Reducing Decisional Conflict and Enhancing Satisfaction with Information among Women Considering Breast Reconstruction following Mastectomy: Results from the BRECONDA Randomized Controlled Trial

Sherman, Kerry A.; Shaw, Laura Kate E.; Winch, Caleb J.; Harcourt, Diana; Boyages, John; Cameron, Linda D.; Brown, Paul; Lam, Thomas; Elder, Elisabeth; French, James; Spillane, Andrew

Abstract

Background: Deciding whether or not to have breast reconstruction following breast cancer diagnosis is a complex decision process. This randomized controlled trial assessed the impact of an online decision aid [Breast RECONstruction Decision Aid (BRECONDA)] on breast reconstruction decision-making.

Methods: Women (n = 222) diagnosed with breast cancer or ductal carcinoma in situ, and eligible for reconstruction following mastectomy, completed an online baseline questionnaire. They were then assigned randomly to receive either standard online information about breast reconstruction (control) or standard information plus access to BRECONDA (intervention). Participants then completed questionnaires at 1 and 6 months after randomization. The primary outcome was participants' decisional conflict 1 month after exposure to the intervention. Secondary outcomes included decisional conflict at 6 months, satisfaction with information at 1 and 6 months, and 6-month decisional regret.

Results: Linear mixed-model analyses revealed that 1-month decisional conflict was significantly lower in the intervention group (27.18) compared with the control group (35.5). This difference was also sustained at the 6-month follow-up. Intervention participants reported greater satisfaction with information at 1- and 6-month follow-up, and there was a nonsignificant trend for lower decisional regret in the intervention group at 6-month follow-up. Intervention participants' ratings for BRECONDA demonstrated high user acceptability and overall satisfaction.

Conclusions: Women who accessed BRECONDA benefited by experiencing significantly less decisional conflict and being more satisfied with information regarding the reconstruction decisional process than women receiving standard care alone. These findings support the efficacy of BRECONDA in helping women to arrive at their breast reconstruction decision.

• Presentation Conference Type: Conference Paper (published)
• Acceptance Date: Apr 15, 2016
• Online Publication Date: Oct 1, 2016
• Publication Date: Oct 1, 2016
• Deposit Date: May 4, 2016
• Publicly Available Date: Oct 1, 2017
• Journal: Plastic and Reconstructive Surgery
• Print ISSN: 0032-1052
• Electronic ISSN: 1529-4242
• Publisher: Lippincott, Williams & Wilkins
• Peer Reviewed: Peer Reviewed
• Volume: 138
• Issue: 4
• Pages: 592e-602e
• DOI: https://doi.org/10.1097/PRS.0000000000002538
• Keywords: mastectomy, breast reconstruction, BRECONDA, visible difference, body image
• Public URL: https://uwe-repository.worktribe.com/output/923199
• Publisher URL: http://dx.doi.org/10.1097/PRS.0000000000002538
• Additional Information: Additional Information : This is the accepted version of an article published in Plastic and Reconstructive Surgery. The final version can be found online at http://dx.doi.org/10.1097/PRS.0000000000002538
• Contract Date: May 4, 2016