Sherman Kerry A, Shaw Laura-Kate E, Winch Caleb J, Harcourt Diana, Boyages John, Cameron Linda D, Brown Paul, Lam Thomas, Elder Elisabeth, French James, Spillane Andrew
Sydney, Australia; Bristol, United Kingdom; and Merced, Calif.
From the Centre for Emotional Health, Macquarie University; the Westmead Breast Cancer Institute, Westmead Hospital; the Macquarie University Cancer Institute, Australian School of Advanced Medicine, Macquarie University; The Poche Centre, Mater Hospital; the Centre for Appearance Research, University of West of England; and the University of California, Merced.
Plast Reconstr Surg. 2016 Oct;138(4):592e-602e. doi: 10.1097/PRS.0000000000002538.
Deciding whether or not to have breast reconstruction following breast cancer diagnosis is a complex decision process. This randomized controlled trial assessed the impact of an online decision aid [Breast RECONstruction Decision Aid (BRECONDA)] on breast reconstruction decision-making.
Women (n = 222) diagnosed with breast cancer or ductal carcinoma in situ, and eligible for reconstruction following mastectomy, completed an online baseline questionnaire. They were then assigned randomly to receive either standard online information about breast reconstruction (control) or standard information plus access to BRECONDA (intervention). Participants then completed questionnaires at 1 and 6 months after randomization. The primary outcome was participants' decisional conflict 1 month after exposure to the intervention. Secondary outcomes included decisional conflict at 6 months, satisfaction with information at 1 and 6 months, and 6-month decisional regret.
Linear mixed-model analyses revealed that 1-month decisional conflict was significantly lower in the intervention group (27.18) compared with the control group (35.5). This difference was also sustained at the 6-month follow-up. Intervention participants reported greater satisfaction with information at 1- and 6-month follow-up, and there was a nonsignificant trend for lower decisional regret in the intervention group at 6-month follow-up. Intervention participants' ratings for BRECONDA demonstrated high user acceptability and overall satisfaction.
Women who accessed BRECONDA benefited by experiencing significantly less decisional conflict and being more satisfied with information regarding the reconstruction decisional process than women receiving standard care alone. These findings support the efficacy of BRECONDA in helping women to arrive at their breast reconstruction decision.
乳腺癌确诊后决定是否进行乳房重建是一个复杂的决策过程。这项随机对照试验评估了在线决策辅助工具[乳房重建决策辅助工具（BRECONDA）]对乳房重建决策的影响。
222名被诊断为乳腺癌或原位导管癌且符合乳房切除术后重建条件的女性完成了一份在线基线调查问卷。然后，她们被随机分配接受关于乳房重建的标准在线信息（对照组）或标准信息并可使用BRECONDA（干预组）。参与者在随机分组后的1个月和6个月完成调查问卷。主要结局是参与者在接触干预措施1个月后的决策冲突。次要结局包括6个月时的决策冲突、1个月和6个月时对信息的满意度以及6个月时的决策遗憾。
线性混合模型分析显示，干预组（27.18）的1个月决策冲突明显低于对照组（35.5）。这种差异在6个月随访时也持续存在。干预组参与者在1个月和6个月随访时对信息的满意度更高，且干预组在6个月随访时决策遗憾较低的趋势不显著。干预组参与者对BRECONDA的评分显示出较高的用户接受度和总体满意度。
与仅接受标准护理的女性相比，使用BRECONDA的女性受益于决策冲突显著减少，并且对重建决策过程的信息更满意。这些发现支持了BRECONDA在帮助女性做出乳房重建决策方面的有效性。
