Semin Plast Surg 2004; 18(2): 139-147
DOI: 10.1055/s-2004-829048
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001 USA.

Patient Education and Decision Making in Breast Reconstruction

Lior Heller1 , Michael J. Miller1
  • 1Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX
Further Information

Publication History

Publication Date:
14 June 2004 (online)

A well-informed patient who actively participates in decision making is an essential ingredient of successful outcome in breast reconstruction. The plastic surgeon must be prepared to answer all the patient's questions in a clear and concise manner. All women considering breast reconstruction need to understand the rationale for reconstruction and have realistic expectations for what can be accomplished. They need to consider the optimal timing and the advantages and disadvantages of each technical option. The patient education process can be enhanced by the thoughtful inclusion of growing set of educational tools and decision aids. This article reviews each of these issues and suggests a way to organize and present the essential material in a way that has proven effective with women in our practice.

REFERENCES

  • 1 Emanuel E J, Emanuel L L. Four models of the physician-patient relationship.  JAMA. 1992;  267 2221-2226
  • 2 Laine C, Davidoff F. Patient-centered medicine. A professional evolution.  JAMA. 1996;  275 152-156
  • 3 Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model.  Soc Sci Med. 1999;  49 651-661
  • 4 Kasper J F, Mulley Jr A G, Wennberg J E. Developing shared decision-making programs to improve the quality of health care.  QRB Qual Rev Bull. 1992;  18 183-190
  • 5 van den Borne H W. The patient from receiver of information to informed decision-maker.  Patient Educ Couns. 1998;  34 89-102
  • 6 Haynes R B, McKibbon K A, Kanani R. Systematic review of randomised trials of interventions to assist patients to follow prescriptions for medications.  Lancet. 1996;  348 383-386
  • 7 Brody D S. The patient's role in clinical decision-making.  Ann Intern Med. 1980;  93 718-722
  • 8 Weiss S M et al.. Patient satisfaction with decision-making for breast cancer therapy.  Ann Surg Oncol. 1996;  3 285-289
  • 9 Greenfield S, Kaplan S, Ware Jr J E. Expanding patient involvement in care. Effects on patient outcomes.  Ann Intern Med. 1985;  102 520-528
  • 10 Greenfield S et al.. Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes.  J Gen Intern Med. 1988;  3 448-457
  • 11 Stewart M A. Effective physician-patient communication and health outcomes: a review.  CMAJ. 1995;  152 1423-1433
  • 12 Street Jr R L et al.. Increasing patient involvement in choosing treatment for early breast cancer.  Cancer. 1995;  76 2275-2285
  • 13 Fallowfield L. Offering choice of surgical treatment to women with breast cancer.  Patient Educ Couns. 1997;  30 209-214
  • 14 Singletary S E, Kroll S S. Skin-sparing mastectomy with immediate breast reconstruction [Review].  Advances in Surgery. 1996;  30 39-52
  • 15 Rosenqvist S, Sandelin K, Wickman M. Patients' psychological and cosmetic experience after immediate breast reconstruction.  Eur J Surg Oncol. 1996;  22 262-266
  • 16 Magarey C J. Aspects of the psychological management of breast cancer [Review].  Medical Journal of Australia. 1988;  148 239-242
  • 17 Wellisch D K, Schain W S, Noone R B, Little III J W. Psychosocial correlates of immediate versus delayed reconstruction of the breast.  Plastic & Reconstructive Surgery. 1985;  76 713-718
  • 18 Dean C, Chetty U, Forrest A P. Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy.  Lancet. 1983;  1 459-462
  • 19 Stevens L A, McGrath M H, Druss R G, Kister S J, Gump F E, Forde K A. The psychological impact of immediate breast reconstruction for women with early breast cancer.  Plastic & Reconstructive Surgery. 1984;  73 619-628
  • 20 Mansel R E, Horgan K, Webster D J, Shrotria S, Hughes L E. Cosmetic results of immediate breast reconstruction post-mastectomy: a follow-up study.  British Journal of Surgery. 1986;  73 813-816
  • 21 Schover L R, Yetman R J, Tuason L J et al.. Partial mastectomy and breast reconstruction. A comparison of their effects on psychosocial adjustment, body image, and sexuality.  Cancer. 1995;  75 54-64
  • 22 Noguchi M, Kitagawa H, Kinoshita K et al.. Psychologic and cosmetic self-assessments of breast conserving therapy compared with mastectomy and immediate breast reconstruction.  J Surg Oncol. 1993;  54 260-266
  • 23 Buchholz T A, Kronowitz S J, Kuerer H M. Immediate breast reconstruction after skin-sparing mastectomy for the treatment of advanced breast cancer: radiation oncology considerations. [comment].  Annals of Surgical Oncology. 2002;  9 820-821
  • 24 Kroll S S, Schusterman M A, Tadjalli H E, Singletary S E, Ames F C. Risk of recurrence after treatment of early breast cancer with skin-sparing mastectomy.  Ann Surg Oncol. 1997;  4 193-197
  • 25 Newman L A, Kuerer H M, Hunt K K et al.. Presentation, treatment, and outcome of local recurrence afterskin-sparing mastectomy and immediate breast reconstruction.  Ann Surg Oncol. 1998;  5 620-626
  • 26 Tran N V, Chang D W, Gupta A, Kroll S S, Robb G L. Comparison of immediate and delayed free TRAM flap breast reconstruction in patients receiving postmastectomy radiation therapy.  Plast Reconstr Surg. 2001;  108 78-82
  • 27 Buchholz T A, Strom E A, Perkins G H, McNeese M D. Controversies regarding the use of radiation after mastectomy in breast cancer.  Oncologist. 2002;  7 539-546
  • 28 Kronowitz S. Delayed-immediate breast reconstruction [abstract]. Proceedings of the American Association of Plastic Surgeons May 4-7 Baltimore, Maryland;
  • 29 Kronowitz S J, Robb G L, Youssef A et al.. Optimizing autologous breast reconstruction in thin patients.  Plastic & Reconstructive Surgery. 2003;  112 1768-1778
  • 30 Kroll S S. Why autologous tissue [Review]?.  Clinics in Plastic Surgery. 1998;  25 135-143
  • 31 Rosen P B, Jabs A D, Kister S J, Hugo N E. Clinical experience with immediate breast reconstruction using tissue expansion or transverse rectus abdominis musculocutaneous flaps [See comment].  Ann Plast Surg. 1990;  25 249-257
  • 32 Eberlein T J, Crespo L D, Smith B L, Hergrueter C A, Douville L, Eriksson E. Prospective evaluation of immediate reconstruction after mastectomy.  Annals of Surgery. 1993;  218 29-36
  • 33 Slavin S A, Love S M, Sadowsky N L. Reconstruction of the radiated partial mastectomy defect with autogenous tissues [See comment].  Plastic & Reconstructive Surgery. 1992;  90 854-865 , discussion 866-869
  • 34 O'Connor A M, Fiset V, DeGrasse C et al.. Decision aids for patients facing health treatment or screening decisions: systematic review.  BMJ. 1999;  319 731-734
  • 35 Levine M N, Gafni A, Markham B, MacFarlane D. A bedside decision instrument to elicit a patient's preference concerning adjuvant chemotherapy for breast cancer.  Ann Intern Med. 1992;  117 53-58
  • 36 Whelan T et al.. Mastectomy or lumpectomy? Helping women make informed choices.  J Clin Oncol. 1999;  17 1727-1735
  • 37 Sawka C A, Goel V, Mahut C A et al.. Development of a patient decision aid for choice of surgical treatment for breast cancer.  Health Expect. 1998;  1 23-36
  • 38 Gramlich E P, Waitzfelder B E. Interactive video assists in clinical decision making.  Methods Inf Med. 1998;  37 201-205
  • 39 Stalmeier P F, Unic I J, Verhoef L C, Van Daal W A. Evaluation of a shared decision making program for women suspected to have a genetic predisposition to breast cancer: preliminary results.  Med Decis Making. 1999;  19 230-241
  • 40 Gordon J B, Barot L R, Fahey A L, Matthews M S. The Internet as a source of information on breast augmentation.  Plastic & Reconstructive Surgery. 2001;  107 171-176
  • 41 Wise P H, Dowlatshahi D C, Farrant S, Fromson S, Meadows K A. Effect of computer-based learning on diabetes knowledge and control.  Diabetes Care. 1986;  9 504-508
  • 42 Wheeler L A, Wheeler M L, Ours P, Swider C. Evaluation of computer-based diet education in persons with diabetes mellitus and limited educational background.  Diabetes Care. 1985;  8 537-544
  • 43 Stromberg A, Ahlen H, Fridlund B, Dahlstrom U. Interactive education on CD-ROM-a new tool in the education of heart failure patients.  Patient Educ Couns. 2002;  46 75-81
  • 44 Nebel I T, Bluher M, Starcke U, Muller U A, Haak T, Paschke R. Evaluation of a computer based interactive diabetes education program designed to train the estimation of the energy or carbohydrate contents of foods.  Patient Educ Couns. 2002;  46 55-59
  • 45 Richards M A, Ramirez A J, Degner L F, Fallowfield L J, Maher E J, Neuberger J. Offering choice of treatment to patients with cancers. A review based on a symposium held at the 10th annual conference of The British Psychosocial Oncology Group, December 1993.  Eur J Cancer. 1995;  31A 112-116
  • 46 O'Connor A M, Llewellyn-Thomas H A, Sawka C, Pinfold S P, To T, Harrison D E. Physicians' opinions about decision aids for patients considering systemic adjuvant therapy for axillary-node negative breast cancer.  Patient Educ Couns. 1997;  30 143-153
  • 47 Towle A, Godolphin W. Framework for teaching and learning informed shared decision making.  BMJ. 1999;  319 766-771
  • 48 Coulter A. Partnerships with patients: the pros and cons of shared clinical decision-making.  J Health Serv Res Policy. 1997;  2 112-121

Michael J MillerM.D. 

Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center

1515 Holcombe Blvd.

Houston, TX 77030

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