Factors Influencing Patient Choice in Type of Breast Reconstruction: A Qualitative Study

Lankage, Dinush LM ORCID: 0009-0008-7690-2365 (2023). Factors Influencing Patient Choice in Type of Breast Reconstruction: A Qualitative Study. University of Birmingham. M.D.

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Abstract

Background
Mastectomy involves the surgical removal of the breast, often forming part of the treatment for primary breast cancer. Current guidance recommends that all women having mastectomy should have access to choice when selecting a type of surgical breast reconstruction, unless clinically circumscribed. The National Mastectomy and Breast Reconstruction Audit found that despite this guidance there was wide geographical variation in uptake of different reconstructive options, suggesting that factors other than women’s preference could have played a role. Although women’s experiences of choosing whether to undergo breast reconstruction is well described in the literature, there is limited research that examines what is important to women when selecting a particular type of reconstructive surgery.
Aims
This study addresses this gap by exploring women’s and clinicians’ perceptions of the decision-making process taking place within the breast reconstruction consultation. It aims to answer the following research questions:
What do women with breast cancer perceive as influential when choosing a type of breast reconstruction?
What experiences were important to women with breast cancer undergoing mastectomy when choosing to have breast reconstruction?
What do clinicians think is important to women when choosing a type of breast reconstruction?
Design
A two-phase design including a qualitative evidence synthesis and a qualitative study is described in this thesis.
Methods
A search of the electronic databases MEDLINE, CINAHL, EMBASE and PsycINFO was completed using a search strategy following transparent reporting of systematic reviews and meta-analysis (PRISMA) guidelines. Data which contributed to understanding the first research question were extracted and analysed using thematic synthesis.
Semi-structured interviews with 20 women with mastectomy and six clinicians recruited from two NHS Hospital Trusts in England were completed. Following transcription, these were analysed using descriptive thematic analysis supported by NVivo.
Results
In the evidence synthesis, four studies from the US, Netherlands and UK were included, with a total of 104 participants. Following data extraction and analysis, six themes were identified: Appearance, Return to Normal, Natural, Perception of Reconstructive Risks, The Surgical Consultation, and Body Ethics.
Analysis of interviews with women identified two themes that illustrated their decision making: Caring for the Body and The Influence of the Surgeon. Separate analysis of interviews with clinicians identified three themes: Trust, The Clinician’s Preference, and Clinical Restrictions on Choice.
Conclusion
These findings provide insight into women’s experiences when faced with a choice between breast reconstruction options. Women generally chose a type of reconstruction based on personal preference, perception of risk and practicality. Clinicians may need to pay greater attention to women’s understanding of risk in order to truly achieve patient-centredness. This will help support women’s decision-making during breast reconstruction consultations, to ensure choice is aligned with their individual needs.