Decisional conflict in breast cancer patients considering immediate breast reconstruction
Jacqueline A. ter Stege,
Hester S.A. Oldenburg,
Leonie A.E. Woerdeman,
Arjen J. Witkamp,
Jacobien M. Kieffer,
Martine A. van Huizum,
Frederieke H. van Duijnhoven,
Daniela E.E. Hahn,
Miranda A. Gerritsma,
Marianne A. Kuenen,
Nikola (A.N.) Kimmings,
Quinten (P.Q.) Ruhé,
Irene S. Krabbe-Timmerman,
Martijne van’t Riet,
Eveline M.L. Corten,
Kerry A. Sherman,
Eveline M.A. Bleiker
Affiliations
Jacqueline A. ter Stege
Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
Hester S.A. Oldenburg
Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
Leonie A.E. Woerdeman
Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
Arjen J. Witkamp
University Medical Center Utrecht, Utrecht, the Netherlands
Jacobien M. Kieffer
Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
Martine A. van Huizum
Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
Frederieke H. van Duijnhoven
Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
Daniela E.E. Hahn
Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
Miranda A. Gerritsma
Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
Marianne A. Kuenen
Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
Nikola (A.N.) Kimmings
Slotervaart Medical Center, Amsterdam, the Netherlands
Quinten (P.Q.) Ruhé
Meander Medical Center, Amersfoort, the Netherlands
Irene S. Krabbe-Timmerman
Medical Center Leeuwarden, Leeuwarden, the Netherlands
Martijne van’t Riet
Reinier de Graaf Gasthuis, Delft, the Netherlands
Eveline M.L. Corten
Erasmus Medical Center, Rotterdam, the Netherlands; Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
Kerry A. Sherman
Macquarie University, Sydney, Australia
Eveline M.A. Bleiker
Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Leiden University Medical Center, Leiden, the Netherlands; Corresponding author. Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
Background: Breast cancer (BC) patients who are treated with mastectomy are frequently offered immediate breast reconstruction. This study aimed to assess decisional conflict in patients considering immediate breast reconstruction, and to identify factors associated with clinically significant decisional conflict (CSDC). Methods: Baseline data of a multicenter randomized controlled trial evaluating the impact of an online decision aid for BC patients considering immediate breast reconstruction after mastectomy were analyzed. Participants completed questionnaires assessing sociodemographic and clinical characteristics, decisional conflict and other patient-reported outcomes related to decision-making such as breast reconstruction preference, knowledge, information resources used, preferred involvement in decision-making, information coping style, and anxiety. Multivariable logistic regression analysis was performed to identify factors associated with CSDC (score > 37.5 on decisional conflict). Results: Of the 250 participants, 68% experienced CSDC. Patients with a slight preference for breast reconstruction (odds ratio (OR) = 6.19, p < .01), with no preference for or against breast reconstruction (OR = 11.84, p < .01), and with a strong preference for no breast reconstruction (OR = 5.20, p < .05) were more likely to experience CSDC than patients with a strong preference for breast reconstruction. Furthermore, patients with more anxiety were more likely to experience CSDC (OR = 1.03, p = .01). Conclusion: A majority of BC patients who consider immediate breast reconstruction after mastectomy experience clinically significant decisional conflict. The findings emphasize the need for decision support, especially for patients who do not have a strong preference for breast reconstruction.
