title: Shared decision-making: applying a person-centered approach to tailored breast reconstruction information provides high satisfaction across a variety of breast reconstruction options.
abstract: BACKGROUND
  A person-centered approach to co-decision-making using tailored information respects each woman's preferences and may heighten breast reconstruction satisfaction.
  
  
  METHODS
  Women seeking breast reconstruction underwent initial and follow-up consultations wherein suitable options were discussed, and take-away material, balanced website links, and access to a nurse specialist and peer volunteers was provided. After reconstruction, the BRECON-31(©) was administered and analyzed in three groups: autologous, alloplastic, and latissimus dorsi (LD)/implant. BRECON-31(©) subscale scores were compared between the groups, and multiple regression used to determine if the type of reconstruction independently predicted satisfaction.
  
  
  RESULTS
  One hundred twenty three of 176 (70%) women completed the questionnaire (43% autologous, 47% alloplastic, and 10% LD/implant reconstructions). The LD/implant group had a low rate of immediate reconstruction (8.3%, P = 0.04), and the highest rate of chemotherapy (91.7%, P = 0.002) and radiation (100%, P = 0.003). The alloplastic group had a high rate of bilateral reconstruction (86.8%, P = 0.01). All groups scored well on the self-image, arm concerns, intimacy, satisfaction, and expectations subscales. All groups scored moderately on the self-consciousness, appearance, and nipple subscales. The autologous group scored the lowest on recovery (51 vs. 68 and 65, P < 0.0001) and only moderately well on the abdomen subscale (67). Multiple regression analysis showed that satisfaction was not driven by type of reconstruction (P > 0.05).
  
  
  CONCLUSIONS
  High satisfaction can be achieved using a person-centered approach by providing detailed information, appreciating each woman's unique features, and tailoring the reconstruction plan to the individual. Recovery remains a particular challenge, especially for women undergoing autologous reconstruction.
authors.affiliation: Sections of Plastic Surgery and Surgical Oncology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Claire
authors.initials: C
authors.lastname: Temple-Oberle
authors.forename: Omodole
authors.initials: O
authors.lastname: Ayeni
authors.forename: Carmen
authors.initials: C
authors.lastname: Webb
authors.forename: Margo
authors.initials: M
authors.lastname: Bettger-Hahn
authors.forename: Olubukunola
authors.initials: O
authors.lastname: Ayeni
authors.forename: Nadia
authors.initials: N
authors.lastname: Mychailyshyn
mesh_terms: D018427:Breast Implants; D001943:Breast Neoplasms / Q000523:psychology / Q000601:surgery*; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction; D010549:Personal Satisfaction; D011379:Prognosis; D012649:Self Concept; D011795:Surveys and Questionnaires
keywords: breast; cancer; person-centered care; satisfaction; types of reconstruction