Decisional Aid Intervention for Women Considering Breast Reconstruction

描述（由申请人提供）：决定是否进行乳房重建（BR）可能具有挑战性。女性必须权衡手术潜在益处的重要性、她们的个人价值观和偏好与手术相关的风险，并决定她们应该进行哪种类型的重建。这个决定通常是在压力下做出的，这是在最初诊断出乳腺癌后立即做出的。更复杂的是，有证据表明，对BR的美容结果的满意度是不同的。结果可能与患者最初的预期不一致。BR可能是在压力环境下做出的一个困难的决定，女性可能不像她们所能了解的那样了解其长期影响。当患者面临个人价值观和生活质量问题所影响的治疗决定，并且有多种治疗选择时，决策辅助形式的决策支持可以帮助患者做出明智的选择。决策支持辅助是一种辅助执业医师咨询的策略，以帮助他们了解治疗方案，每种方案的优缺点，考虑他们对每种方案的利益和风险的个人重要性，并鼓励他们积极参与护理提供者决定采取哪种方案。我们建议为获得BR的妇女开发一个基于网络的DA。我们将分三个阶段实现这一目标。第一阶段是一个发展阶段，研究小组根据接受过BR治疗、曾接受BR治疗但决定不接受BR治疗或正在考虑BR治疗的患者的意见，制定基本的DA内容。我们将纳入少数民族妇女、65岁以上妇女和受教育程度较低的妇女的意见，她们较少获得BR。第二阶段包括收集关于数据挖掘原型的反馈条款，这些反馈来自经历过BR的女性、接受过BR但选择不做BR的女性以及正在考虑BR的女性。同样，少数民族妇女、65岁以上妇女和受教育程度较低妇女的反馈也将包括在内。BR决策援助（BRDA）将最终确定。第三阶段将以考虑BR的妇女为样本，对DA进行可用性和可行性试点测试。这项研究有一个主要目的和两个次要目的。主要目的是评估一种辅助决策的可用性和可行性，以帮助妇女作出接受BR的决定。次要目的是检验BRDA的可接受性，并提供BRDA对BR知识、价值观、决策冲突、准备、BR兴趣和焦虑的影响的初步数据。

DESCRIPTION (provided by applicant): The decision whether to pursue breast reconstruction (BR) can be challenging. Women must weigh the importance of potential benefits of the procedure and their personal values and preferences against the risks associated with the procedure and decide what type of reconstruction to have should they pursue it. The decision is typically made in a stressful circumstance, which is immediately after the initial diagnosis of breast cancer. Complicating matters is the fact that there is evidence to suggest that there are variable rates of satisfaction with the cosmetic outcomes of BR. Outcomes may not be in line with what the patient initially expected. BR can be a difficult decision made under stressful circumstances and women may not be as well- informed about the long-term effects as they could be. When patients are faced with treatment decisions for which personal values and quality of life issue play a role and there are multiple treatment choices, decision support in the form of decision aids can be helpful to the process of making a well-informed choice. Decision support aids are a strategy used as an adjunct to practitioners' counseling to facilitate their understanding of the treatment options, the advantages and disadvantages of each option, consideration of the personal importance they attach to the benefits and risks of each alternative, and to encourage active participation with the care provider in deciding which option to pursue. We propose to develop a web-based DA for women being offered BR. We will accomplish this in three phases. Phase 1 is a developmental phase where the basic DA content is developed by the study team with input from patients who have undergone BR, were offered BR and decided against it, or are considering BR. We will include input from minority women, women over 65 years of age, and less educated women, who have less access to BR. Phase 2 consists of gathering feedback terms on the DA prototype from women who have undergone BR, women who were offered BR and chose not to have it, and women who are considering BR. Again, feedback from minority women, women over 65 years of age, and less educated women will be included. The BR Decision Aid (BRDA) will then be finalized. Phase 3 will be a usability and feasibility pilot test of the DA with a sample of women considering BR. The study has one primary aim and two secondary aims. The primary aim is to evaluate the usability and feasibility of a decisional aid to assist women with making the decision to undergo BR. The secondary aims are to examine the acceptability of the BRDA and to provide preliminary data on the impact of BRDA on BR knowledge, values, decisional conflict, preparedness, BR interest, and anxiety.