Online tool supports decisions about breast reconstruction after mastectomy

For women with breast cancer undergoing mastectomy, an online decision aid can help in making informed decisions regarding immediate breast reconstruction (IBR), reports a randomized trial in the October issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS). The journal is published in the Lippincott portfolio by Wolters Kluwer.

“In our study, use of a patient decision aid helped women feel better prepared to discuss their options on whether or not to undergo IBR with the plastic surgeon,” comments Eveline M.A. Bleiker, Ph.D., of Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam.

For women with breast cancer undergoing mastectomy, breast reconstruction can improve psychosocial outcomes such as body image and sexual functioning. Among the complex decisions facing these patients is whether to undergo breast reconstruction immediately after mastectomy or at a later time, or not to have reconstruction. Rates of IBR have increased in recent years, although considerable variations remain.

Patient decision aids (pDAs) are tools to support the process of shared decision making between patients and doctors. Although pDAs have been shown to reduce decisional conflict for a range of treatment decisions, “there are limited interventions to support patient decision making about breast reconstruction available, particularly when the health care context is considered,” the researchers write.

Prof. Bleiker and colleagues evaluated a newly developed pDA to support informed decision-making about IBR. The study included 250 patients with breast cancer scheduled for mastectomy at eight Dutch centers. Patients were randomly assigned to receive the online pDA or a standard informational leaflet.

The pDA provided evidence-based information on breast reconstruction options and support in clarifying patients’ personal values affecting their treatment decision. On completing the pDA, patients received a summary sheet including their breast reconstruction preferences.

Women using pDA ‘feel better prepared for decision making’

The two groups were compared on measures of decisional conflict—uncertainty about choosing between competing options—and other aspects of the decision-making process. Nearly all patients assigned to the pDA used the online tool; just over half discussed their summary sheet with the plastic surgeon.

With either the pDA or informational leaflet, decisional conflict decreased over time. In both groups, about 13% of patients had clinically significant decisional conflict.

Women assigned to the decision aid “reported feeling better prepared for decision making than those in the control group,” the researchers write. Other assessments were similar between groups, including shared decision making and satisfaction with breast reconstruction information.

Knowledge increased in both groups, with no difference in decision regret. With either source of information, about 70% of women opted for IBR.

“Our findings indicate that both the online pDA and the information leaflet are helpful for breast cancer patient having to make a decision about IBR,” Dr. Bleiker and co-authors write.

They add, “The online format of the pDA more easily allows for adaptions required by future developments in breast reconstruction options and scientific evidence, and for the further tailoring of information to patients’ personal situation and information needs.”

Publication of the new study is timed to coincide with Breast Cancer Awareness Month and Breast Reconstruction Awareness Day. Celebrated October 16 this year, “BRA Day” is designed to educate women about post-cancer breast reconstruction options and outcomes—including the federal requirement for insurance coverage for breast reconstruction surgery.

BRA Day events worldwide bring attention to the varied options and procedures available plus give information to patients and their supporters so they can make informed decisions about their care.