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Assessing the effectiveness of interventions to support patient decision making about breast reconstruction: A systematic review

Paraskeva, Nicole; Guest, Ella; Lewis-Smith, Helena; Harcourt, Diana


Diana Harcourt
Professor in Appearance & Health Psychology Research


© 2018 Elsevier Ltd Background: Decision making about breast reconstruction (BR) following a diagnosis of breast cancer, Ductal Carcinoma in Situ (DCIS), or to reduce future breast cancer risk, is difficult and complex. This paper systematically reviews interventions aiming to support patients facing the option of BR, and assesses their effectiveness in improving a range of patient outcomes. Methods: Ten databases were searched for articles published up to October 2017 that evaluated interventions to support patient decision making about BR within controlled trials. All included studies were assessed for methodological quality. Descriptive analyses of patient outcomes within included studies were performed. Results: The search yielded 3291 articles. Eight studies met the inclusion criteria resulting in the evaluation of seven distinct interventions (n = 1212). Six studies were assessed to be of weak methodological quality, with one of moderate and one of strong quality. Three out of five interventions demonstrated a reduction in decisional conflict (ds = 0.26–0.69) and two out of three interventions resulted in reductions in decisional regret (ds = 0.27–3.69) at various time points. Treatment choice was altered in two of five studies. There were no changes in patient-reported anxiety levels, whilst the impact on depression was mixed. In all studies which reported on it, improvements in patient satisfaction and involvement in decision making were found. Conclusions: Few interventions are currently available. Whilst some findings are encouraging, improvements on patient outcomes are mixed. Further research should focus on the development and evaluation of effective interventions.

Journal Article Type Review
Publication Date Aug 1, 2018
Journal Breast
Print ISSN 0960-9776
Electronic ISSN 1532-3080
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 40
Pages 97-105
APA6 Citation Paraskeva, N., Guest, E., Lewis-Smith, H., & Harcourt, D. (2018). Assessing the effectiveness of interventions to support patient decision making about breast reconstruction: A systematic review. Breast, 40, 97-105.
Keywords breast reconstruction, decision making, systematic review, interventions, effectiveness, outcome and process assessment, decision support techniques, patient participation
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