Efficacy of a Decision Aid in Breast Cancer Patients Considering Immediate Reconstruction: Results of a Randomized Controlled Trial.

IF 3.2 2区医学 Q1 SURGERY Plastic and reconstructive surgery Pub Date : 2024-10-01 Epub Date: 2023-10-09 DOI:10.1097/PRS.0000000000011100

Jacqueline A Ter Stege, Leonie A E Woerdeman, Jacobien M Kieffer, Kerry A Sherman, Joost A Agelink van Rentergem, Frederieke H van Duijnhoven, Martine A van Huizum, Miranda A Gerritsma, Marianne Kuenen, Eveline M L Corten, Nikola A N Kimmings, Quinten P Q Ruhé, Irene S Krabbe-Timmerman, Martijne Van't Riet, Daniela E E Hahn, Arjen J Witkamp, Hester S A Oldenburg, Eveline M A Bleiker

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Abstract

Background: Breast cancer patients face complex decisions about immediate breast reconstruction (BR) after mastectomy. The authors evaluated the efficacy of an online decision aid in improving the decision-making process, decision quality, and health outcomes in breast cancer patients considering immediate BR.

Methods: In a multicenter, randomized, controlled trial, patients were allocated to either the intervention group, receiving care as usual with access to an online decision aid, or the control group, receiving care as usual with an information leaflet. The primary outcome was decisional conflict. Secondary outcomes assessed the process of decision-making (eg, preparation for decision-making, satisfaction with information), decision quality (decision regret, knowledge), and health outcomes (eg, satisfaction with BR outcomes, body image). Patients completed questionnaires at time (T) 0 (baseline); T1 (1 week after consultation with a plastic surgeon); and T2 (3 months) and T3 (12 months) after surgery.

Results: The authors included 250 patients. Decisional conflict decreased over time in both groups, with no between-group differences. Intervention participants felt better prepared for decision-making than controls ( P = 0.002). At T2, 87% of intervention participants were very satisfied with the information about BR, compared with 73% of control participants ( P = 0.011). No significant between-group differences were observed in any other outcome.

Conclusions: The authors' online decision aid was as effective in reducing decisional conflict as an information leaflet about immediate BR after mastectomy. However, the decision aid substantially improved the decision-making process by better preparing breast cancer patients for decisions about immediate BR.

Clinical question/level of evidence: Therapeutic, II.

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决策辅助对考虑立即重建的癌症患者的疗效：一项随机对照试验的结果。

目的：癌症患者在乳房切除术后面临着关于立即乳房重建（BR）的复杂决定。我们评估了在线决策辅助在改善考虑即时BR的癌症患者的决策过程、决策质量和健康结果方面的功效。方法：在一项多中心随机对照试验中，患者被分配到接受护理即服务（CAU）的干预组，或对照组接受带有信息传单的CAU。主要结果是决策冲突。次要结果评估了决策过程（如决策准备、对信息的满意度）、决策质量（决策后悔、知识）和健康结果（如对BR结果的满意度、身体形象）。患者在基线（T0）、咨询整形外科医生后1周（T1）、术后3个月（T2）和术后12个月（T3）完成问卷调查。结果：我们纳入了250名患者。两组的决策冲突随着时间的推移而减少，组间没有差异。与对照组相比，干预组参与者感觉自己为决策做好了更好的准备（P=0.002）。在T2，87%的干预组参与者对BR的信息感到（非常）满意，而对照组参与者的这一比例为73%（P=0.011）。在任何其他结果上，组间均未观察到显著差异。结论：我们的在线决策辅助在减少决策冲突方面与乳房切除术后立即BR的信息传单一样有效。然而，决策辅助通过更好地为癌症患者做出关于立即BR的决策做好准备，大大改进了决策过程。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Plastic and reconstructive surgery 医学-外科

CiteScore

5.00

自引率

13.90%

发文量

1436

审稿时长

1.5 months

期刊介绍： For more than 70 years Plastic and Reconstructive Surgery® has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. Plastic and Reconstructive Surgery® , the official journal of the American Society of Plastic Surgeons, is a benefit of Society membership, and is also available on a subscription basis. Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, cosmetic surgery, as well as news on medicolegal issues. The cosmetic section provides expanded coverage on new procedures and techniques and offers more cosmetic-specific content than any other journal. All subscribers enjoy full access to the Journal''s website, which features broadcast quality videos of reconstructive and cosmetic procedures, podcasts, comprehensive article archives dating to 1946, and additional benefits offered by the newly-redesigned website.