title: A five year experience of measuring clinical effectiveness in a breast reconstruction service using the BREAST-Q patient reported outcomes measure: A cohort study.
abstract: OBJECTIVE
  To assess the clinical effectiveness of breast reconstruction and the utility of the BREAST-Q patient-reported outcomes measure for routine patient care.
  
  
  METHODS
  The BREAST-Q was administered to all patients attending a breast reconstructive service (n = 343) at a University Hospital at each visit.
  
  
  RESULTS
  The BREAST-Q was easy to administer in a clinic setting, with a high participation rate (64.2% completing the minimum dataset of three BREAST-Qs). Pre-operatively, women with invasive cancer scored lower than those with DCIS or high-risk status (eg. mean psychosocial well-being scores 51.45 vs 63.74 vs 65.56, p < 0.05). At six months post-mound reconstruction the mean values for immediate and delayed timing of reconstruction were similar, with the change in quality of life from pre-reconstruction to this time-point post-reconstruction being greater in the delayed group (eg. mean improvement in psychosocial well-being scores for immediate 8.90 vs delayed 19.87, p < 0.05). Women with autologous flaps had greater improvements than women with implant-based reconstruction (eg. mean increase in psychosocial well-being scores 20.29 vs 9.58, p < 0.05). Breast reconstruction was highly effective in terms of improving psychosocial (mean pre-op 55.44 vs post-op 71.47, p < 0.001), physical (mean pre-op 69.82 vs post-op 74.78, p < 0.001), and sexual well-being (mean pre-op 38.74 vs post-op 54.17, p < 0.001), as well as satisfaction with breasts (mean pre-op 44.99 vs post-op 64.92, p < 0.001), in this non-selected cohort of patients.
  
  
  CONCLUSIONS
  Breast reconstruction is highly effective in improving the well-being of women undergoing mastectomy. The BREAST-Q is well suited for clinical effectiveness research and easily incorporated into routine patient care.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Level 5, Flinders Medical Centre/Flinders University, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia. Electronic address: nicola.dean@sa.gov.au.
authors.forename: Nicola R
authors.initials: NR
authors.lastname: Dean
authors.affiliation: Department of Plastic and Reconstructive Surgery, Level 5, Flinders Medical Centre/Flinders University, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia.
authors.forename: Tamara
authors.initials: T
authors.lastname: Crittenden
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006785:Hospitals, University; D006801:Humans; D016462:Mammaplasty / Q000523:psychology*; D008408:Mastectomy / Q000523:psychology*; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction; D011788:Quality of Life; D012189:Retrospective Studies; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: BREAST-Q; Breast reconstruction; Clinical effectiveness research; Comparative effectiveness research; Patient-reported outcomes measures