Do patients and providers agree about the most important facts and goals for breast reconstruction decisions?

Decisions about breast reconstruction after mastectomy are some of the most difficult decisions a breast cancer patient makes. To make a good decision, the patient should have adequate knowledge of specific facts related to the decision, and the treatment chosen should be consistent with the patient's personal preferences or goals. We sought to identify the most important facts and goals for decisions about breast reconstruction after mastectomy, and to compare patients' and providers' perspectives. We conducted a cross-sectional survey of breast cancer survivors and providers. Participants rated and ranked the importance of facts and goals/concerns related to breast reconstruction after mastectomy. We compared patients' and providers' rankings using chi2 tests and compared ratings using t-tests. About 21 patients and 20 providers participated. Facts: Providers were more concerned about the impact of radiation on the success of the reconstruction than patients (60% vs. 24%, 95% CI of the difference: -64, -8). Thirty percent of providers placed the fact that women who do not have reconstruction are equally satisfied as women who have reconstruction in the top 3, whereas almost no patients did (30% vs. 5%, 95% CI: -47, -3). For all 3 of the facts about immediate versus delayed reconstruction, women placed a higher priority on these facts than providers did.

Patients placed greater importance on avoiding use of a prosthesis (33% vs. 0%, 95% CI of the difference: 13, 54). There was a trend toward less patient concern about "looking natural without clothes" compared to providers (24% vs. 40%, 95% CI of the difference: -12, 44). Significant variability exists among patients and between patients and providers, with respect to the most important facts and goals to guide decision making about reconstruction. Providers should ensure that women understand that reconstruction can be performed immediately or delayed, as well as the likelihood and type of complications. Surgeons should ask each woman which goals and concerns are most important to her. Specifically, they should inquire as to how women feel about using a prosthesis, and how they feel about their appearance with and without clothes.