Decisional conflict in breast cancer patients considering immediate breast reconstruction. (February 2021)

• Record Type: Journal Article
• Authors: ter Stege, Jacqueline A.; Oldenburg, Hester S.A.; Woerdeman, Leonie A.E.; Witkamp, Arjen J.; Kieffer, Jacobien M.; van Huizum, Martine A.; van Duijnhoven, Frederieke H.; Hahn, Daniela E.E.; Gerritsma, Miranda A.; Kuenen, Marianne A.; Kimmings, Nikola (A.N.); Ruhé, Quinten (P.Q.); Krabbe-Timmerman, Irene S.; Riet, Martijne van't; Corten, Eveline M.L.; Sherman, Kerry A.; Bleiker, Eveline M.A.
• Is Part Of: Breast. Volume 55(2021)
• Page Start: 91
• Page End: 97
• Publication Date: 2021-02
• Subjects: Decisional conflict -- Immediate breast reconstruction -- Surgical preferences; Breast -- Diseases -- Periodicals; Breast -- Tumors -- Periodicals; Breast -- Periodicals; Electronic journals; Periodicals; 616
• DOI: 10.1016/j.breast.2020.12.001
• Languages: English
• ISSNs: 0960-9776

Abstract

Abstract: Background: Breast cancer (BC) patients who are treated with mastectomy are frequently offered immediate breast reconstruction. This study aimed to assess decisional conflict in patients considering immediate breast reconstruction, and to identify factors associated with clinically significant decisional conflict (CSDC). Methods: Baseline data of a multicenter randomized controlled trial evaluating the impact of an online decision aid for BC patients considering immediate breast reconstruction after mastectomy were analyzed. Participants completed questionnaires assessing sociodemographic and clinical characteristics, decisional conflict and other patient-reported outcomes related to decision-making such as breast reconstruction preference, knowledge, information resources used, preferred involvement in decision-making, information coping style, and anxiety. Multivariable logistic regression analysis was performed to identify factors associated with CSDC (score > 37.5 on decisional conflict). Results: Of the 250 participants, 68% experienced CSDC. Patients with a slight preference for breast reconstruction (odds ratio (OR) = 6.19, p < .01), with no preference for or against breast reconstruction (OR = 11.84, p < .01), and with a strong preference for no breast reconstruction (OR = 5.20, p < .05) were more likely to experience CSDC than patients with a strong preference for breast reconstruction. Furthermore, patients with more anxiety were more likely to experience CSDC (OR = 1.03, p = .01). Conclusion: A majority of BC patients who consider immediate breast reconstruction after mastectomy experience clinically significant decisional conflict. The findings emphasize the need for decision support, especially for patients who do not have a strong preference for breast reconstruction. Highlights: A majority of patients considering immediate breast reconstruction experience decisional conflict. Patients without a strong preference for breast reconstruction are more likely to experience decisional conflict. Patients with more anxiety are more likely to experience decisional conflict.