Breast Specialist Nurses – Expensive Hand Holding or Cost-Effective Counselling?

Abstract

Abstract IntroductionCounselling breast cancer patients for reconstruction is complex and time consuming. Post-reconstruction satisfaction has been shown to be related to the quality of information provided to patients. Decisions regarding the type of breast reconstruction suitable for each patient is multi-factorial, including the autologous tissue available, general health, patient lifestyle and suitability, as well as patient preference. In our institution we offer a full range of reconstruction techniques. Initial pre-operative counselling is performed by a breast reconstruction specialist nurse at a consultation lasting at least 1 hour. During this time, all reconstructive options are discussed.Implications of surgery, photographs of post-operative results and the details of the procedures are explained and written information is provided. The option to meet a patient advocate at a later date is offered. An indication of the suitable reconstructive options available to the individual is given, however the surgeon, at a separate consultation lasting 10 minutes, performs the formal assessment of reconstructive type.MethodA comparison was made of patient satisfaction with pre-operative counselling and information giving, between those patients who were counselled by the operative surgeon alone and those counselled by the Breast Reconstruction Specialist nurse. A questionnaire to assess patient satisfaction with the reconstruction counselling was designed in conjunction with the Clinical Psychology team. This questionnaire was posted retrospectively to all patients who had undergone reconstruction counselling irrespective of whether they had subsequently undergone breast reconstruction. Patients were asked to respond to questions on a 5 point Likert scale. Patients were divided into 2 groups dependent on the person performing the counselling, ie. surgeon or nurse. All questionnaires were anonymous.ResultsQuestionnaires were allocated a random number and the data were analyzed independently by 2 separate clinical psychologists, blinded to which group the patients belonged to. Group 1 was counselled by the operative surgeon alone and Group 2 by the Breast Reconstruction Nurse. There was a very high response rate in both groups (70% in Group 1 and 71% in Group 2). Qualitative and quantitative data were analyzed separately. There was a high satisfaction rating in both groups with responses to all questions having a mean rating of above 4 out of 5. Patient satisfaction between the 2 groups was compared using the Mann-Whitney U test. There was no significant reported difference between how useful each of the groups found the contact.ConclusionEmploying a Specialist Nurse to perform the time-consuming pre-operative counselling for breast reconstruction is a cost effective measure, allowing Surgeons time to assess more patients or perform more appropriate skilled tasks instead. Patient satisfaction with the counselling service and information-giving was equal in both groups suggesting that nurse-led counselling, even for complex surgical procedures, is acceptable to patients. Having someone, other than the operative surgeon, give an independent and unbiased perspective on reconstructive options may be important in patient decision making. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1075.