average, they overestimated the negative impact of mastectomy and the positive impact of reconstruction. Prediction accuracy was not associated with decisional satisfaction.