Improving Decision Making in Breast Reconstruction Through Use of a Validated Picture Option Grid: A Pilot Study
Amanda M. Rizzo, BA, Carrie S. Stern, MD, Jeffrey Arendash, BS, Evan S. Garfein, MD, Teresa Benacquista, MD, J. Alejandro Conejero, MD, Lawrence Draper, MD, Katie E. Weichman, MD.
Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
Purpose: Patients of low socioeconomic status have several barriers to effective shared decision-making. Decision aids have been shown to improve outcomes, understanding, and compliance. The purpose of this study was to pilot a new decision aid, the Picture Option Grid (POG), in patients seeking breast reconstruction after mastectomy.
Methods: A randomized control trial of patients undergoing primary consultation for breast reconstruction at Montefiore Medical Center between March 2017 and September 2017 was conducted. Patients were randomized immediately prior to consultation into two groups: Usual care or care with the addition of the Picture Option Grid (POG). Patients were analyzed at three time points: pre-consultation (T0), post-consultation (T1), and one month postoperatively (T2). The primary outcome measures examined included Breast Reconstruction Decision Quality Instrument (DQI), Decision Regret, CollaboRATE, and Patient Satisfaction with Information using the BREAST-Q (Reconstruction Module). Bivariate tests were performed to compare patient demographic characteristics between groups, and survey responses were analyzed using Mann-Whitney tests or Chi-Square tests as appropriate.
Results: Forty-one patients met inclusion criteria (POG n=21, usual care n=20) and were similar in mean age, race/ethnicity (83% Black and/or Hispanic), education level, and health literacy. When comparing outcome measures, patients in both groups had similar median DQI scores at both T0 and T1 (40%). However, at T1, patients in the POG cohort had higher median satisfaction with information (POG 100 [IQR 91-100], usual care 68 [IQR 56-91]; p=0.004) and also had lower decision regret relative to usual care at T2 (POG 10 [IQR 5-37.5], usual care 35 [IQR 0-55]; p=0.68). Both groups had similar proportions of CollaboRATE top scores at T1 (POG 94%, usual care 89%; p>0.99).
Conclusions: Use of the POG at initial consultation is associated with greater satisfaction with information and lower decision regret, suggesting efficacy in patients undergoing breast reconstruction.
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