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Stakeholders' Perspectives on Postmastectomy Breast Reconstruction: Recognizing Ways to Improve Shared Decision
Jessica M Hasak1, Terence M Myckatyn1, Victoria F Grabinski1
1Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo.; and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Mo.
Shared decision making (SDM) in postmastectomy breast reconstruction (PMBR) is crucial. Improving patient-clinician trust and information sharing can reduce decision regret and enhance patient-centered care.
Area of Science:
- Oncology
- Plastic Surgery
- Health Services Research
Background:
- Postmastectomy breast reconstruction (PMBR) is a complex decision made under stress.
- Shared decision making (SDM) can improve outcomes for preference-sensitive choices.
- Understanding stakeholder perspectives is key to supporting PMBR decisions.
Purpose of the Study:
- To explore stakeholder perspectives on supporting postmastectomy breast reconstruction decisions.
- To identify barriers and facilitators to shared decision making in PMBR.
- To inform interventions for improving patient-centered care in breast cancer reconstruction.
Main Methods:
- Conducted 40 semi-structured interviews with postmastectomy patients, surgeons, and nurses.
- Utilized an implementation research framework and grounded theory for theme identification.
- Recruited diverse participants across the United States.
Main Results:
- Variable engagement in SDM was observed.
- Patients desired more information on PMBR risks; some clinicians downplayed risks.
- Patients reported feeling pressured and perceived potential bias in information sharing.
Conclusions:
- Patient-clinician trust is vital for high-quality PMBR decisions.
- Lack of engagement in PMBR discussions led to decision regret.
- Interventions supporting SDM can enhance decision quality and patient-centered care.
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