Grants Funded

Abstract
Breast reconstruction after mastectomy has significantly increased in the United States after the enactment of the Women's Health and Cancer Rights Act of 1998, which federally required health care coverage for breast reconstruction. Since this time, the volume of immediate breast reconstruction has increased an average of 5% per year, reaching almost 100,000 procedures in 2013. There are many reconstructive options for these patients, and the shared decision-making between physicians and patients is multifaceted and complex. Counseling patients of low socioeconomic status (SES) can present unique challenges for health care providers, including limited literacy and language barriers. Decision aids such as the Picture Option Grid have been shown to enhance shared decision-making, knowledge, and decision quality in SES patients undergoing other surgical procedures. Our central hypothesis is that the Picture Option Grid (available in English, Spanish, and Chinese) will be highly useable and acceptable to underserved patients undergoing breast reconstruction. The grid will improve shared decision-making, reduce decisional conflict and regret, and improve patient satisfaction and quality of life. For our project we aim to first develop a Picture Option Grid in English, Spanish, and Chinese with the aid of patients who have undergone breast reconstruction in the prior three years. Once developed, we will perform a two-arm randomized control trial with patients currently considering breast reconstruction at two medical centers (Montefiore Medical Center and Bellevue Hospital Center) providing care to underserved individuals. We will use several validated outcome measures to assess efficacy. Knowledge and decision quality will be assessed by the validated Breast Reconstruction Decision Quality Instrument (DQI). Shared decision making will be assessed by validated 3-item CollaboRATE measure. Decisional regret will be evaluated by 5 item decision regret scale. Lastly, patient satisfaction with outcome and information will be assessed by the BREAST-Q. Data gathered will be analyzed to determine efficacy and acceptability of the Picture Option Grid. Once shown to be efficacious, a definitive trial will be performed.

Biography
Dr. Weichman is an Associate Professor of Plastic Surgery at Montefiore Medical Center/Albert Einstein College of Medicine. Dr. Weichman received her BS from Fordham University in the Bronx and then attended Creighton University Medical School. She completed her general surgical residency and plastic surgery fellowship at New York University Langone Medical Center. Given her interest in breast reconstruction she decided to pursue an additional year of training at Memorial Sloan Kettering Cancer Center in microsurgery. After completing her plastic surgery training she started her career at Montefiore Medical Center in the Bronx and focused on breast reconstruction. Her research interested are centered on many aspects of breast reconstruction including comparative effectiveness and outcomes studies.