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PEGASUS: the Design of an Intervention to Facilitate Shared Decision-making in Breast Reconstruction

Clarke, Alex; Paraskeva, N.; White, P.; Tollow, P.; Hansen, Esther; Harcourt, D.

Authors

Alex Clarke

Paul White Paul.White@uwe.ac.uk
Associate Professor in Applied Statistics

Dr Pippa Howard Pippa.Tollow@uwe.ac.uk
Research Fellow in Burns PROMS Research

Esther Hansen



Abstract

© 2020, The Author(s). Studies have found varying levels of satisfaction after breast reconstruction surgery with a substantial group of patients reporting some level of regret about their decision. The variable outcomes reported by women undergoing breast reconstruction surgery suggest a role for improved pre-operative communication and shared decision-making (SDM) between patient and health professional. Pragmatic approaches such as decision aids have been evaluated, but the aim of the Patient Expectations and Goals Assisting Shared Understanding of Surgery (PEGASUS) intervention is to facilitate closer interaction between the patient and clinical team. PEGASUS is a standardised two-stage process, in which patients’ goals are first elicited, ranked in importance and recorded before being used to frame discussion and decision-making with the surgeon managing care. Following the Medical Research Council (MRC) model, feasibility and acceptability studies have already been reported and a 4-year multicentre randomised controlled trial of 180 participants is underway, (completion 2020). This paper therefore focuses on the design of the intervention itself, in line with recent advice that interventions, in comparison with evaluations, commonly lack a theoretical base and are often under reported. We report a retrospective application of the Capability, Opportunity, Motivation-Behaviour (COM-B) model to provide explicit detail of each step in the intervention design. This is intended to facilitate replication by other clinicians and to provide systematic guidance for others wishing to develop PEGASUS as a strategy for implementing SDM in other clinical populations. Trial Registration: ISRCTN 18000391 (DOI 10.1186/ISRCTN18000391) 27/01/2016.

Journal Article Type Article
Publication Date Jan 1, 2020
Journal Journal of Cancer Education
Print ISSN 0885-8195
Electronic ISSN 1543-0154
Publisher Springer (part of Springer Nature)
Peer Reviewed Peer Reviewed
APA6 Citation Clarke, A., Paraskeva, N., White, P., Tollow, P., Hansen, E., & Harcourt, D. (2020). PEGASUS: the Design of an Intervention to Facilitate Shared Decision-making in Breast Reconstruction. Journal of Cancer Education, https://doi.org/10.1007/s13187-019-01656-6
DOI https://doi.org/10.1007/s13187-019-01656-6
Keywords PEGASUS, Behaviour change, COM-B, shared decision-making, breast reconstruction.

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http://creativecommons.org/licenses/by/4.0/

Copyright Statement
Open Access This article is licensed under a Creative Commons
Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.





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