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Cancer Control Research

Abstract

DESCRIPTION (provided by applicant): The overriding goal of post-mastectomy breast reconstruction is to satisfy the patient's expectations with respect to her body image and quality of life (Sarwer, 1998). Studies have revealed a strong correlation between expectations and satisfaction, suggesting that unrecognized or unfulfilled expectations are associated with patient ratings of poor outcome and dissatisfaction with the result of surgery (Mancuso, 2003). Understanding individual patient expectations would allow surgeons to identify patients who have unrealistic expectations and to address their issues preoperatively. Despite this, no instruments have been developed to accurately measure patient expectations about breast reconstruction. The objective of this project is thus to develop a new patient reported measure of expectations to serve as a valuable preoperative assessment tool. It will provide patients with a way to specifically indicate what they anticipate from surgery, and provide surgeons with a template to guide discussion about realistic and unrealistic goals for individual patients. Measure development will be conducted in accordance with an internationally recognized sequence of steps recommended by quality of life experts and psychometricians (Medical Outcomes Trust, 2002). Breast reconstruction patients will be recruited from MSKCC for questionnaire content generation and field- testing. Preliminary versions of the scale will be developed from three sources: literature review, patient interviews and expert opinion. Semi-structured interviews (n=30) with open-ended questions will be performed by a trained interviewer to generate categories of expectations. The item pool will be pre-tested on a small sample of patients (n=20) to clarify ambiguities, confirm appropriateness, determine acceptability and determine completion time. The instrument will be field-tested in a sample of 150 preoperative patients to determine items that demonstrate the best psychometric properties and to identify subscales. Following development of this new questionnaire, future grant funding will be sought to complete validation studies. This questionnaire will be clinically useful and will aid surgeons as they endeavor to better understand and to fulfill their patients' expectations. Within a broader program of research, this new instrument will facilitate future studies to examine the interface between expectations and satisfaction and to help identify patients at risk for dissatisfaction. This knowledge will also guide the establishment of new educational materials specifically designed to address and modify individual patient expectations in a systematic fashion. By carefully examining and addressing individual patient expectations, we will thus identify significant and innovative ways to improve preoperative patient education and satisfaction with the outcome of reconstruction for breast cancer survivors. The objective of this project is to develop a new, clinically useful questionnaire to evaluate preoperative patient expectations about post-mastectomy breast reconstruction. It will provide patients with a way to specifically indicate what they anticipate from surgery, and provide surgeons with a template to guide discussion about realistic and unrealistic goals for individual patients. Within a broader program of research, this new questionnaire will facilitate future studies to help improve preoperative education and satisfaction with the outcome of reconstruction for breast cancer survivors.