title: How Informed Is the Decision About Breast Reconstruction After Mastectomy?: A Prospective, Cross-sectional Study.
abstract: OBJECTIVE
  To assess how informed patients are about breast reconstruction, and how involved they are in decision making.
  
  
  BACKGROUND
  Breast reconstruction is an important treatment option for patients undergoing mastectomy. Wide variations in who gets reconstruction, however, have led to concerns about decision making.
  
  
  METHODS
  We conducted a prospective cross-sectional study of patients planning mastectomy at a single site, over 20 months. Before surgery, patients completed a survey with validated scales to assess knowledge about breast reconstruction and involvement in decision making. Factors associated with knowledge were examined in a multivariable linear regression model.
  
  
  RESULTS
  A total of 145 patients enrolled (77% enrollment rate), and 126 remained eligible. The overall knowledge score was 58.5% (out of 100%). Knowledge about risk of complications was especially low at 14.3%. Knowledge did not differ by treatment (reconstruction or not). On multivariable analysis, non-white race was independently associated with lower knowledge. Most patients (92.1%) reported some discussion with a provider about reconstruction, and most (90.4%) reported being asked their preference. More patients reported discussing the advantages of reconstruction (57.9%) than the disadvantages (27.8%).
  
  
  CONCLUSIONS
  Women undergoing mastectomy in this sample were highly involved in decision making, but had major deficits in knowledge about the procedure. Knowledge about the risk of complications was particularly low. Providers seemed to have discussed the advantages of reconstruction more than its disadvantages.
authors.affiliation: *Department of Surgery, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC†Department of Health Policy and Management, School of Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC‡Lineberger Comprehensive Cancer Center, University of North Carolina Chapel Hill, Chapel Hill, NC§Department of Marketing, Fuqua School of Business, Duke University, Durham, NC¶Lineberger Comprehensive Cancer Center Biostatistics Core Facility, University of North Carolina Chapel Hill, Chapel Hill, NC||Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA**Department of Medicine, Massachusetts General Hospital, Boston, MA††Department of Medicine, Harvard Medical School, Boston, MA‡‡Department of Medicine, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC.
authors.forename: Clara Nan-Hi
authors.initials: CN
authors.lastname: Lee
authors.forename: Peter Anthony
authors.initials: PA
authors.lastname: Ubel
authors.forename: Allison M
authors.initials: AM
authors.lastname: Deal
authors.forename: Lillian Burdick
authors.initials: LB
authors.lastname: Blizard
authors.forename: Karen R
authors.initials: KR
authors.lastname: Sepucha
authors.forename: David W
authors.initials: DW
authors.lastname: Ollila
authors.forename: Michael Patrick
authors.initials: MP
authors.lastname: Pignone
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016462:Mammaplasty / Q000523:psychology*; D008408:Mastectomy; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome