A Multi-institutional Survey Of Breast Cancer Patients’ Intention Of Breast Reconstruction And The Factors Influencing Their Choices

ObjectirvesThe aim of this study was to investigate the cognition,attitudes and needs of breast reconstruction among breast cancer patients in China,to explore the factors influencing the patients’ choices of breast reconstruction and to evaluate the changes in patients’ cognition and choices of breast reconstruction before and after the relevant preoperative education.We tried to provide reliable data support to help the breast cancer patients get fully involved in their own clinical decision-making and realize the patient-centered individualized treatment.MethodsWe used a literature review,patient interviews and expert panels to develop the preoperative education material regarding indications,advantages and disadvantages of different timing and various surgical methods,postoperative outcomes,complications,and recovery time of breast reconstruction.We tried to get all the factors that may influence the patients’ choices of breast reconstruction involved in the questionnaire based on the literature review and clinical conditions.The consecutive breast cancer patients from four different institutions across China were involved in the study between December,2017 to May,2018.We surveyed the patients to ascertain their cognition,choices and concerns of breast reconstruction before and after reading the education material.The classification and rating data obtained by the questionnaire statistics were described by the frequency and composition ratio.The X2 test was used to compare the rates of classification data.Ranked sum test was used to compare the ordered multi-classification data.The patients’ cognition and attitudes of breast reconstruction were described and compared before and after reading the education material.The patients’ intention of breast reconstruction before and after reading the education material was compared using McNemar-Bowker test.The patients were divided into different groups according to whether or not they refused breast reconstruction,and a Logistic regression model was established to analyze the factors influencing their choices.ResultsA total of 366 valid questionnaires were collected in the study.274 patients(74.9%)were aware of breast reconstruction before reading the education material and 170 patients(46.4%)indicated that they had been informed of breast reconstruction by breast surgeons.The main ways for the patients to know breast reconstruction were breast surgeons,media,and other patients.The patients’ favorite way to obtain breast reconstruction information was from the breast surgeons.The main reasons for the patients to choose breast reconstruction were to regain the complete body,to make up the psychological disorder induced by breast loss,to wear various clothes,and to restore female charm.The reasons for the patient’s refusal of breast reconstruction were mainly concerned with the risk of surgery or related complications,the shape of the breast was no more important with the age increasing,worry about the pain of surgery.Before reading the education material,the patient’ s cognitive level of the oncology safety and improvement of postoperative quality of life about breast reconstruction was low.After reading the education material,the patient’ s relevant cognitive level was significantly improved,and they were more inclined to choose to consider breast reconstruction.The Logistic regression analysis showed that before reading the education material,patients aged 40 and below,with medical insurance,and who had been informed of the possibility of breast reconstruction by breast surgeons,were more likely to choose breast reconstruction.After reading the education material,patients who had medical insurance and had been informed of the possibility of breast reconstruction by breast surgeons,were more likely to choose breast reconstruction.ConclusionsBreast cancer patients generally had insufficient awareness of breast reconstruction in the study.The preoperative education can help the patients fully understand breast reconstruction and make truly informed clinical decisions.Medical insurance is an important factor influencing patients’ choices of breast reconstruction.The information about breast reconstruction from the breast surgeons plays an important role in the clinical decision-making for breast cancer patients.The demand for breast reconstruction among Chinese breast cancer patients has not been fully met.Doctors should provide each breast cancer patient with sufficient information about breast reconstruction,and respect and satisfy their clinical decisions based on full awareness.