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Decision Aid for Women with Newly Diagnosed Breast Cancer seeking Breast Reconstruction Surgery: A Prospective, Randomized, Controlled, Single-Blinded, Pilot Study
Kevin M. Klifto, PharmD, Hetty Khan, DNP, Jillian G. Goles, PA-C, Michele A. Manahan, MD, MBA, Justin M. Sacks, MD, MBA, Kristen P. Broderick, MD, Oluseyi Aliu, MD, Damon S. Cooney, MD, PhD, Carisa M. Cooney, MPH, Gedge D. Rosson, MD.
The Johns Hopkins University School of Medicine, Baltimore, MD, USA.

BACKGROUND: Women undergoing immediate mastectomy for breast cancer often experience anxiety when faced with breast reconstruction and the type of reconstruction to choose. The purpose of this study is to analyze the impact of a decision aid on decisional conflict in women with newly diagnosed breast cancer seeking breast reconstruction.
METHODS: Thirty-three newly diagnosed breast cancer patients seeking breast reconstruction at a single-center were prospectively randomized into two groups. Comparisons were made between two groups using the Decisional Conflict Scale (DCS): women who reviewed the standard educational materials prior to initial consultation (control) and women who reviewed standard materials prior to initial consultation and then reviewed a decision aid brochure at initial consultation and two weeks post-consultation (intervention). Differences between pre-to-post-consultation DCS scores, and DCS scores two weeks post-consultation in the control groups and intervention groups were compared to assess which group had lower DCS scores.
RESULTS: A total of 20 patients, mean age 539 years were included. Median differences between pre-to-post-consultation DCS Total scores in the control and intervention groups lowered from 32 to 22 and 28 to 16, respectively. Significant differences in subscores were control group: Uncertainty: 54 to 21(p=0.030), and intervention group: Uncertainty: 46 to 29(p=0.036) and Values clarity: 29 to 25(p=0.042). Differences between DCS scores and subscores two weeks post-consultation did not demonstrate any statistical significance.
CONCLUSIONS: Decision aids did not significantly reduce pre-operative DCS scores compared to current educational materials. Patients receiving the decision aid felt they clearly understood what meant most to them when selecting a reconstruction option prior to surgery.


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