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, 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 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 post-operatively (T2). The primary outcome measures examined included Decision Quality Index (DQI), Decision Regret, Collaboration, and Patient Satisfaction with Information using the BREAST-Q.
Results: Forty-one patients met inclusion criteria (usual care n=20, POG n=21) 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 cohorts had the same median DQI score 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).
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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