Breast Reconstruction, Breast Cancer
Conditions
Keywords
Breast cancer, Breast Reconstruction, Breast Reconstruction Education, Breast Reconstruction Decision Tool
Brief summary
Breast reconstruction after mastectomy is a highly personal decision. Although it can restore quality of life for many, there are numerous risks associated with the procedure. The risk of complications exceeds that of most elective procedures. In past work, a clinical decision support tool, BREASTChoice, with personalized risk information and patient preferences, was created to be used to address these issues. It was modified with extensive stakeholder input and built to be incorporated into electronic health records and patient portals. This randomized control trial will evaluate whether the implementation of BREASTChoice into routine care delivery is more effective than a control website, at improving the quality of reconstruction decisions.
Detailed description
Prior to the beginning of the Randomized Control Trial (RCT), a pilot phase will be launched to test the workflow and procedures. The investigators plan to recruit up to 20 patients, continuing until procedures are smooth and ready for the randomized trial. The investigators will follow these same procedures as the trial, other than randomization, to test the workflow and tool use programming. For the RCT, patients considering mastectomy at academic and community practices (n=340) will be randomized over 18 months to use BREASTChoice or a control website. After the patient participant consents to be in the study, they will be randomized (using computer random assignment) participants to view the clinical decision support tool, BREASTChoice or the attention control website, using block randomization (block size of 2 and 4). Depending on the clinic work-flow, the patients may be sent the link to the tool or control website: 1) by email or MyChart message, prior to their visit with the plastic or reconstruction surgeon, for them to complete from home or in the waiting room (ideal and preferred approach); 2) by email or MyChart, in person or virtually at the time of their plastic or reconstruction visit, for patients that have same-day breast surgeon and plastic reconstruction surgeon visits, with time to wait in between appointments; or 3) by email or MyChart, after the plastic surgery appointment, if they have not yet made a decision about reconstruction after mastectomy (e.g., if they are undergoing neoadjuvant chemotherapy, or they want or need more time to decide on their surgery choices). Participants will be sent the link via MyChart unless they do not have a MyChart account. In that case, they will be sent the link via email. Study staff will be available to answer questions about MyChart via phone or email. BREASTChoice is interactive with multiple modules. It starts with facts about breast reconstruction. Modules describe pros and cons of reconstruction, reconstruction timing, and reconstruction types. When discussing reconstruction timing, a risk prediction model pulls health data from the EHR (asking patients information in the model that is missing) to personalize risk of complications from immediate breast reconstruction. It also shows average risks for mastectomy alone and mastectomy plus immediate breast reconstruction so women can compare their personalized risk to average risks. Each module contains real patient quotes, a section called Let's review which checks patients' understanding, and What matters to you, which elicits patients' preferences. Diverse patient photos and outcomes are provided. It is written at a 7th grade reading level. Data on patients' risks and a summary of her preferences are sent to their plastic/reconstructive surgeon to view in the electronic health record. The tool takes the patient about 20minutes to complete. Control Website: The investigators chose an attention control, rather than usual care, to reduce differences between arms in participant expectation of benefit. Those in the control arm will get a link to an NCI website about breast reconstruction. That website includes 10 sections with information about types of breast reconstruction, timing, recovery, risks, cancer surveillance and additional resources. The website provides information, but does not include values clarification or tailored risk information. It is not interactive and does not include photos.. (https://www.cancer.gov/types/breast/reconstruction-fact-sheet)
Interventions
OTHERBreast Reconstruction Education and Support Tool (BREASTChoice)
The tool is an interactive website and can be sent through My Chart and integrated into the electronic health record
OTHERAttention Control Website
-(https://www.cancer.gov/types/breast/reconstruction-fact-sheet)
OTHERClinician Survey
-Questions regarding opinions on shared decision-making with answers ranging from 1-7 with 1=strongly disagree or harmful to 7=strongly agree or beneficial. The higher the score the more the physician agrees with shared decision making.
Sponsors
Agency for Healthcare Research and Quality (AHRQ)
Washington University School of Medicine
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 18 years of age or older * Diagnosis of incident or recurrent stage 0-III breast carcinoma
Exclusion criteria
* Stage IV breast carcinoma * Histology type besides ductal/lobular carcinoma (e.g. phyllodes, sarcoma - these rare tumors differ in treatment and prognosis) * Prior mastectomy and are seeking delayed breast reconstruction * No malignancy (i.e., considering mastectomy for prophylaxis only) * Cannot give informed consent or use provided study materials due to self-reported or observed cognitive, visual, or emotional barriers Inclusion Criteria for Clinicians: -Clinicians who provide breast cancer care within the plastic and reconstructive surgery at Barnes Jewish Hospital, Siteman Cancer Center, Barnes Jewish West County, Christian Hospital North East, and the Stefanie Spielman Comprehensive Breast Center of OSU who provide care for patients considering breast reconstruction after mastectomy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Knowledge as Measured by Decision Quality Instrument | After initial visit but before surgery, estimated to be before day 7 | -The validated Breast Reconstruction Decision Quality Instrument (DQI) knowledge scale contains 9 items on key facts about reconstruction. A value of 1 is given for each correct answer and a value of 0 is given for each incorrect answer. An overall knowledge score is calculated for each patient by dividing the number of correct responses (range 0-9) by 9 to be re-scaled from 0-100. Higher values indicate higher knowledge. |
| Preference Concordance | Preference assessed after initial visit, estimated to be day 7; actual treatment received collected from the EHR | * Investigators will estimate the patient's preferred treatment (mastectomy alone vs. mastectomy with reconstruction), by inputting values (entered into BREASTChoice or control survey) into a statistical model to compute preferred treatment. The investigators will compare preferred treatments to actual treatment received, with concordance determined by agreement between preferred and actual treatment received. The investigators will consider actual treatment received to be delayed reconstruction, if she states an intention to have delayed reconstruction, as she might not have started this process during the study. * Reconstruction vs no reconstruction excluded includes those who did not have a mastectomy, unsure or no preference, or received lumpectomy. * Immediate vs delayed reconstruction excluded includes those with unsure preference or no preference. * Flap vs implant reconstruction excluded includes those unsure of final reconstruction type, unsure preference, or no preference. |
| Decisional Conflict as Measured by the SURE (Sure of Myself; Understand Information; Risk-benefit Ratio; Encouragement) Scale for Decisional Conflict | After initial visit but before surgery, estimated to be before day 7 | -The validated, widely-used SURE (Sure of myself; Understand information; Risk-benefit ratio; Encouragement) Measure of Decisional Conflict asks whether patients have enough information to make a choice, enough support to make a choice, and are clear about their values. It is a 4-item measure of yes/no questions (1=yes, 0=no). A score of ≤3 indicates decisional conflict; the outcome is binary indicating a score of 4 (no decisional conflict) vs. ≤3 (presence of decisional conflict). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Consult Time as Measured by Time Spent With Clinician During the Visit | Initial visit (day 1) | -Consult time using the BREASTChoice will be compared to consult using the attention control. |
| Usability as Measured by the System Usability Scale (SUS) | After initial visit but before surgery, estimated to be before day 7 | -The System Usability Index (SUS) is a 10-item measure (each scaled 1-5) of how easy a website is to use. It is asked of only those in the BreastChoice group to assess the usability of tool. A usability score is calculated by adding the items and multiplying the sum by 2.5. Usability scores can range from 0-100 with higher scores indicating greater usability. A score greater than 68 indicates adequate usability. |
| Compare Number of High-risk Participants From Each Arm Who Chose Breast Reconstruction | After patient participation (approximately 18 months) | -Participants will be considered high-risk if their risk exceeds two times the population average |
| Preference Concordance as Measured by the Decision Quality Instrument | Preference assessed after initial visit, estimated to be day 7; actual treatment received collected from the EHR | * The investigators will estimate the patient's preferred treatment (mastectomy alone versus mastectomy with reconstruction), by inputting values (entered into BREASTChoice or control survey) into a statistical model to compute preferred treatment. The investigators will compare preferred treatments to actual treatment received, with concordance determined by agreement between preferred and actual treatment received. The investigators will consider actual treatment received to be delayed reconstruction, if she states an intention to have delayed reconstruction, as she might not have started this process during the study. * Reconstruction vs no reconstruction excluded includes those who did not have a mastectomy, no preference, or received lumpectomy. * Immediate vs delayed reconstruction excluded includes those with unsure preference or no preference. * Flap vs implant reconstruction excluded includes those unsure of final reconstruction type, unsure preference, or no preference. |
| Decisional Conflict as Measured by the SURE (Sure of Myself; Understand Information; Risk-benefit Ratio; Encouragement) Scale for Decisional Conflict | After initial visit but before surgery, estimated to be before day 7 | -The validated, widely-used SURE measure of decisional conflict asks whether patients have enough information to make a choice, enough support to make a choice, and are clear about their values. It is a 4-item measure of yes/no questions (1=yes, 0=no). A score of ≤3 indicates decisional conflict. |
| Knowledge as Measured by Decision Quality Instrument | After initial visit but before surgery, estimated to be before day 7 | -The validated Breast Reconstruction Decision Quality Instrument (DQI) knowledge scale contains 9 items on key facts about reconstruction. A knowledge score will be calculated for each patient by dividing the number of correct responses by the number of knowledge items. Value of 1 given for each correct answer and value of 0 for each incorrect answer. Overall knowledge score range is 0-9 re-scaled from 0-100. |
| Provider Intention to Engage in Shared Decision Making as Measured by the Change in the Mean CPD (Continuing Professional Development)-Reaction Scale | Assessed pre- and post-study (approximately 24 months) | -The Continuing Professional Development (CPD) Reaction scale is a 12-item measure with each item having a scale of 1-7. These 12 items correspond to the following 5 constructs (2-3 items per construct) are assessed: intention (2 items), social influence (3 items), beliefs about capabilities (3 items), moral norm (2 items), and beliefs about consequence (2 items). The possible scale range is 1-7. Higher values or a positive change indicates higher intention, social influence, beliefs about capabilities, moral norm, or beliefs about consequences of engaging in shared decision making. Each scale is reported as an average. \*\*For clinician arm only |
| Knowledge as Measured by Knowledge Questions Developed in Previous Studies | After initial visit but before surgery, estimated before day 7 | -This is a an 11-item measure using true/false/unsure response options. A knowledge score is calculated by dividing the number of correct responses (each scored 1 if correct, 0 if incorrect, unsure, or blank) by the number of knowledge items (11), to be re-scaled to 0-100. Higher values indicate higher knowledge. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| BREASTChoice * After consent, the participant will be randomized
* Depending on the clinic work-flow, the patient will be sent the link to the BREASTChoice tool by email or MyChart message
* 1\) prior to their visit with the surgeon;
* 2\) at the time of their visit with the surgeon;
* 3\) after the surgeon appointment
* Will receive an online survey to complete after viewing the BREASTChoice tool assessing socio-demographics, knowledge, health literacy, decisional conflict, patient engagement, health-related quality of life, preferred decision role, and usability of the website.
* Will pull from the electronic medical record breast cancer diagnosis stage, previous breast cancer surgery and participants' reconstruction decision after enrollment. | 184 |
| Attention Control Website * After consent, the participant will be randomized
* Depending on the clinic work-flow, the patient will be sent the link to the website by email or MyChart message
* 1\) prior to their visit with the surgeon;
* 2\) at the time of their visit with the surgeon;
* 3\) after the surgeon appointment
* Will receive an online survey to complete after viewing the website assessing socio-demographics, knowledge, preferences, health literacy, decisional conflict, measure of patient engagement, health-related quality of life, preferred decision role, consult time, and usability of the website.
* Will pull from the electronic medical record breast cancer diagnosis stage, previous breast cancer surgery and participants' reconstruction decision after enrollment. | 185 |
| Clinicians * Will receive a brief virtual training on how BREASTChoice functions and the features, including placement of the patient tool summary in the electronic health record
* Will complete pre-post trial survey about shared decision making | 23 |
| Total | 392 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Accidently randomized | 3 | 1 | 0 |
| Overall Study | Did not complete survey | 28 | 20 | 3 |
Baseline characteristics
| Characteristic | BREASTChoice | Attention Control Website | Clinicians | Total |
|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 28 Participants | 27 Participants | 0 Participants | 55 Participants |
| Age, Categorical Between 18 and 65 years | 156 Participants | 158 Participants | 0 Participants | 314 Participants |
| Age, Continuous | 51.0 years | 51.2 years | — | 51.3 years |
| Annual household income <$30,000 | 12 Participants | 17 Participants | — | 29 Participants |
| Annual household income $30,000 to $74,999 | 33 Participants | 28 Participants | — | 61 Participants |
| Annual household income $75,000 or more | 91 Participants | 96 Participants | — | 187 Participants |
| Annual household income Prefer not to answer | 16 Participants | 17 Participants | — | 33 Participants |
| Breast cancer stage Stage 0 | 41 Participants | 32 Participants | — | 73 Participants |
| Breast cancer stage Stage I | 75 Participants | 77 Participants | — | 152 Participants |
| Breast cancer stage Stage II | 45 Participants | 54 Participants | — | 99 Participants |
| Breast cancer stage Stage III | 22 Participants | 19 Participants | — | 41 Participants |
| Breast cancer stage Stage IV | 1 Participants | 3 Participants | — | 4 Participants |
| Educational attainment College degree | 47 Participants | 58 Participants | 0 Participants | 105 Participants |
| Educational attainment Graduate/professional degree | 49 Participants | 57 Participants | 23 Participants | 129 Participants |
| Educational attainment High school or less | 15 Participants | 16 Participants | 0 Participants | 31 Participants |
| Educational attainment Some college | 26 Participants | 22 Participants | 0 Participants | 48 Participants |
| Educational attainment Technical training | 5 Participants | 5 Participants | 0 Participants | 10 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 2 Participants | 5 Participants | 0 Participants | 7 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 182 Participants | 180 Participants | 23 Participants | 385 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 2 Participants | 3 Participants | 4 Participants | 9 Participants |
| Race (NIH/OMB) Black or African American | 11 Participants | 21 Participants | 0 Participants | 32 Participants |
| Race (NIH/OMB) More than one race | 4 Participants | 3 Participants | 0 Participants | 7 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 2 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) White | 167 Participants | 156 Participants | 19 Participants | 342 Participants |
| Region of Enrollment United States | 184 participants | 185 participants | 23 participants | 392 participants |
| Sex: Female, Male Female | 184 Participants | 185 Participants | 12 Participants | 381 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 11 Participants | 11 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 156 | 1 / 165 | 0 / 0 |
| other Total, other adverse events | 0 / 156 | 0 / 165 | 0 / 0 |
| serious Total, serious adverse events | 0 / 156 | 0 / 165 | 0 / 0 |
Outcome results
Primary
Decisional Conflict as Measured by the SURE (Sure of Myself; Understand Information; Risk-benefit Ratio; Encouragement) Scale for Decisional Conflict
-The validated, widely-used SURE (Sure of myself; Understand information; Risk-benefit ratio; Encouragement) Measure of Decisional Conflict asks whether patients have enough information to make a choice, enough support to make a choice, and are clear about their values. It is a 4-item measure of yes/no questions (1=yes, 0=no). A score of ≤3 indicates decisional conflict; the outcome is binary indicating a score of 4 (no decisional conflict) vs. ≤3 (presence of decisional conflict).
Time frame: After initial visit but before surgery, estimated to be before day 7
Population: Overall number of participants analyzed include those in the intent to treat analysis. Data for this outcome measure was not collected on Clinicians.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| BREASTChoice | Decisional Conflict as Measured by the SURE (Sure of Myself; Understand Information; Risk-benefit Ratio; Encouragement) Scale for Decisional Conflict | Decisional conflict | 31 Participants |
| BREASTChoice | Decisional Conflict as Measured by the SURE (Sure of Myself; Understand Information; Risk-benefit Ratio; Encouragement) Scale for Decisional Conflict | No decisional conflict | 111 Participants |
| Attention Control Website | Decisional Conflict as Measured by the SURE (Sure of Myself; Understand Information; Risk-benefit Ratio; Encouragement) Scale for Decisional Conflict | Decisional conflict | 44 Participants |
| Attention Control Website | Decisional Conflict as Measured by the SURE (Sure of Myself; Understand Information; Risk-benefit Ratio; Encouragement) Scale for Decisional Conflict | No decisional conflict | 113 Participants |
p-value: 0.2317Fisher Exact
Primary
Knowledge as Measured by Decision Quality Instrument
-The validated Breast Reconstruction Decision Quality Instrument (DQI) knowledge scale contains 9 items on key facts about reconstruction. A value of 1 is given for each correct answer and a value of 0 is given for each incorrect answer. An overall knowledge score is calculated for each patient by dividing the number of correct responses (range 0-9) by 9 to be re-scaled from 0-100. Higher values indicate higher knowledge.
Time frame: After initial visit but before surgery, estimated to be before day 7
Population: Overall number of participants analyzed include those in the intent to treat analysis. Data for this outcome measure was not collected on Clinicians.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| BREASTChoice | Knowledge as Measured by Decision Quality Instrument | 66.7 score on a scale |
| Attention Control Website | Knowledge as Measured by Decision Quality Instrument | 66.7 score on a scale |
p-value: 0.801Kruskal-Wallis
Primary
Preference Concordance
* Investigators will estimate the patient's preferred treatment (mastectomy alone vs. mastectomy with reconstruction), by inputting values (entered into BREASTChoice or control survey) into a statistical model to compute preferred treatment. The investigators will compare preferred treatments to actual treatment received, with concordance determined by agreement between preferred and actual treatment received. The investigators will consider actual treatment received to be delayed reconstruction, if she states an intention to have delayed reconstruction, as she might not have started this process during the study. * Reconstruction vs no reconstruction excluded includes those who did not have a mastectomy, unsure or no preference, or received lumpectomy. * Immediate vs delayed reconstruction excluded includes those with unsure preference or no preference. * Flap vs implant reconstruction excluded includes those unsure of final reconstruction type, unsure preference, or no preference.
Time frame: Preference assessed after initial visit, estimated to be day 7; actual treatment received collected from the EHR
Population: Overall number of participants analyzed include those in the intent to treat analysis. Data for this outcome measure was not collected on Clinicians.
| Arm | Measure | Group | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|---|
| BREASTChoice | Preference Concordance | Reconstruction versus No reconstruction | Treatment does not match preference | 13 Participants |
| BREASTChoice | Preference Concordance | Immediate reconstruction versus delayed reconstruction | Excluded | 44 Participants |
| BREASTChoice | Preference Concordance | Immediate reconstruction versus delayed reconstruction | Treatment matches preference | 48 Participants |
| BREASTChoice | Preference Concordance | Flap reconstruction versus Implant reconstruction | Treatment matches preference | 33 Participants |
| BREASTChoice | Preference Concordance | Reconstruction versus No reconstruction | Excluded | 60 Participants |
| BREASTChoice | Preference Concordance | Flap reconstruction versus Implant reconstruction | Treatment does not match preference | 6 Participants |
| BREASTChoice | Preference Concordance | Immediate reconstruction versus delayed reconstruction | Treatment does not match preference | 11 Participants |
| BREASTChoice | Preference Concordance | Flap reconstruction versus Implant reconstruction | Excluded | 64 Participants |
| BREASTChoice | Preference Concordance | Reconstruction versus No reconstruction | Treatment matches preference | 83 Participants |
| Attention Control Website | Preference Concordance | Flap reconstruction versus Implant reconstruction | Excluded | 33 Participants |
| Attention Control Website | Preference Concordance | Reconstruction versus No reconstruction | Treatment matches preference | 113 Participants |
| Attention Control Website | Preference Concordance | Reconstruction versus No reconstruction | Treatment does not match preference | 9 Participants |
| Attention Control Website | Preference Concordance | Reconstruction versus No reconstruction | Excluded | 43 Participants |
| Attention Control Website | Preference Concordance | Immediate reconstruction versus delayed reconstruction | Treatment matches preference | 73 Participants |
| Attention Control Website | Preference Concordance | Immediate reconstruction versus delayed reconstruction | Treatment does not match preference | 22 Participants |
| Attention Control Website | Preference Concordance | Immediate reconstruction versus delayed reconstruction | Excluded | 14 Participants |
| Attention Control Website | Preference Concordance | Flap reconstruction versus Implant reconstruction | Treatment matches preference | 60 Participants |
| Attention Control Website | Preference Concordance | Flap reconstruction versus Implant reconstruction | Treatment does not match preference | 16 Participants |
Comparison: Reconstruction versus No reconstructionp-value: 0.1336Fisher Exact
p-value: 0.5505Fisher Exact
Comparison: Flap reconstruction versus Implant reconstructionp-value: 0.6178Fisher Exact
Secondary
Compare Number of High-risk Participants From Each Arm Who Chose Breast Reconstruction
-Participants will be considered high-risk if their risk exceeds two times the population average
Time frame: After patient participation (approximately 18 months)
Population: Only high risk participants are included in this outcome measure. Data for this outcome measure was not collected on Clinicians.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| BREASTChoice | Compare Number of High-risk Participants From Each Arm Who Chose Breast Reconstruction | 8 Participants |
| Attention Control Website | Compare Number of High-risk Participants From Each Arm Who Chose Breast Reconstruction | 11 Participants |
p-value: 0.036Fisher Exact
Secondary
Compare Number of High-risk Participants From Each Arm Who Chose Breast Reconstruction
-Participants will be considered high-risk if their risk exceeds two times the population average
Time frame: After patient participation (approximately 18 months)
Population: Overall number of participants analyzed include those in the intent to treat analysis. Data for this outcome measure was not collected on Clinicians.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| BREASTChoice | Compare Number of High-risk Participants From Each Arm Who Chose Breast Reconstruction | 10 Participants |
| Attention Control Website | Compare Number of High-risk Participants From Each Arm Who Chose Breast Reconstruction | 11 Participants |
p-value: 0.1052Fisher Exact
Secondary
Consult Time as Measured by Time Spent With Clinician During the Visit
-Consult time using the BREASTChoice will be compared to consult using the attention control.
Time frame: Initial visit (day 1)
Population: The data for this outcome measure was not collected.
Secondary
Decisional Conflict as Measured by the SURE (Sure of Myself; Understand Information; Risk-benefit Ratio; Encouragement) Scale for Decisional Conflict
-The validated, widely-used SURE measure of decisional conflict asks whether patients have enough information to make a choice, enough support to make a choice, and are clear about their values. It is a 4-item measure of yes/no questions (1=yes, 0=no). A score of ≤3 indicates decisional conflict.
Time frame: After initial visit but before surgery, estimated to be before day 7
Population: For this analysis, BREASTChoice participants who never accessed the tool were excluded. If participants did not answer the questions, they were also excluded. Data for this outcome measure was not collected on Clinicians.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| BREASTChoice | Decisional Conflict as Measured by the SURE (Sure of Myself; Understand Information; Risk-benefit Ratio; Encouragement) Scale for Decisional Conflict | Decisional conflict | 31 Participants |
| BREASTChoice | Decisional Conflict as Measured by the SURE (Sure of Myself; Understand Information; Risk-benefit Ratio; Encouragement) Scale for Decisional Conflict | No decisional conflict | 105 Participants |
| Attention Control Website | Decisional Conflict as Measured by the SURE (Sure of Myself; Understand Information; Risk-benefit Ratio; Encouragement) Scale for Decisional Conflict | Decisional conflict | 44 Participants |
| Attention Control Website | Decisional Conflict as Measured by the SURE (Sure of Myself; Understand Information; Risk-benefit Ratio; Encouragement) Scale for Decisional Conflict | No decisional conflict | 113 Participants |
p-value: 0.308Fisher Exact
Secondary
Knowledge as Measured by Decision Quality Instrument
-The validated Breast Reconstruction Decision Quality Instrument (DQI) knowledge scale contains 9 items on key facts about reconstruction. A knowledge score will be calculated for each patient by dividing the number of correct responses by the number of knowledge items. Value of 1 given for each correct answer and value of 0 for each incorrect answer. Overall knowledge score range is 0-9 re-scaled from 0-100.
Time frame: After initial visit but before surgery, estimated to be before day 7
Population: For this analysis, BREASTChoice participants who never accessed the tool were excluded. Data for this outcome measure was not collected on Clinicians.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| BREASTChoice | Knowledge as Measured by Decision Quality Instrument | 66.7 score on a scale |
| Attention Control Website | Knowledge as Measured by Decision Quality Instrument | 66.7 score on a scale |
p-value: 0.0302Kruskal-Wallis
Secondary
Knowledge as Measured by Knowledge Questions Developed in Previous Studies
-This is a an 11-item measure using true/false/unsure response options. A knowledge score is calculated by dividing the number of correct responses (each scored 1 if correct, 0 if incorrect, unsure, or blank) by the number of knowledge items (11), to be re-scaled to 0-100. Higher values indicate higher knowledge.
Time frame: After initial visit but before surgery, estimated before day 7
Population: Overall number of participants analyzed include those in the intent to treat analysis. Data for this outcome measure was not collected on Clinicians.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| BREASTChoice | Knowledge as Measured by Knowledge Questions Developed in Previous Studies | 84.7 score on a scale | Standard Deviation 13.8 |
| Attention Control Website | Knowledge as Measured by Knowledge Questions Developed in Previous Studies | 66.5 score on a scale | Standard Deviation 15.8 |
p-value: <0.001Kruskal-Wallis
Secondary
Preference Concordance as Measured by the Decision Quality Instrument
* The investigators will estimate the patient's preferred treatment (mastectomy alone versus mastectomy with reconstruction), by inputting values (entered into BREASTChoice or control survey) into a statistical model to compute preferred treatment. The investigators will compare preferred treatments to actual treatment received, with concordance determined by agreement between preferred and actual treatment received. The investigators will consider actual treatment received to be delayed reconstruction, if she states an intention to have delayed reconstruction, as she might not have started this process during the study. * Reconstruction vs no reconstruction excluded includes those who did not have a mastectomy, no preference, or received lumpectomy. * Immediate vs delayed reconstruction excluded includes those with unsure preference or no preference. * Flap vs implant reconstruction excluded includes those unsure of final reconstruction type, unsure preference, or no preference.
Time frame: Preference assessed after initial visit, estimated to be day 7; actual treatment received collected from the EHR
Population: For this analysis, BREASTChoice participants who never accessed the tool were excluded. Data for this outcome measure was not collected on Clinicians.
| Arm | Measure | Group | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|---|
| BREASTChoice | Preference Concordance as Measured by the Decision Quality Instrument | Reconstruction versus No reconstruction | Treatment does not match preference | 13 Participants |
| BREASTChoice | Preference Concordance as Measured by the Decision Quality Instrument | Immediate reconstruction versus delayed reconstruction | Excluded | 41 Participants |
| BREASTChoice | Preference Concordance as Measured by the Decision Quality Instrument | Immediate reconstruction versus delayed reconstruction | Treatment matches preference | 48 Participants |
| BREASTChoice | Preference Concordance as Measured by the Decision Quality Instrument | Flap reconstruction versus Implant reconstruction | Treatment matches preference | 33 Participants |
| BREASTChoice | Preference Concordance as Measured by the Decision Quality Instrument | Reconstruction versus No reconstruction | Excluded | 54 Participants |
| BREASTChoice | Preference Concordance as Measured by the Decision Quality Instrument | Flap reconstruction versus Implant reconstruction | Treatment does not match preference | 6 Participants |
| BREASTChoice | Preference Concordance as Measured by the Decision Quality Instrument | Immediate reconstruction versus delayed reconstruction | Treatment does not match preference | 11 Participants |
| BREASTChoice | Preference Concordance as Measured by the Decision Quality Instrument | Flap reconstruction versus Implant reconstruction | Excluded | 61 Participants |
| BREASTChoice | Preference Concordance as Measured by the Decision Quality Instrument | Reconstruction versus No reconstruction | Treatment matches preference | 83 Participants |
| Attention Control Website | Preference Concordance as Measured by the Decision Quality Instrument | Flap reconstruction versus Implant reconstruction | Excluded | 33 Participants |
| Attention Control Website | Preference Concordance as Measured by the Decision Quality Instrument | Reconstruction versus No reconstruction | Treatment matches preference | 113 Participants |
| Attention Control Website | Preference Concordance as Measured by the Decision Quality Instrument | Reconstruction versus No reconstruction | Treatment does not match preference | 9 Participants |
| Attention Control Website | Preference Concordance as Measured by the Decision Quality Instrument | Reconstruction versus No reconstruction | Excluded | 43 Participants |
| Attention Control Website | Preference Concordance as Measured by the Decision Quality Instrument | Immediate reconstruction versus delayed reconstruction | Treatment matches preference | 73 Participants |
| Attention Control Website | Preference Concordance as Measured by the Decision Quality Instrument | Immediate reconstruction versus delayed reconstruction | Treatment does not match preference | 22 Participants |
| Attention Control Website | Preference Concordance as Measured by the Decision Quality Instrument | Immediate reconstruction versus delayed reconstruction | Excluded | 14 Participants |
| Attention Control Website | Preference Concordance as Measured by the Decision Quality Instrument | Flap reconstruction versus Implant reconstruction | Treatment matches preference | 60 Participants |
| Attention Control Website | Preference Concordance as Measured by the Decision Quality Instrument | Flap reconstruction versus Implant reconstruction | Treatment does not match preference | 16 Participants |
Comparison: Reconstruction versus No reconstructionp-value: 0.135Fisher Exact
Comparison: Immediate reconstruction versus delayed reconstructionp-value: 0.51Fisher Exact
Comparison: Flap reconstruction versus Implant reconstructionp-value: 0.469Fisher Exact
Secondary
Provider Intention to Engage in Shared Decision Making as Measured by the Change in the Mean CPD (Continuing Professional Development)-Reaction Scale
-The Continuing Professional Development (CPD) Reaction scale is a 12-item measure with each item having a scale of 1-7. These 12 items correspond to the following 5 constructs (2-3 items per construct) are assessed: intention (2 items), social influence (3 items), beliefs about capabilities (3 items), moral norm (2 items), and beliefs about consequence (2 items). The possible scale range is 1-7. Higher values or a positive change indicates higher intention, social influence, beliefs about capabilities, moral norm, or beliefs about consequences of engaging in shared decision making. Each scale is reported as an average. \*\*For clinician arm only
Time frame: Assessed pre- and post-study (approximately 24 months)
Population: This outcome measure is for Clinicians only.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Clinicians | Provider Intention to Engage in Shared Decision Making as Measured by the Change in the Mean CPD (Continuing Professional Development)-Reaction Scale | Intention (Pre-Study) | 6.40 score on a scale | Standard Deviation 0.8 |
| Clinicians | Provider Intention to Engage in Shared Decision Making as Measured by the Change in the Mean CPD (Continuing Professional Development)-Reaction Scale | Intention (Post-Study) | 6.55 score on a scale | Standard Deviation 0.76 |
| Clinicians | Provider Intention to Engage in Shared Decision Making as Measured by the Change in the Mean CPD (Continuing Professional Development)-Reaction Scale | Social influence (Pre-Study) | 5.23 score on a scale | Standard Deviation 1.78 |
| Clinicians | Provider Intention to Engage in Shared Decision Making as Measured by the Change in the Mean CPD (Continuing Professional Development)-Reaction Scale | Social influence (Post-Study) | 5.18 score on a scale | Standard Deviation 1.57 |
| Clinicians | Provider Intention to Engage in Shared Decision Making as Measured by the Change in the Mean CPD (Continuing Professional Development)-Reaction Scale | Beliefs about capabilities (Pre-Study) | 6.04 score on a scale | Standard Deviation 0.86 |
| Clinicians | Provider Intention to Engage in Shared Decision Making as Measured by the Change in the Mean CPD (Continuing Professional Development)-Reaction Scale | Beliefs about capabilities (Post-Study) | 6.07 score on a scale | Standard Deviation 0.75 |
| Clinicians | Provider Intention to Engage in Shared Decision Making as Measured by the Change in the Mean CPD (Continuing Professional Development)-Reaction Scale | Moral norm (Pre-Study) | 6.43 score on a scale | Standard Deviation 0.75 |
| Clinicians | Provider Intention to Engage in Shared Decision Making as Measured by the Change in the Mean CPD (Continuing Professional Development)-Reaction Scale | Moral norm (Post-Study) | 6.68 score on a scale | Standard Deviation 0.56 |
| Clinicians | Provider Intention to Engage in Shared Decision Making as Measured by the Change in the Mean CPD (Continuing Professional Development)-Reaction Scale | Beliefs about consequences (Pre-Study) | 6.33 score on a scale | Standard Deviation 0.8 |
| Clinicians | Provider Intention to Engage in Shared Decision Making as Measured by the Change in the Mean CPD (Continuing Professional Development)-Reaction Scale | Beliefs about consequences (Post-Study) | 6.53 score on a scale | Standard Deviation 0.99 |
Secondary
Usability as Measured by the System Usability Scale (SUS)
-The System Usability Index (SUS) is a 10-item measure (each scaled 1-5) of how easy a website is to use. It is asked of only those in the BreastChoice group to assess the usability of tool. A usability score is calculated by adding the items and multiplying the sum by 2.5. Usability scores can range from 0-100 with higher scores indicating greater usability. A score greater than 68 indicates adequate usability.
Time frame: After initial visit but before surgery, estimated to be before day 7
Population: Only participants in the BREASTChoice arm were evaluable for this outcome measure.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| BREASTChoice | Usability as Measured by the System Usability Scale (SUS) | 84.6 score on a scale | Standard Deviation 14.3 |