Grants Funded

Abstract

Project Summary: Approximately 40% of breast reconstruction patients experience dissatisfaction due to inaccurate expectations of post-surgical well-being, and aesthetic and physical outcomes of surgery that do not reflect personal treatment preferences. The decisions surrounding breast reconstruction involve trade-offs between multiple simultaneous concerns (i.e. 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 are most important to each patient when making patient-centered treatment decisions. Adaptive Choice-Based Conjoint analysis is a form of preference elicitation that 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 decision tool to facilitate shared decision-making (SDM) and individualize breast reconstruction care. Our preliminary work has developed a decision tool, based on conjoint analysis for patients considering breast reconstruction (RECONJOINT). The goal of this proposal is to optimize the workflow for RECONJOINT to support SDM and then assess the effectiveness and implementation potential of this decision tool in clinical practice. Our specific aims are the following Aim 1: Optimize the Use of RECONJOINT in clinical care through identification of site-specific facilitators and barriers, Aim 2.1: Assess the effectiveness of the RECONJOINT decision tool, and Aim 2.2: Evaluate potential for implementation of the RECONJOINT decision tool. Our central hypothesis is that eliciting treatment preferences with RECONJOINT will support a SDM process and enable surgeons to identify treatment strategies most in line with patient values. Our long-term goal is to develop a clinically relevant decision tool that will improve decisional satisfaction, involvement in SDM, and patient-centered care.

Impact Statement: This work is impactful, because RECONJOINT has the promise to improve SDM through: 1) the identification of breast reconstruction attributes which are most meaningful to an individual patient, and 2) the encouragement of bidirectional communication between patients and surgeons. In turn, this will enhance SDM with thousands of patients facing decisions for breast reconstruction. These findings will help ensure the scalability and implementation of this decision tool and will be crucial in supporting a larger, multi-institutional RCT to evaluate the RECONJOINT decision tool in clinical practice.

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.