Poster Presentation Cancer Survivorship 2019

The Type and Timing of Breast Reconstruction after Mastectomy: Qualitative Insights into Women’s Decision-Making (#128)

Sarah Guinta 1 , Rebekah Laidsaar-Powell 2 , Natasha Hatcher 1 , Lorna Huang 1 , Haryana Dhillon 2 3 , Danielle Muscat 4 , Susan Carroll 5 6 , Catriona McNeil 5 7 , Lucinda Burke 7 , Pamela Howson 8 , Belinda Chan 7 9 , Ilona Juraskova 2
  1. School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
  2. Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
  3. Psycho-Oncology Cooperative Research Group, University of Sydney, NSW, Australia
  4. Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
  5. Faculty of Medicine and Health Sciences, Sydney Medical School, The University of Sydney, NSW, Australia
  6. Northern Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
  7. Chris O'Brien Lifehouse, Sydney, NSW, Australia
  8. Dept of Breast Surgery, Concord Repatriation General Hospital, Concord, NSW, Australia
  9. Strathfield Private Hospital, Strathfield, NSW

Background: Women who choose to have a breast reconstruction (BR) following mastectomy for breast cancer need to make decisions concerning the type and timing of their reconstruction. They may opt for the increasingly common delayed-immediate (expander-based) reconstruction, however, little is known about women’s motivations for choosing this option. BR decisions are further complicated when post-mastectomy radiation therapy (PMRT) is indicated, as radiation to the reconstructed breast may lead to complications and poorer aesthetic outcomes.

 

Aims: To qualitatively explore Australian women’s experiences of BR decision-making and factors that influence their BR decision.

 

Methods: Semi-structured telephone interviews were conducted with women treated with mastectomy and prosthetic or autologous reconstructions that were immediate, delayed or delayed-immediate.  Purposive sampling continued until data saturation was reached. Interviews asked women about: information received from their medical team; reasons for reconstructive choices; and their feelings about their decision. Interviews were audiotaped, transcribed verbatim and analysed thematically using the Framework method.

 

Results: From interviews with 29 women, mean age 54 years (SD 6.78), seven main themes were identified: i) information provision and needs; ii) values and preferences; iii) decisional pressure; iv) feasibility; v) social influence and support; vi) interprofessional team and organisational structures; and vii) decision implementation and outcomes. Women commonly chose delayed-immediate expander-based BR due to practical factors and to lessen their feelings of (perceived/actual) decisional pressure. Women reported receiving little information about possible PMRT impact on reconstructed breast(s). Collaboration and communication within multidisciplinary teams were found to support the BR decision-making process.

 

Conclusion: These themes offer a comprehensive explanation of how Australian women make BR decisions. The findings explain women’s reasons for choosing delayed-immediate (expander-based) reconstructions, and highlight the often limited information-sharing regarding adjuvant PMRT. Strategies for patients, clinicians and organisations to enhance patient-centred interprofessional care are proposed, including development of in-consultation decision support tools.