title: Patient involvement in the decision-making process improves satisfaction and quality of life in postmastectomy breast reconstruction.
abstract: BACKGROUND
  The patient-physician relationship has evolved from the paternalistic, physician-dominant model to the shared-decision-making and informed-consumerist model. The level of patient involvement in this decision-making process can potentially influence patient satisfaction and quality of life. In this study, patient-physician decision models are evaluated in patients undergoing postmastectomy breast reconstruction.
  
  
  METHODS
  All women who underwent breast reconstruction at an academic hospital from 1999-2007 were identified. Patients meeting inclusion criteria were mailed questionnaires at a minimum of 1 y postoperatively with questions about decision making, satisfaction, and quality of life.
  
  
  RESULTS
  There were 707 women eligible for our study and 465 completed surveys (68% response rate). Patients were divided into one of three groups: paternalistic (n = 18), informed-consumerist (n = 307), shared (n = 140). There were differences in overall general satisfaction (P = 0.034), specifically comparing the informed group to the paternalistic group (66.7% versus 38.9%, P = 0.020) and the shared to the paternalistic group (69.3% versus 38.9%, P = 0.016). There were no differences in aesthetic satisfaction. There were differences found in the SF-12 physical component summary score across all groups (P = 0.033), and a difference was found between the informed and paternalistic groups (P < 0.05). There were no differences in the mental component score (P = 0.42).
  
  
  CONCLUSIONS
  Women undergoing breast reconstruction predominantly used the informed model of decision making. Patients who adopted a more active role, whether using an informed or shared approach, had higher general patient satisfaction and physical component summary scores compared with patients whose decision making was paternalistic.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
authors.forename: Azra A
authors.initials: AA
authors.lastname: Ashraf
authors.forename: Salih
authors.initials: S
authors.lastname: Colakoglu
authors.forename: John T
authors.initials: JT
authors.lastname: Nguyen
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Anastasopulos
authors.forename: Ahmed M S
authors.initials: AM
authors.lastname: Ibrahim
authors.forename: Janet H
authors.initials: JH
authors.lastname: Yueh
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Lin
authors.forename: Adam M
authors.initials: AM
authors.lastname: Tobias
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology* / Q000534:rehabilitation / Q000601:surgery; D003625:Data Collection; D003657:Decision Making; D005260:Female; D006304:Health Status; D006801:Humans; D016462:Mammaplasty / Q000523:psychology* / Q000534:rehabilitation; D008408:Mastectomy / Q000523:psychology* / Q000534:rehabilitation; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011788:Quality of Life
keywords: Breast cancer; Breast reconstruction; Mastectomy; Patient satisfaction; Quality of life; Shared decision making