title: National study of the impact of patient information and involvement in decision-making on immediate breast reconstruction rates.
abstract: BACKGROUND
  Reconstructive alternatives should be discussed with women facing mastectomy for breast cancer. These include immediate and delayed reconstruction, which both have inherent advantages and disadvantages. Immediate reconstruction rates vary considerably in Swedish healthcare regions, and the aim of the study was to analyse reasons for this disparity.
  
  
  METHODS
  All women who underwent mastectomy for primary breast cancer in Sweden in 2013 were included. Tumour data were retrieved from the Swedish National Breast Cancer Registry and from questionnaires regarding patient information and involvement in preoperative decision-making sent to women who were still alive in 2015.
  
  
  RESULTS
  Of 2929 women who had undergone 2996 mastectomies, 2906 were still alive. The questionnaire response rate was 76·3 per cent. Immediate reconstruction rates varied regionally, between 3·0 and 26·4 per cent. Tumour characteristics impacted on reconstruction rates but did not explain regional differences. Patient participation in decision-making, availability of plastic surgery services and patient information, however, were independent predictors of immediate breast reconstruction, and varied significantly between regions. Even in younger patients with low-risk tumours, rates of patient information ranged between 34·3 and 83·3 per cent.
  
  
  CONCLUSIONS
  Significant regional differences in immediate reconstruction rates were not explained by differences in tumour characteristics, but by disparities in patient information, availability of plastic surgery services and involvement in decision-making.
authors.affiliation: Department of Emergency Medicine and Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Frisell
authors.affiliation: Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden.|Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Lagergren
authors.affiliation: Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden. Jana.De-Boniface@ki.se.|Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden. Jana.De-Boniface@ki.se.
authors.forename: J
authors.initials: J
authors.lastname: de Boniface
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology / Q000523:psychology / Q000601:surgery*; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000523:psychology / Q000706:statistics & numerical data*; D008408:Mastectomy / Q000523:psychology / Q000706:statistics & numerical data; D008875:Middle Aged; D010353:Patient Education as Topic; D010358:Patient Participation / Q000523:psychology*; D012042:Registries; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult