Preferences for Care Among African American Women Considering Postmastectomy Breast Reconstruction.

Abstract

Background: Approximately 20% of patients report inadequate discussions with their providers about reconstructive options, with an increased frequency reported in non-White women. Eliciting treatment preferences with adaptive choice-based conjoint (ACBC) analysis can improve our understanding of what patients' value. We aimed to determine what African American (AA) patients value when considering breast reconstruction options.

Methods: Cross-sectional ACBC with AA women considering breast reconstruction recruited through community partnerships and an academic medical center. Relative importance scores, part-worth utilities, and maximum-acceptable risks were calculated to assess preferences for attributes of flap versus implant reconstruction.

Results: Overall, 181 women, 101 from an academic center and 80 from the community were included. The most important attributes were risk of complications [mean (SD) relative importance (RI), 26% (12%)], additional surgeries [RI, 24% (14%)], and abdominal morbidity [RI, 22% (11%)]. Women were least concerned with appearance [RI, 15% (12%)] and recovery time [RI, 14%, (10%)]. Fewer women preferred a profile representing flap (n=27, 15%) compared to implant reconstruction (n=154, 85%). Those who preferred flap reconstruction cared most about additional surgeries [RI, 36% (15%)]; in contrast, those who preferred implant reconstruction cared most about complications [RI, 27% (12%)]. Participants with fewer comorbidities [OR, 0.84; p=0.012], no prior surgical complication (OR, 0.32; p=0.029), and prophylactic mastectomy (OR, 6.07; p=0.19) were more likely to choose the implant profile.

Conclusion: AA patients place greatest value on minimizing complication risk and additional surgeries when considering post-mastectomy reconstruction. Future studies should assess how eliciting individual-level preferences can improve shared decision-making in surgery.