Grants Funded

Abstract

Impact Statement: This project will improve the practice of plastic surgery by optimizing a platform for incorporating real-time feedback on patient-reported outcomes into routine care for breast cancer patients undergoing postmastectomy breast reconstruction. Despite the BREAST-Q's status as a standard patient-reported outcome measure, patients and providers do not yet have a means of meaningfully interpreting scores. This project will accelerate the uptake of BREAST-Q as a means of informing clinical decisions and identification of poor outcomes earlier among breast cancer survivors.

Project Summary: We aim to elevate the clinical value of the BREAST-Q, a patient-reported outcome measure (PROM), by creating a real-time score interpretation tool for clinical decision-making. This addresses the critical need for a generalized framework for utilization of PROMs in postmastectomy breast reconstruction clinical practice. We are uniquely positioned to address this barrier because of our established infrastructure for BREAST-Q administration, leading to strong clinical engagement with BREAST-Q from patients and clinicians (BREAST-Q response rates of ~90%). We will use our new BREAST-Q Reconstruction Engagement and Communication Tool (BREAST-Q REACT), a score interpretation tool integrated into the electronic health record, to provide breast cancer patients and providers with individualized comparisons of an individual patient's scores to those of the “average patient” and recommendations for corresponding actions in real time. Ours is the first set of reference values to represent the expected BREAST-Q score trajectory up to 2 years after mastectomy and breast reconstruction. Our central hypothesis is that patients and providers will find the ability to receive real-time feedback regarding an individual patient's progress relative to other patients who have undergone similar procedures to have high clinical applicability and utility. We will test our hypothesis using two aims. Aim 1: Assess patient perception of patient-facing BREAST-Q REACT design and clinical utility. In focus groups with breast reconstruction patients grouped based on modality and timing from reconstructive surgery, we will demonstrate the patient-facing REACT to participants and elicit feedback regarding its design, functionalities, and clinical utility. Aim 2: Assess provider perception of provider-facing BREAST-Q REACT design, clinical utility, and workflow integration. In focus groups with plastic surgeons, breast surgeons, and advanced practice providers, we will demonstrate the provider-facing REACT to participants and elicit feedback regarding its design, functionalities, and clinical utility. The long-term objective of our proposal is to use BREAST-Q REACT to provide automated, real-time clinical decision support and allow earlier identification of poor outcomes to improve the quality of life and satisfaction of breast cancer survivors. This pilot study will provide the foundation for a randomized study evaluating the effects of REACT on the quality of real-time patient care.

Biography
Jonas Nelson, MD, MPH, is Assistant Attending in the Plastic and Reconstructive Surgery Service in the Department of Surgery at Memorial Sloan Kettering Cancer Center (MSK). Dr. Nelson specializes in reconstruction following surgery for breast cancer and head and neck cancers. He has expertise in microsurgical breast reconstruction, head and neck reconstruction with free-tissue transfer, and complex abdominal wall reconstruction. His research focuses on patient-reported outcomes after reconstruction. Through a better understanding of what leads to long-term satisfaction following reconstructive procedures, Dr. Nelson aims to improve preoperative counseling to guide patient decision-making and manage expectations. After receiving his medical degree from the University of Maryland School of Medicine, Dr. Nelson completed residency at the University of Pennsylvania School of Medicine and a Breast Reconstruction and Microsurgery fellowship at MSK. Throughout his training, he distinguished himself with receipt of several honors and awards, including a Clinical Research Fellowship from the Doris Duke Charitable Foundation (2008) and induction into the Alpha Omega Alpha Medical Honor Society in 2010. To further refine and expand his skills in patient-reported outcomes research, Dr. Nelson recently obtained a Master of Public Health degree from Johns Hopkins Bloomberg School of Public Health. He has published extensively (135 publications; h index: 29, 41 as first author).