Nicole Paraskeva Nicole.Paraskeva@uwe.ac.uk
Senior Research Fellow
A multi-centred sequential trial comparing PEGASUS, an intervention to promote shared decision making about breast reconstruction with usual care
Paraskeva, Nicole; Tollow, Philippa; Clarke, Alex; White, P.; Powell, Jane E; Cox, Danielle M; Harcourt, Diana M
Authors
Dr Pippa Howard Pippa.Tollow@uwe.ac.uk
Senior Research Fellow
Alex Clarke
Paul White Paul.White@uwe.ac.uk
Professor in Applied Statistics
Jane E Powell
Danielle M Cox
Diana M Harcourt
Contributors
Nicole Paraskeva Nicole.Paraskeva@uwe.ac.uk
Researcher
Abstract
Decision making about breast reconstruction (BR) is complex. The Patients’ Expectations and Goals: Assisting Shared Understanding of Surgery (PEGASUS) intervention aims to support shared decision making by helping women and clinicians clarify and discuss their expectations around reconstructive surgery. We conducted a multi-centred sequential trial comparing PEGASUS (n = 52) with usual care (UC) (n = 86) in women considering reconstruction, who completed outcome measures at baseline, and 3, 6 and 12 months post-surgery. The primary outcome was BR-specific quality of life (Breast-Q) 6 months post-intervention. Secondary outcomes were health-related quality of life (EQ-5D-5L), capabilities (ICECAP-A) and decisional regret, compared using t-tests and Cohen's d. Comparative analyses revealed no significant differences between groups in Breast-Q scores at any time point, except for a favourable effect for UC on psychological well-being at 3 months (t = -2.41, p = .019, d= -0.59). Intervention participants reported significantly higher, therefore improved, ICECAP-A (t = -2.13, p = .037, d = -0.45) and EQ VAS (t = -2.28, p = .026, d = -0.49) scores at 12 months compared to UC. Decisional regret was significantly lower in the PEGASUS group compared to the UC group at 6 months (t =2.06, p = .044, d= -0.51), but this was not sustained at 12 months. In conclusion, the PEGASUS intervention offers some benefits to women considering BR. At times, women experienced less decisional regret, improved health-related quality of life and capability well-being. Findings are discussed in the light of fidelity testing and embedding PEGASUS into practice.
Citation
Paraskeva, N., Tollow, P., Clarke, A., White, P., Powell, J. E., Cox, D. M., & Harcourt, D. M. (2022). A multi-centred sequential trial comparing PEGASUS, an intervention to promote shared decision making about breast reconstruction with usual care. Journal of Plastic, Reconstructive and Aesthetic Surgery, 75(4), 1342-1351. https://doi.org/10.1016/j.bjps.2021.11.033
Journal Article Type | Article |
---|---|
Acceptance Date | Nov 6, 2021 |
Online Publication Date | Nov 15, 2021 |
Publication Date | Apr 1, 2022 |
Deposit Date | May 4, 2022 |
Publicly Available Date | May 5, 2022 |
Journal | Journal of Plastic, Reconstructive and Aesthetic Surgery |
Print ISSN | 1748-6815 |
Electronic ISSN | 1878-0539 |
Publisher | Elsevier |
Peer Reviewed | Peer Reviewed |
Volume | 75 |
Issue | 4 |
Pages | 1342-1351 |
DOI | https://doi.org/10.1016/j.bjps.2021.11.033 |
Keywords | Breast reconstruction; shared decision making; intervention; patient expectations |
Public URL | https://uwe-repository.worktribe.com/output/9451362 |
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A multi-centred sequential trial comparing PEGASUS, an intervention to promote shared decision making about breast reconstruction, with usual care
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Publisher Licence URL
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