Webb Carmen, Sharma Vishal, Temple-Oberle Claire
Departments of Surgery and Oncology, University of Calgary, Calgary, Alberta, Canada.
Plast Surg (Oakv). 2018 Feb;26(1):26-32. doi: 10.1177/2292550317750139. Epub 2018 Jan 9.
To discover missed opportunities for providing information to women undergoing breast reconstruction in an effort to decrease regret and improve patient education, teaching modalities, and satisfaction.
Thirty- to 45-minute semi-structured interviews were conducted exploring patient experiences with information provision on breast reconstruction. Purposeful sampling was used to include women with a variety of reconstruction types at different time points along their recovery. Using grounded theory methodology, 2 independent reviewers analyzed the transcripts and generated thematic codes based on patient responses. BREAST-Q scores were also collected to compare satisfaction scores with qualitative responses.
Patients were interested in a wide variety of topics related to breast reconstruction including the pros and cons of different options, nipple-sparing mastectomies, immediate breast reconstruction, oncological safety/monitoring and the impact of chemotherapy and radiotherapy, secondary procedures (balancing, nipple reconstruction), post-operative recovery, and long-term expectations. Patients valued accessing information from multiple sources, seeing numerous photographs, being guided to reliable information online, and having access to a frequently asked questions file or document. Information delivery via interaction with medical personnel and previously reconstructed patients was most appreciated. Compared with BREAST-Q scores for satisfaction with the plastic surgeon (mean: 95.7, range: 60-100), informational satisfaction scores were lower at 74.7 (50-100), confirming the informational gaps expressed by interviewees.
Women having recently undergone breast reconstruction reported key deficiencies in information provided prior to surgery and identified preferred information delivery options. Addressing women's educational needs is important to achieve appropriate expectations and improve satisfaction.
发现向接受乳房重建的女性提供信息方面存在的遗漏机会，以减少遗憾，改善患者教育、教学方式及满意度。
进行30至45分钟的半结构化访谈，探讨患者在乳房重建信息提供方面的经历。采用立意抽样法，纳入处于恢复不同时间点、具有多种重建类型的女性。运用扎根理论方法，两名独立评审员分析访谈记录，并根据患者回答生成主题代码。还收集了BREAST-Q评分，以将满意度评分与定性回答进行比较。
患者对与乳房重建相关的众多主题感兴趣，包括不同选择的利弊、保留乳头的乳房切除术、即刻乳房重建、肿瘤学安全性/监测以及化疗和放疗的影响、二次手术（调整、乳头重建）、术后恢复和长期期望。患者重视从多个来源获取信息、查看大量照片、获得在线可靠信息引导以及能够获取常见问题文件或文档。通过与医务人员及先前接受重建的患者互动来传递信息最受赞赏。与对整形外科医生满意度的BREAST-Q评分（均值：95.7，范围：60 - 100）相比，信息满意度评分较低，为74.7（50 - 100），证实了受访者所表达的信息差距。
近期接受乳房重建的女性报告了术前提供信息方面的关键不足，并确定了首选的信息传递方式。满足女性的教育需求对于实现恰当期望和提高满意度很重要。
