Pusic Andrea L, Klassen Anne F, Scott Amie M, Klok Jennifer A, Cordeiro Peter G, Cano Stefan J
New York, N.Y.; Hamilton and Vancouver, Canada; and London, United Kingdom From the Memorial Sloan-Kettering Cancer Center, McMaster University, University of British Columbia, and University College London.
Plast Reconstr Surg. 2009 Aug;124(2):345-353. doi: 10.1097/PRS.0b013e3181aee807.
Measuring patient-reported outcomes has become increasingly important in cosmetic and reconstructive breast surgery. The objective of this study was to develop a new patient-reported outcome measure to assess the unique outcomes of breast surgery patients.
Patient interviews, focus groups, expert panels, and a literature review were used to develop a conceptual framework and a list of questionnaire items. Three procedure-specific questionnaires (augmentation, reduction, and reconstruction) were developed and cognitive debriefing interviews used to pilot each questionnaire. Revised questionnaires were field tested with 1950 women at five centers in the United States and Canada (response rate, 72 percent); 491 patients also completed a test-retest questionnaire. Rasch measurement methods were used to construct scales, and traditional psychometric analyses, following currently recommended procedures and criteria, were performed to allow for comparison with existing measures.
The conceptual framework included six domains: satisfaction with breasts, overall outcome, and process of care, and psychosocial, physical, and sexual well-being. Independent scales were constructed for these domains. This new patient-reported outcome measure "system" (the BREAST-Q) contains three modules (augmentation, reconstruction, and reduction), each with a preoperative and postoperative version. Each scale fulfilled Rasch and traditional psychometric criteria (including person separation index 0.76 to 0.95; Cronbach's alpha 0.81 to 0.96; and test-retest reproducibility 0.73 to 0.96).
The BREAST-Q can be used to study the impact and effectiveness of breast surgery from the patient's perspective. By quantifying satisfaction and important aspects of health-related quality of life, the BREAST-Q has the potential to support advocacy, quality metrics, and an evidence-based approach to surgical practice.
在美容和重建乳房手术中，测量患者报告的结局变得越来越重要。本研究的目的是开发一种新的患者报告结局测量方法，以评估乳房手术患者的独特结局。
通过患者访谈、焦点小组、专家小组和文献综述来构建概念框架和问卷项目列表。开发了三份针对特定手术的问卷（隆胸、缩胸和重建），并通过认知性深入访谈对每份问卷进行预试验。修订后的问卷在美国和加拿大的五个中心对1950名女性进行了现场测试（应答率为72%）；491名患者还完成了重测问卷。采用拉施测量方法构建量表，并按照当前推荐的程序和标准进行传统心理测量分析，以便与现有测量方法进行比较。
概念框架包括六个领域：对乳房的满意度、总体结局、护理过程，以及心理社会、身体和性健康状况。为这些领域构建了独立的量表。这种新的患者报告结局测量“系统”（BREAST-Q）包含三个模块（隆胸、重建和缩胸），每个模块都有术前和术后版本。每个量表均符合拉施和传统心理测量标准（包括个人分离指数为0.76至0.95；克朗巴哈系数为0.81至0.96；重测信度为0.73至0.96）。
BREAST-Q可用于从患者角度研究乳房手术的影响和效果。通过量化满意度以及与健康相关生活质量的重要方面，BREAST-Q有可能为倡导、质量指标以及基于证据的手术实践方法提供支持。
