Decisional Aid Intervention for Women Considering Breast Reconstruction

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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. PUBLIC HEALTH RELEVANCE: 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. We propose to develop a web-based decision aid for women being offered BR, evaluate its usability, feasibility, and acceptability, and gather preliminary data on its impact of BR knowledge, values, decisional conflict, preparedness, BR interest, and anxiety.