The Importance of Shared Decision Making: Breast Reconstruction
What is the importance of shared decision making in breast reconstruction? A recent study published on the JAMA Network site stated this in the Conclusions and Relevance portion of the article:
Shared decision making is needed to support decisions about breast reconstruction.
Breast reconstruction has the potential to improve a person’s body image and quality of life but has important risks. Variations in who undergoes breast reconstruction have led to questions about the quality of patient decisions.
My breast reconstruction experience was successful even though met with challenges that included out of pocket costs for travel, planning and recovery, calling on family and friends to help with recovery, and subsequent surgeries for scar revision and symmetry. It also improved my body image and quality of life. This happened because the plastic surgery group I chose strongly believes in shared decision making.
The process of deciding who I would go to for my delayed DIEP flap breast reconstruction, up to and including the final phone call for my surgery date, was a five-month process after my double mastectomy. There were multiple aids used by my micro-surgical team to help me gain as much information as I could prior to my initial one hour consult with my plastic surgeon. These aids included:
- Videos on their website.
- Speaking with other patients who had gone to this group and were happy with the results.
- Phone calls with their patient liaison on several occasions discussing individual surgeons, scheduling, and more importantly, where I was in my post mastectomy testing and surgical follow up.
- Viewing before and after photos on their website.
- A multitude of additional patient resources including but not limited to insurance, travel, and recovery information.
These aids along with the information I received at my one hour consult left me feeling confident about making an informed decision to move forward with DIEP flap surgery to rebuild my breasts after mastectomy. I speak with many individuals who share the same confidence in their plastic surgeon when deciding on breast reconstruction after mastectomy. They were given the information needed to make an informed decision and chose a plastic surgeon who practiced shared decision making.
These studies are important to all of us, patient advocates and surgeons, to continue to decrease the number of patients who are not being fully educated and informed about all options and risks associated with breast reconstruction in a shared decision-making setting.
As a side note, the JAMA article was referenced in articles from Natural News and Oncology News. The title of the article from Natural News was sent to me in a tweet. My Twitter handle was tagged and it understandably caught my attention. The title of the articles from each of these websites was:
Over HALF of women undergoing mastectomy surgery have no idea how painful reconstructive surgery and recovery will be.
The title was eye-catching to be sure since it used the words, “have no idea how painful reconstructive surgery and recovery will be”. I looked at the contents of the articles carefully and respectfully decided not to “like” or “retweet”. Why? I personally felt the title was taken out of context from the study cited in JAMA that both Natural News and Oncology news mentioned in their own articles. The title of the JAMA article was:
Quality of Patient Decisions About Breast Reconstruction After Mastectomy
The study was about quality of patient decisions. There was no mention in the JAMA article of painful reconstructive surgery and recovery. My recovery from DIEP flap breast reconstruction had surprisingly minimal pain. It was managed well by the protocols put in place by my surgeon and the hospital I had my procedure at.
Our Responsibility as Patients and Plastic Surgeons
It is important as advocates, clinicians, and educators of breast reconstruction that we look carefully at how information if presented to those who are faced with deciding to proceed with breast reconstruction or not. In my humble opinion, we should not rely on eye-catching titles when patients will be subject to interpretation of the titles. Information must be carefully presented so that the content can be used by patients to help them make an informed decision about breast reconstruction.
My sincere hope is that more patients can be part of a shared decision-making process when it comes to breast reconstruction. The responsibility lies on many. How as patients and advocates can we help our fellow breast cancer comrades to make this possible? How as plastic surgeons can you make your potential breast reconstruction patients feel more a part of the shared decision-making process?
I welcome your feedback. I sense that it has the potential to improve experiences in the complex and difficult decision to have breast reconstruction in a shared decision-making setting.