The Influence of Dispositional Optimism on Decision Regret to Undergo Major Breast Reconstructive Surgery

Abstract

INTRODUCTION: Optimism improves patient reported outcomes in breast cancer survivors, however, it is not known if optimism influences a patient’s regret following major reconstructive breast surgery. We examined the relationship between dispositional optimism, major complications and decision regret in patients undergoing microsurgical breast reconstruction. METHODS: A consecutive series of 290 patients with a minimum of one-year follow-up after microsurgical breast reconstruction were surveyed. The two independent variables were: 1) dispositional optimism measured by the Life Orientation Test-Revised(LOT-R) and 2) major complications. The primary outcome was the Decision Regret Scale, a validated instrument in breast reconstruction. A multivariate regression analysis determined the relationship between the independent variables, confounders and decision regret. RESULTS: Of the 181 respondents, 63% reported no regret after breast reconstruction, 26% had mild regret and 11% moderate to severe regret. On the multivariate analysis, major complications did not have a significant effect on decision regret, and the impact of dispositional optimism was not significant in Caucasian women. However, there was a significant effect in non-Caucasian women with greater optimism who had significantly lower levels of mild regret 0.72(0.50-0.95) and lower levels of moderate to severe regret 0.67 (CI 0.28-0.97). CONCLUSION: This is the first paper to identify a vulnerable subgroup of non-Caucasian patients with low dispositional optimism who may be at risk for developing regret after microsurgical breast reconstruction. Possible strategies to ameliorate regret may involve addressing cultural and language barriers, setting realistic expectations for surgical outcomes, and providing more supports during the pre-operative decision-making phase. DISCLOSURES: Dr. Zhong is supported by an American Society of Clinical Oncology, Conquer Cancer Foundation Career Development Award. Dr. Hofer is supported by the Wharton Chair in Plastic and Reconstructive Surgery at the University Health Network. Doctors Hofer, Metcalfe and Zhong are supported by grant funding from the Canadian Breast Cancer Foundation and the Canadian Institutes of Health Research. The remaining authors do not have a financial interest to declare. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.