Abstract P4-17-04: BRECONDA: Development and acceptability of an interactive decisional support tool for women considering breast reconstruction

Abstract

Abstract Introduction: Women needing a mastectomy for breast cancer, or cancer prophylaxis, are faced with the difficult decision regarding whether, and how, to restore breast shape after surgery. To a large extent this decision is based on personal preferences and values. In view of limited support resources available in this context, we have developed an online interactive decision aid, BRECONDA, to assist with decision-making. BRECONDA uses a multi-media platform to provide up-to-date information about surgical choices, interactive decision sheets encouraging women to weigh-up perceived benefits and risks and identify personal values and preferences, and video recorded patient stories. Since psychological stress can hamper decision-making, BRECONDA also demonstrates videoed stress management relaxation techniques. The aim of this study was to assess the user acceptability of this intervention. Methods: Following diagnosis, and prior to surgery, 54 women with breast cancer who were eligible for breast reconstruction following mastectomy were randomly assigned into one of two conditions: 1) Intervention group which received access to the BRECONDA program as well as a standard information booklet about breast surgery given to all such patients; and, 2) Control/Usual care group which received the standard information booklet alone. User ratings of satisfaction and reactions to BRECONDA were documented at 6-week follow-up for the Intervention group through quantitative measures and telephone interviews. Additionally, perceived decisional conflict, distress (intrusive and avoidant thoughts), knowledge and satisfaction with information at the 6-week assessment were documented for all participants. ANCOVAs were used to identify between group differences on these key variables at follow-up. Results: Intervention participants' ratings of BRECONDA demonstrated high user acceptability, with high scores on perceived usefulness, ease of use and provision of sufficient information. Interview data indicated that Intervention participants perceived BRECONDA to be well-balanced, informative, and beneficial to the decision making process and that it helped them feel more secure in their decision and to prepare questions for their surgeon. Interactive decision sheets, patient testimonials and photo galleries were highly valued by all interviewees. At follow-up, 40% of participants had undergone immediate reconstruction, with fewer Intervention participants electing this surgery. Furthermore, Intervention participants reported lower decisional conflict compared with Usual Care participants at follow-up (p <.05). Specifically, these participants reported feeling significantly clearer about personal values for benefits and risks of reconstruction compared with those receiving Usual Care. Conclusions: Users of the interactive online BRECONDA intervention reported high levels of user satisfaction with this innovative decisional support resource, as well as benefits in terms of experiencing less decisional conflict related to the ability to clarify the values that are personally important in the decision making context. This provides preliminary evidence for the acceptability and efficacy of this decision support intervention. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-17-04.