Ronnie Shammas, MD, Plastic Surgery Resident, Duke University Medical Center, Durham, North Carolina
Approximately 40% of breast reconstruction patients experience dissatisfaction due to inaccurate expectations of post-surgical well-being, and aesthetic and physical outcomes of surgery that do not reflect personal treatment preferences. The decisions surrounding breast reconstruction involve trade-offs between multiple simultaneous concerns (i.e. cost, complications, recovery time) to arrive at a treatment that is reflective of personal preferences and values. Thus, it is essential to understand which aspects of breast reconstruction are most important to each patient when making patient-centered treatment decisions. Conjoint analysis is a unique statistical technique that determines how consumers value different features of a product. This form of preference elicitation shows extraordinary promise in health care to determine how patients value different aspects of treatment. By utilizing conjoint analysis, the relative importance of various treatment attributes can be determined and communicated to the provider to better align treatment preferences with the ultimate outcome. In the context of breast reconstruction, conjoint analysis can determine which attributes of reconstructive surgery are most important to a patient when communicating the shared treatment decision and can be used as part of a shared decision-making tool to facilitate patient-physician communication and individualize breast reconstruction care. Through this research, we will utilize conjoint analysis to assess how patients value different aspects of breast reconstruction and will use these findings to develop a unique shared decision-making tool (RECONJOINT) that will help prioritize patient preferences for breast reconstruction and communicate these preferences to the provider.
Our specific aims are the following:
- Aim 1 Design and test the conjoint analysis
- Aim 2 Assess patient preferences for breast reconstruction, and
- Aim 3 Develop RECONJOINT and assess patient and provider experience with the shared decision-making tool. Our central hypothesis is that eliciting treatment preferences with conjoint analysis will enable surgeons to identify treatment strategies most in line with patient values. Our long-term goal is to develop a clinically relevant tool that will improve patient satisfaction, decision quality, and mitigate regret after breast reconstruction.
- Impact Statement The product of this research will be an enhanced understanding of how patient preferences for breast reconstruction are influenced by socioeconomic and medical characteristics and will promote the development of a clinically relevant tool that aligns personal preferences with treatment outcomes. These findings have the potential to transform clinical practice by providing surgeons with information about what matters most to each patient seeking reconstructive surgery. In turn, this will enhance shared decision-making with thousands of women facing decisions for breast reconstruction. These findings will be used in a future proposal for extramural funding to assess whether RECONJOINT improves outcomes after breast reconstruction in a randomized controlled trial
What does participation involve?
You must complete a survey.
Anywhere in the U.S. and virtual
How can I sign up for this study?
You can sign up for this study if you match all of these main criteria. Please read this list carefully.
- ≥18 years old
- Have you been diagnosed with breast cancer, or do you have a genetic predisposition to breast cancer (BRCA1, BRCA2, etc.)?
- Have you considered or undergone a mastectomy?