Summary
Introduction
The evaluation of breast reconstruction after treatment for cancer sometimes differs
between the patient who receives it and the surgeon who performs it. Questionnaire
studies shed little light on this. We therefore aimed to discover what factors influence
how patients evaluate breast reconstruction and thereby to understand sources of disagreement
between practitioners and patients in their evaluation.
Methods
At the study centre, patients who undergo reconstruction following breast cancer rate
their subjective evaluation of the procedure, and the surgeon and breast care nurse
jointly rate their assessment of cosmesis. We interviewed in depth 27 patients with
a range of scores on each rating to elicit the reasons for their evaluations. Interviews
were analysed qualitatively with particular attention to patients whose evaluations
diverged from those of practitioners.
Results
Influences on patients' subjective evaluations included two aspects of cosmesis (how
‘normal’ they felt and how normal or attractive they thought they appeared to others),
but also how much they trusted and respected their practitioners and felt cared for
by them, whether reconstruction had helped to complete their ‘cancer journey’ and
post-operative complications.
Conclusion
Patients' subjective evaluation of reconstruction after cancer treatment extends well
beyond cosmesis, and experience of cancer influences what they consider important.
Evaluations therefore often differ from those of practitioners. Surgeons and specialist
nurses need to be aware of the factors that influence patients' evaluations in order
to guide patients appropriately in decisions about surgery, and to evaluate outcomes
across the domains that matter to patients.
Keywords
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Article info
Publication history
Published online: April 04, 2012
Accepted:
March 1,
2012
Received:
July 20,
2011
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
