Decisional conflict in
breast cancer patients considering immediate breast reconstruction
The Breast:
Published: December 09, 2020
by Jacqueline A. ter Stege, Hester S.A. Oldenburg, Leonie
A.E. Woerdeman, Arjen J. Witkamp, Jacobien M. Kieffer, Martine A. van Huizum,
Frederieke H. van Duijnhoven, Daniela E.E. Hahn, Miranda A. Gerritsma, Marianne
A. Kuenen, Nicola (A.N.) Kimmings, Quinten (P.Q.) Ruhé, Irene S.
Krabbe-Timmerman, Martijne van’t Riet, Eveline M.L. Corten, Kerry A. Sherman,
Eveline M.A. Bleiker
Highlights
•A majority of patients considering immediate breast
reconstruction experience decisional conflict.
•Patients without a strong preference for breast
reconstruction are more likely to experience decisional conflict.
•Patients with more anxiety are more likely to experience
decisional conflict.
Background
Breast cancer (BC) patients who are treated with mastectomy
are frequently offered immediate breast reconstruction. This study aimed to
assess decisional conflict in patients considering immediate breast
reconstruction, and to identify factors associated with clinically significant
decisional conflict (CSDC).
Methods
Baseline data of a multicenter randomized controlled trial
evaluating the impact of an online decision aid for BC patients considering
immediate breast reconstruction after mastectomy were analyzed. Participants
completed questionnaires assessing sociodemographic and clinical
characteristics, decisional conflict and other patient-reported outcomes
related to decision-making such as breast reconstruction preference, knowledge,
information resources used, preferred involvement in decision-making,
information coping style, and anxiety. Multivariable logistic regression
analysis was performed to identify factors associated with CSDC (score > 37.5
on decisional conflict).
Results
Of the 250 participants, 68% experienced CSDC. Patients with
a slight preference for breast reconstruction (odds ratio (OR) = 6.19, p
<.01), no preference for or against breast reconstruction (OR = 11.84, p
<.01), and a strong preference for no breast reconstruction (OR = 5.20, p
<.05) were more likely to experience CSDC than patients with a strong
preference for breast reconstruction. Furthermore, patients with more anxiety
were more likely to experience CSDC (OR = 1.03, p = .01).
Conclusion
A majority of BC patients who consider immediate breast
reconstruction after mastectomy experience clinically significant decisional
conflict. The findings emphasize the need for decision support, especially for
patients who do not have a strong preference for breast reconstruction.
