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 by non-White women. Eliciting treatment preferences with adaptive choice-based conjoint (ACBC) analysis can improve understanding of what patients value. The authors aimed to determine what African American patients value when considering breast reconstruction options.

Methods: Cross-sectional ACBC analysis was performed for African American women considering breast reconstruction who were 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 operations (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 with implant reconstruction ( n = 154 [85%]). Those who preferred flap reconstruction cared most about additional operations (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 pervious surgical complications (OR, 0.32; P = 0.029), or prophylactic mastectomy (OR, 6.07; P = 0.19) were more likely to choose the implant profile.

Conclusions: African American patients place greatest value on minimizing complication risk and additional surgery when considering postmastectomy reconstruction. Future studies should assess how eliciting individual-level preferences can improve shared decision-making in surgery.