Grants Funded

Abstract

Impact Statement: The product of this research will be an enhanced understanding of how patient preferences for breast reconstruction are influenced by socioeconomic and medical characteristics and will promote the development of a clinically relevant tool that aligns personal preferences with treatment outcomes. These findings have the potential to transform clinical practice by providing surgeons with information about what matters most to each patient seeking reconstructive surgery. In turn, this will enhance shared decision-making with thousands of women facing decisions for breast reconstruction. These findings will be used in a future proposal for extramural funding to assess whether RECONJOINT improves outcomes after breast reconstruction in a randomized controlled trial.

Project Summary: Approximately 40% of breast reconstruction patients experience dissatisfaction due to outcomes of surgery that do not reflect personal treatment preferences. The decisions surrounding breast reconstruction involve trade-offs between multiple simultaneous concerns (i.e. cost, complications, recovery time) to arrive at a treatment that is reflective of personal preferences and values. Thus, it is essential to understand which aspects of breast reconstruction care are most important to each patient when making patient-centered treatment decisions. Conjoint analysis is a unique statistical technique that determines how consumers value different features of a product. This form of preference elicitation shows extraordinary promise in health care to determine how patients value different aspects of treatment. By utilizing conjoint analysis, the relative importance of various treatment attributes can be determined and communicated to the provider to better align treatment preferences with the ultimate outcome. In the context of breast reconstruction, conjoint analysis can determine which attributes of reconstructive surgery are most important to a patient when communicating the shared treatment decision and can be used as part of a shared decision-making tool to facilitate patient-physician communication and individualize breast reconstruction care. Through this research, we will utilize conjoint analysis to assess how patients value different aspects of breast reconstruction and will use these findings to develop a unique shared decision-making tool (RECONJOINT) that will help prioritize patient preferences for breast reconstruction and communicate these preferences to the provider. Our specific aims are the following Aim 1: Design and test the conjoint analysis, Aim 2: Assess patient preferences for breast reconstruction, and Aim 3: Develop RECONJOINT and Clinical Implementation and Analysis. Our central hypothesis is that eliciting treatment preferences with conjoint analysis will enable surgeons to identify treatment strategies most in line with patient preferences and values. Our long-term goal is to develop a clinically relevant tool that will improve patient satisfaction, decision quality, and mitigate regret after breast reconstruction.

Biography
I am a plastic and reconstructive surgery resident with clinical interests in post-oncologic reconstruction and health services research. My long-term research goal is to improve patient care following post-oncologic reconstruction. I completed my medical degree at Duke University Medical School, at which time I dedicated two years to clinical and basic science research. As part of my research efforts, I worked closely with the breast cancer research outcomes group at Duke University. These efforts have produced 6 separate publications that were the result of a multi-disciplinary collaboration between reconstructive surgeons, breast surgeons, and breast oncologists. Furthermore, I have been involved in several clinical projects which mainly focus on evaluating patient outcomes following reconstructive surgery. To date, this has resulted in 28 manuscripts that have been accepted for publication. Importantly, I helped lead a recently published project which assessed treatment preferences for non-displaced scaphoid fractures utilizing conjoint analysis and discrete choice experiments. This has provided me with a basic skill set to design and successfully carry out projects utilizing conjoint analysis.