title: The acceptability of PEGASUS: an intervention to facilitate shared decision-making with women contemplating breast reconstruction.
abstract: Good practice guidelines recommend that women who undergo mastectomy are offered reconstructive surgery. However, many who choose this option report a degree of decisional regret and dissatisfaction because their pre-surgical expectations were not met. This paper reports an acceptability study of a new intervention (PEGASUS) that aims to support shared decision-making by eliciting women's pre-surgical expectations and setting patient-centred goals. Eighteen women contemplating breast reconstruction completed the PEGASUS intervention. Semi-structured interviews were conducted with 12 women and 3 health professionals to explore their experiences of using PEGASUS. Interview transcripts were subjected to a thematic analysis, and a content analysis was conducted on 79 goals that the 18 women identified. Feedback was extremely positive--women found that completing PEGASUS alongside a discussion with a specially trained health professional helped them prepare for the surgical consultation and increased their trust in their surgeon. Staff reported that PEGASUS facilitated patient-centred discussions and informed the decisions made about potential surgery. This preliminary study suggests that this novel intervention is acceptable to patients and health professionals alike. Further work is needed to evaluate its efficacy and then its effectiveness with a larger sample of women, and its potential use with other patient groups.
authors.affiliation: a Centre for Appearance Research , University of the West of England , Bristol , UK.
authors.forename: Diana
authors.initials: D
authors.lastname: Harcourt
authors.affiliation: a Centre for Appearance Research , University of the West of England , Bristol , UK.
authors.forename: Catrin
authors.initials: C
authors.lastname: Griffiths
authors.affiliation: b Department of Plastic and Reconstructive Surgery , Royal Free Hospital , London , UK.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Baker
authors.affiliation: b Department of Plastic and Reconstructive Surgery , Royal Free Hospital , London , UK.
authors.forename: Esther
authors.initials: E
authors.lastname: Hansen
authors.affiliation: c Department of Engineering, Design and Mathematics , University of the West of England , Bristol , UK.
authors.forename: Paul
authors.initials: P
authors.lastname: White
authors.affiliation: b Department of Plastic and Reconstructive Surgery , Royal Free Hospital , London , UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Clarke
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000601:surgery; D003142:Communication; D003657:Decision Making; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000523:psychology*; D008408:Mastectomy; D008875:Middle Aged; D010358:Patient Participation / Q000379:methods*; D010817:Physician-Patient Relations; D036301:Qualitative Research; D012017:Referral and Consultation; D035502:Trust
keywords: PEGASUS; acceptability; breast reconstruction; intervention; shared decision-making