Grants We Funded

Abstract

Project Summary: Breast reconstruction plays an important role in restoring the form and function of the breast for many individuals following surgery for breast cancer. However, there are significant disparities in breast reconstruction in the United States based on race and ethnicity, with lower rates in women who are Black, Hispanic, and Asian. A major modifiable factor that impacts disparities in breast reconstruction is patient education. When patients lack information about breast reconstruction, they are unaware of their options, are less able to advocate for care, and are limited in the ability to participate in shared decision making about surgery. Current barriers to providing patients with adequate education include factors inherent in our current healthcare system. These are patient-physician racial, ethnic, and cultural differences, patient medical knowledge, a patient's ability to process information in the stress of cancer, limits in physician time, and general racial and ethnic disparities in how healthcare is delivered. The long-term goal of our research is to reduce racial and ethnic disparities in breast reconstruction through improving patient education. To achieve this goal, we propose the use of patient-led storytelling as a novel method of education. Through storytelling, patients educate other patients in a way that eliminates the cultural barriers and biases present in traditional patient encounters, empowering patients to become more active participants in decision making. To work towards achieving this long-term goal through this grant, we will pilot the use of storytelling for patient education in breast reconstruction. We will achieve this through training patients as master storytellers to tell their stories, videotaping the storytelling, and then evaluating the impact on patient education and shared decision making by showing the storytelling videos to groups of patients and physicians. As a secondary goal, by surveying patients we will identify and measure how sources of information influence surgical decision making by patient race and ethnicity. If successful, these findings will form the foundation for a large-scale storytelling grant aimed at improving patient education to reduce disparities in breast reconstruction.

Impact Statement: This project has a long-term goal of improving racial and ethnic disparities in breast reconstruction through the use of patient-led storytelling as a method of providing patient-to-patient education that will address the current limitations of traditional patient-physician clinical encounters. Our primary study objective is to test the use of storytelling as a patient education tool in breast reconstruction. Our secondary objective is to better understand and evaluate the influence of available sources of information and education for patients. If successful, this work will form the foundation for a large study evaluating the impact of patient-led storytelling on racial and ethnic disparities in breast reconstruction.

Biography
Lily Mundy, MD is an Assistant Professor in the Department of Plastic and Reconstructive Surgery at Johns Hopkins University. Dr. Mundy specializes in reconstructive microsurgery, with clinical and research focuses in breast and extremity reconstruction. Her research expertise includes patient-reported outcome instrument development as well as research in health disparities, financial toxicity, and better understanding the patient experience. Her aim is to improve racial and ethnic disparities in breast reconstruction using patient-centered techniques. Dr. Mundy received her undergraduate training from New York University and medical degree from the College of Physicians and Surgeons, Columbia University. She completed her plastic surgery training at Duke University, followed by advanced clinical and research training in complex extremity reconstruction and microsurgery at the R Adams Cowley Shock Trauma Center, University of Maryland. She has been acknowledged with several notable honors during her training, including summa cum laude (2009), and inductions into both the Alpha Omega Alpha Honor Medical Society (2014) and Arnold P. Gold Humanism Honor Society (2014). She received the Albert B. Knapp Award (2014) and Glasgow-Rubin Achievement Award (2015) at Columbia University. Lastly, her research in patient-reported outcomes in breast surgery patients was awarded the Clifford C. Snyder, MD Past Chairman Award at the 2017 Annual Plastic Surgery Research Council Meeting.