Retrouvey Helene, Zhong Toni, Gagliardi Anna R, Baxter Nancy N, Webster Fiona
Division of Plastic and Reconstructive Surgery, Department of surgery, University of Toronto, Toronto, Ontario, Canada
Department of surgery, University Health Network, Toronto, Ontario, Canada.
BMJ Open. 2019 Sep 3;9(9):e029048. doi: 10.1136/bmjopen-2019-029048.
There has been limited research on the acceptability of breast reconstruction (BR) to breast cancer patients. We performed interviews to explore breast cancer patients' acceptability of BR.
Qualitative study.
Recruitment from six Ontario hospitals across the province (Toronto, Ottawa, Hamilton, London, Thunder Bay and Windsor) as well as key breast cancer organisations between November 2017 and June 2018.
Women of any age with a diagnosis of breast cancer planning to undergo or having undergone a mastectomy with or without BR.
Sixty-minute semi-structured interviews were analysed using qualitative descriptive methodology that draws on inductive thematic analysis.
In the telephone interviews, participants discussed their experience with breast cancer and accessing BR, focusing on the acceptability of BR as a surgical option post-mastectomy.
Of the 28 participants, 11 had undergone BR at the time of the interview, 5 at the time of mastectomy and 6 at a later date. Four inter-related themes were identified that reflected women's evolving ideas about BR as they progressed through different stages of their disease and treatment. The themes we developed were: (1) cancer survival before BR, (2) the influence of physicians on BR acceptability, (3) patient's shift to BR acceptance and (4) women's need to justify BR. For many women, access to BR surgery became more salient over time, thus adding a temporal element to the existing access framework.
In our study, women's access to BR was negatively influenced by the poor acceptability of this surgical procedure. The acceptability of BR was a complex process taking place over time, from the moment of breast cancer diagnosis to BR consideration. BR access may be improved through enhancing patient acceptability of BR. We suggest adapting the current access to care frameworks by further developing the concept of acceptability.
关于乳腺癌患者对乳房重建（BR）的接受度的研究有限。我们进行访谈以探究乳腺癌患者对BR的接受度。
定性研究。
2017年11月至2018年6月期间，从安大略省全省的六家医院（多伦多、渥太华、汉密尔顿、伦敦、桑德贝和温莎）以及主要的乳腺癌组织招募。
任何年龄、被诊断患有乳腺癌且计划接受或已接受乳房切除术（无论是否进行BR）的女性。
采用基于归纳主题分析的定性描述方法对60分钟的半结构化访谈进行分析。
在电话访谈中，参与者讨论了她们患乳腺癌的经历以及获得BR的情况，重点是BR作为乳房切除术后手术选择的可接受性。
28名参与者中，11人在访谈时已接受BR，5人在乳房切除时接受，6人在之后接受。确定了四个相互关联的主题，反映了女性在疾病和治疗的不同阶段对BR的观念演变。我们提出的主题是：（1）BR前的癌症生存，（2）医生对BR可接受性的影响，（3）患者对BR接受度的转变，（4）女性对BR合理性的需求。对许多女性来说，随着时间推移，获得BR手术变得更加突出，从而在现有的获取框架中增加了一个时间因素。
在我们的研究中，女性获得BR受到该手术可接受性差的负面影响。BR的可接受性是一个随着时间推移而发生的复杂过程——从乳腺癌诊断之时到考虑BR之时。通过提高患者对BR的接受度，可能会改善BR的可及性。我们建议通过进一步发展可接受性的概念来调整当前的医疗服务获取框架。
