Breast cancer is the most common non-cutaneous cancer among women in the United States. For women undergoing mastectomy for breast cancer, breast reconstruction may improve quality of life, body image, satisfaction with appearance and physical, psychosocial and sexual well-being. However, the risk of a major complication following mastectomy with breast reconstruction is approximately 23%, exceeding that of most elective procedures. Patient and procedure characteristics predispose patients to reconstruction complications, yet many patients and surgeons lack adequate knowledge of risk information to make informed decisions. Decisions about whether to have reconstruction, when to have it, and what type of reconstruction are often discordant with patients' personal preferences about risk, appearance, recovery, and number of surgeries. There are currently no reliable methods for integrating patient-specific information into the clinician-patient encounter to personalize these decisions. Incomplete or insufficient information could lead to unexpected complications, additional operations, and decision regret. Finally, there are documented disparities in receipt of reconstruction that are not clearly linked to patients' preferences. The long-term objective of this research is to improve the quality of care for patients considering breast reconstruction. The specific objectives of this proposal are to refine a clinical decision support (CDS) tool, BREASTChoice, and test its effectiveness. The central hypothesis is that a workflow-aware CDS tool that incorporates risk prediction at the point-of-care is more effective than a control website, at improving the quality of reconstruction decisions (i.e., informed and preference-concordant choices). We will accomplish our objectives by pursuing the following aims:
Aim 1 : Elicit key stakeholder input to evaluate the implementation potential of the BREASTChoice CDS tool;
Aim 2 : Modify BREASTChoice based on stakeholder input and usability testing and prepare it for implementation into routine care;
Aim 3 : Evaluate the effects of BREASTChoice on decision quality, decisional conflict, and treatment choice in a multi-site randomized trial in a diverse population. This proposal will address the ?5 Rights? framework of delivering the right information, to the right person(s), using the right format, in the right channel, and at the right time during workflow, for breast reconstruction after mastectomy.

Public Health Relevance

Deciding whether or not to have breast reconstruction after mastectomy, when to have reconstruction, and which type of reconstruction to have is highly challenging for patients with breast cancer. In this proposal, we aim to adapt and test a decision support tool that integrates clinical risk information with patient preferences to enable clinicians and patients to make high quality breast reconstruction decisions. This research will promote personalized cancer care and enhance patient-centered communication for patients with breast cancer considering breast reconstruction after mastectomy.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
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Healthcare Information Technology Research (HITR)
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Gamache, Roland
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Washington University
Schools of Medicine
Saint Louis
United States
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