Grants Funded

Abstract
The overriding goal of breast reconstruction is to satisfy the patient's expectations with respect to her body image and quality of life (Sarwer, 1998). Studies have revealed a strong correlation between expectations and satisfaction, suggesting that unrecognized or unfulfilled expectations are associated with patient ratings of poor outcome and dissatisfaction with the result of surgery (Mancuso, 2003). Understanding individual patient expectations would allow surgeons to identify patients who have unrealistic expectations and to address their issues preoperatively. Despite this, no instruments have been developed to accurately measure patient expectations about breast reconstruction. Thus, the objective of this project is to develop a new patient-reported measure of expectations that will serve as a preoperative assessment tool. It will provide patients with a way to specifically indicate what they anticipate from surgery, and provide surgeons with a template to guide discussion about realistic and unrealistic goals for individual patients. Measure development will be conducted in accordance with an internationally recognized sequence of steps recommended by quality of life experts and psychometricians (Medical Outcomes Trust, 2002). Breast reconstruction patients will be recruited from MSKCC for questionnaire development, field-testing and psychometric evaluation. Preliminary versions of the scale will be developed from three sources: literature review, patient interviews and expert opinion. Semi-structured interviews (n=30) with open-ended questions will be performed by a trained interviewer to generate categories of expectations. The item pool will be pretested on a small sample of patients (n=20) to clarify ambiguities, confirm appropriateness, determine acceptability and determine completion time. The instrument will be field-tested in a sample of 150 preoperative patients to determine items that demonstrate the best psychometric properties. This questionnaire will be clinically useful and will aid surgeons as they endeavor to better understand and to fulfill their patients' expectations. Within a broader program of research, this new instrument will facilitate future studies to examine the interface between expectations and satisfaction and to help identify patients at risk for dissatisfaction. This knowledge will also guide the establishment of new educational materials specifically designed to address and modify expectations.

Biography
Dr. Pusic is a reconstructive surgeon at Memorial Sloan-Kettering Cancer Center in New York City. She performed her general surgery residency at Dalhousie University and Plastic Surgery residency at McGill University. She completed a Master’s degree in Epidemiology at Johns Hopkins University in 1997 and a research fellowship at Memorial-Sloan Kettering Cancer Center in 2001. Her research interest lies in assessing patient reported outcomes in plastic surgery patients. With grant support from the American Society of Plastic Surgeons (ASPS), she has developed a new questionnaire, the BREAST-Q, which measures satisfaction and quality of life outcomes among breast surgery patients. This questionnaire examines body image, psychological, social, sexual, and physical function as well as satisfaction with the process of care. She is also involved in research to measure patient expectations in breast reconstruction. This NIH funded study is ultimately aimed at improving patient education and promoting shared medical decision-making. Most recently, with further grant support from the ASPS, her research team is developing a new patient-reported outcome measure for facial aesthetic patients--the FACE-Q.