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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Integrating Shared Decision-Making Into Breast Cancer Postmastectomy Reconstruction: A Systematic Review of Evidence,
Marta Maes-Carballo1, Natalia de-la-Puente-Mota2, Laura Sampol-Ramírez2
1Department of General Surgery, Hospital Público de Verín, Ourense, Spain.
International Journal of Cancer
|May 8, 2026
Summary
Decision aids (DAs) for postmastectomy breast reconstruction improve patient knowledge and reduce decisional conflict. Further research is needed to optimize their implementation and tailor them to patient needs.
Area of Science:
- Oncology
- Medical Informatics
- Health Services Research
Background:
- Postmastectomy breast reconstruction (PMBR) involves complex decisions with significant patient impact.
- Shared decision-making (SDM) is crucial for aligning treatment choices with patient values.
- Decision aids (DAs) are tools designed to support informed decision-making.
Purpose of the Study:
- To systematically review evidence on the development, effectiveness, patient experience, and implementation of DAs for PMBR.
- To evaluate the role of pre-consultation educational interventions in supporting SDM for PMBR.
- To identify gaps and future research directions for PMBR DAs.
Main Methods:
- Systematic review following PRISMA guidelines with a preregistered protocol.
- Searched six electronic databases and gray literature up to November 2025.
- Categorized 32 eligible studies (16 RCTs, 10 observational, 6 qualitative/mixed-methods) using a five-domain framework.
- Assessed study quality using the QualSyst tool.
Main Results:
- DAs consistently improved patient knowledge (15%-30% increase) and reduced decisional conflict (20%-50% reduction).
- High acceptability of DAs across digital, paper, and multimedia formats.
- Effects on SDM behaviors and long-term outcomes were variable, influenced by workflow integration and clinician engagement.
- Implementation studies showed feasibility but highlighted the need for structured clinical integration.
- Qualitative data revealed informational gaps, expectation misalignment, and psychosocial factors affecting decision satisfaction.
Conclusions:
- PMBR DAs effectively enhance patient knowledge, reduce decisional conflict, and support value-concordant decision-making.
- Despite strong RCT evidence, optimizing DA implementation into routine workflows is essential.
- Further research should address psychosocial needs and equity to tailor interventions for diverse patient populations.
