Findings suggest that tools designed to elicit patient values can improve communication and support African American women in choosing between implant-based and autologous reconstruction after mastectomy.
For African American patients undergoing mastectomy, the risk of complications and the postoperative appearance of the breast are key drivers of preferences about breast reconstruction, according to a study in the September issue of Plastic and Reconstructive Surgery. The research highlights the use of an interactive decision-support tool to better clarify patient values and improve shared decision-making.
The study team used a method called adaptive choice-based conjoint (ACBC) analysis to elicit treatment preferences from 181 African American women considering breast reconstruction. The ACBC tool presented patients with information on the expected outcomes and potential risks of both implant-based reconstruction and autologous reconstruction, which uses a patient’s own tissues. The survey included actual patient photos to help patients understand potential results, including scarring and the final appearance of the breast.
The results showed that the risk of major complications was the most important factor affecting patient preferences, with an average relative importance of 26%. The appearance of the reconstructed breast had a relative importance of 15%. After considering all factors, 85% of women expressed a preference for implant-based reconstruction.
Aiding Patient-Clinician Communication
Tools designed to elicit patient values can enhance shared decision-making, particularly when one treatment option is not clearly superior to others. The study notes that previous research indicates about 20% of patients report inadequate discussions concerning their breast reconstruction options, a rate that may be higher for non-White women.
“Especially in light of policies emphasizing shared decision-making between patients and physicians, our findings highlight the need for tools to elicit treatment preferences and the importance of discussing treatment goals and preferences,” says lead author Ronnie L Shammas, MD, MPH, of Memorial Sloan Kettering Cancer Center, in a release.
Two-thirds of women in the study found the ACBC exercise “very or extremely helpful” in their decision-making process. The researchers conclude that actively engaging patients and soliciting their values is critical, especially in historically marginalized groups who report lower rates of involvement in treatment decisions.
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