Decisional Aid Intervention for Women Considering Breast Reconstruction

针对考虑乳房重建的女性的决策性援助干预

• 批准号: 8047439
• 负责人: Sharon L Manne
• 金额: $ 28.03万
• 依托单位: UNIV OF MED/DENT NJ-R W JOHNSON MED SCH
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-13 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8047439
• 关键词: Address; Age-Years; Anxiety; Area; Attitude; Benefits and Risks; Breast; Cancer Survivor; Caring; Complication; Conflict (Psychology); Consultations; Contracture; Cosmetics; Counseling; Data; Decision Aid; Decision Making; Development; Diagnosis; Disadvantaged; Distress; Emotional; Feedback; Implant; Infection; Intention; Intervention; Interview; Knowledge; Long-Term Effects; Mammaplasty; Mastectomy; Methods; Minority; Newly Diagnosed; Online Systems; Operative Surgical Procedures; Outcome; Patients; Phase; Plastic Surgeon; Play; Preparation; Procedures; Process; Provider; Quality of life; Radiation; Randomized Clinical Trials; Reaction; Readiness; Risk; Role; Sampling; Shapes; Staging; Structure; Sum; Surgeon; Testing; Time; Tissue Expanders; Tissues; Woman; alternative treatment; base; breast cancer diagnosis; cost; experience; improved; interest; malignant breast neoplasm; preference; prototype; psychologic; psychosocial; radiation effect; reconstruction; satisfaction; treatment as usual; usability

DESCRIPTION (provided by applicant): The decision whether to pursue breast reconstruction (BR) can be challenging. Women must weigh the importance of potential benefits of the procedure and their personal values and preferences against the risks associated with the procedure and decide what type of reconstruction to have should they pursue it. The decision is typically made in a stressful circumstance, which is immediately after the initial diagnosis of breast cancer. Complicating matters is the fact that there is evidence to suggest that there are variable rates of satisfaction with the cosmetic outcomes of BR. Outcomes may not be in line with what the patient initially expected. BR can be a difficult decision made under stressful circumstances and women may not be as well- informed about the long-term effects as they could be. When patients are faced with treatment decisions for which personal values and quality of life issue play a role and there are multiple treatment choices, decision support in the form of decision aids can be helpful to the process of making a well-informed choice. Decision support aids are a strategy used as an adjunct to practitioners' counseling to facilitate their understanding of the treatment options, the advantages and disadvantages of each option, consideration of the personal importance they attach to the benefits and risks of each alternative, and to encourage active participation with the care provider in deciding which option to pursue. We propose to develop a web-based DA for women being offered BR. We will accomplish this in three phases. Phase 1 is a developmental phase where the basic DA content is developed by the study team with input from patients who have undergone BR, were offered BR and decided against it, or are considering BR. We will include input from minority women, women over 65 years of age, and less educated women, who have less access to BR. Phase 2 consists of gathering feedback terms on the DA prototype from women who have undergone BR, women who were offered BR and chose not to have it, and women who are considering BR. Again, feedback from minority women, women over 65 years of age, and less educated women will be included. The BR Decision Aid (BRDA) will then be finalized. Phase 3 will be a usability and feasibility pilot test of the DA with a sample of women considering BR. The study has one primary aim and two secondary aims. The primary aim is to evaluate the usability and feasibility of a decisional aid to assist women with making the decision to undergo BR. The secondary aims are to examine the acceptability of the BRDA and to provide preliminary data on the impact of BRDA on BR knowledge, values, decisional conflict, preparedness, BR interest, and anxiety. PUBLIC HEALTH RELEVANCE: The decision whether to pursue breast reconstruction (BR) can be challenging. Women must weigh the importance of potential benefits of the procedure and their personal values and preferences against the risks associated with the procedure and decide what type of reconstruction to have should they pursue it. We propose to develop a web-based decision aid for women being offered BR, evaluate its usability, feasibility, and acceptability, and gather preliminary data on its impact of BR knowledge, values, decisional conflict, preparedness, BR interest, and anxiety.

描述（由申请人提供）：决定是否进行乳房重建（BR）可能具有挑战性。女性必须权衡手术潜在益处的重要性以及她们的个人价值观和偏好与手术相关风险，并决定她们应该进行哪种类型的重建。该决定通常是在乳腺癌初步诊断后立即在压力很大的情况下做出的。让事情变得复杂的是，有证据表明，人们对 BR 美容效果的满意度存在差异。结果可能与患者最初的预期不符。在压力很大的情况下，BR 可能是一个艰难的决定，而且女性可能不太了解其长期影响。当患者面临涉及个人价值观和生活质量问题的治疗决策并且存在多种治疗选择时，决策辅助形式的决策支持有助于做出明智的选择。决策支持辅助是一种策略，用作从业者咨询的辅助手段，以促进他们了解治疗方案、每种方案的优点和缺点、考虑他们对每种方案的好处和风险的个人重视程度，并鼓励他们积极参与护理人员决定采取哪种选择。我们建议为接受 BR 的女性开发一个基于网络的 DA。我们将分三个阶段完成这一任务。第一阶段是一个开发阶段，其中基本 DA 内容由研究团队根据接受过 BR、接受过 BR 但决定反对或正在考虑 BR 的患者的意见制定。我们将纳入少数民族妇女、65 岁以上妇女以及受教育程度较低、获得 BR 机会较少的妇女的意见。第 2 阶段包括收集已接受 BR 的女性、已接受 BR 但选择不接受 BR 的女性以及正在考虑 BR 的女性对 DA 原型的反馈条款。同样，少数民族妇女、65 岁以上妇女和受教育程度较低的妇女的反馈也将包括在内。随后将最终确定无线电通信局决策援助 (BRDA)。第三阶段将是对 DA 的可用性和可行性试点测试，以考虑 BR 的女性为样本。该研究有一个主要目标和两个次要目标。主要目的是评估决策援助的可用性和可行性，以帮助妇女做出接受 BR 的决定。第二个目标是检查 BRDA 的可接受性，并提供关于 BRDA 对 BR 知识、价值观、决策冲突、准备情况、BR 兴趣和焦虑影响的初步数据。 公共卫生相关性：决定是否进行乳房重建 (BR) 可能具有挑战性。女性必须权衡手术潜在益处的重要性以及她们的个人价值观和偏好与手术相关风险，并决定她们应该进行哪种类型的重建。我们建议为接受 BR 的女性开发一个基于网络的决策辅助工具，评估其可用性、可行性和可接受性，并收集有关 BR 知识、价值观、决策冲突、准备情况、BR 兴趣和焦虑影响的初步数据。