title: A mixed-methods cohort study to determine perceived patient benefit in providing custom breast prostheses.
abstract: BACKGROUND
  Of all mastectomy patients, 90% will use an external prosthesis where the standard of care uses a stock prosthesis that is purchased "off the shelf." Our objectives were to determine patient demand for and perceived value of a custom breast prosthesis. The information obtained will influence future research and program direction.
  
  
  METHODS
  We asked 65 women who had undergone lumpectomy or mastectomy to participate before exploring rehabilitation options. The quantitative outcome measures were the European Organisation for Research and Treatment of Cancer QLQ-C30 general and -BR23 breast cancer-specific quality of life questionnaires, and the Ambulatory Oncology Patients Satisfaction Tool. The QLQ results were analyzed using the Mann-Whitney U-test. Results of the satisfaction tool were compared using the Fisher exact and chi-square tests. A descriptive qualitative approach-involving in-depth interviews exploring the experiences of the women-was used to establish the perceived value of the services to the patients. The analysis of the interview transcripts was conducted using a standardized content method to describe the experiences of the women.
  
  
  RESULTS
  All the women had had previous experiences with a conventional prosthesis, and they reported that wearing a custom prosthesis was more satisfying for them. They reported comfort and ease in wearing it, coupled with a sense of feeling less like a victim. Comparison of the QLQ and patient satisfaction scores showed no significant difference between the women wearing the conventional prosthesis and those wearing the custom prosthesis.
  
  
  CONCLUSIONS
  The qualitative data provide a strong case in support of the new device. Patient demand, perceived benefit, and experience wearing the prosthesis were documented. Suggestions for improvements in the device and in the program operations were gathered and will influence future development of this service.
authors.affiliation: Craniofacial Prosthetic Unit, Sunnybrook Odette Cancer Centre, Toronto, ON. todd.kubon@sunnybrook.ca
authors.forename: T M
authors.initials: TM
authors.lastname: Kubon
authors.forename: J
authors.initials: J
authors.lastname: McClennen
authors.forename: M I
authors.initials: MI
authors.lastname: Fitch
authors.forename: A
authors.initials: A
authors.lastname: McAndrew
authors.forename: J
authors.initials: J
authors.lastname: Anderson