title: Are patients making high-quality decisions about breast reconstruction after mastectomy? [outcomes article].
abstract: BACKGROUND
  Variation in rates of breast reconstruction after mastectomy has raised concerns about the quality of decisions about reconstruction. The authors sought to evaluate patient decision making about reconstruction, using a validated measure of knowledge and preferences related to reconstruction.
  
  
  METHODS
  A cross-sectional survey of early-stage breast cancer survivors from four university medical centers was conducted. The survey included measures of knowledge about specific reconstruction facts, personal goals and concerns, and involvement in decision making. A multivariable linear regression model of characteristics associated with knowledge and a logistic regression model of factors associated with having reconstruction were developed.
  
  
  RESULTS
  A total of 84 patients participated (59 percent response rate). Participants answered 37.9 percent of knowledge questions correctly. Higher education (beta, 15 percent; p = 0.003) and having reconstruction (beta, 21 percent; p < 0.0001) were associated with higher knowledge. The goals "use your own tissue to make a breast" (odds ratio, 1.53; 95 percent CI, 1.15, 2.05) and "wake up after mastectomy with reconstruction underway" (odds ratio, 1.66; 95 percent CI, 1.30, 2.12) were associated with reconstruction. The goal "avoid putting foreign material in your body" was associated with no reconstruction (odds ratio, 0.64; 95 percent CI, 0.48, 0.86). Most patients reported they mainly made the decision or made the decision with the doctor equally (93 percent; 95 percent CI, 85 to 97 percent) and that their degree of involvement was about right (85 percent; 95 percent CI, 75 to 91 percent).
  
  
  CONCLUSIONS
  Women treated with mastectomy in this study were not well-informed about breast reconstruction. Treatments were associated with patients' goals and concerns, however, and patients were highly involved in their decisions. Knowledge deficits suggest that breast cancer patients would benefit from interventions to support their decision making.
authors.affiliation: Chapel Hill, N.C.; San Francisco, Calif.; and Boston, Mass. From the Division of Plastic and Reconstructive Surgery, Lineberger Comprehensive Cancer Center, Sheps Center for Health Services Research, University of North Carolina; Institute for Health Policy Studies, University of California, San Francisco; and Health Decision Research and the Department of General Medicine, Massachusetts General Hospital, Massachusetts General Hospital Cancer Center, and Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School.
authors.forename: Clara N
authors.initials: CN
authors.lastname: Lee
authors.forename: Jeff
authors.initials: J
authors.lastname: Belkora
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Beverly
authors.initials: B
authors.lastname: Moy
authors.forename: Ann
authors.initials: A
authors.lastname: Partridge
authors.forename: Karen
authors.initials: K
authors.lastname: Sepucha
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006040:Goals; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D016462:Mammaplasty / Q000379:methods / Q000523:psychology*; D008408:Mastectomy; D008875:Middle Aged; D010361:Patients / Q000523:psychology*