j o u r n a l o f s u r g i c a l r e s e a r c h 1 9 5 ( 2 0 1 5 ) 4 1 2 e4 1 7
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofSurgicalResearch.com
Association for Academic Surgery
Patient preferences in access to breast reconstruction Christina R. Vargas, MD,a Oren Ganor, MD,b Maria Semnack, RN,b Samuel J. Lin, MD,b Adam M. Tobias, MD,b and Bernard T. Lee, MD, MBA, MPHa,b,* a
Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
b
article info
abstract
Article history:
Background: Patient access to breast reconstruction is an important component of
Received 13 December 2014
comprehensive breast cancer care. There is currently considerable variability in the timing
Received in revised form
of consultation with a plastic and reconstructive surgeon after the initial diagnosis of
29 January 2015
breast cancer. This study aims to elucidate patients’ preferences for the timing of plastic
Accepted 10 February 2015
surgery consultation as part of the preoperative evaluation and planning process.
Available online 14 February 2015
Methods: A 16-question electronic survey instrument was developed based on formative patient comments and discussion between the breast oncology and plastic surgery teams.
Keywords:
The survey was administered to all patients referred to the plastic and reconstructive
Breast reconstruction
surgery clinic for initial reconstructive consultation during the study period.
Access to care
Results: A total of 31 responses were collected. The largest number of patients (48%) indicated
Patient preferences
they would prefer to see a plastic surgeon 1 wk after their first consultation with a breast surgeon. Only one patient reported a desire to see both surgeons on the same day. Most patients indicated that having a family member or friend accompany them to the appointment (45%) and having time to process their cancer diagnosis before seeing the plastic surgeon (32%) were key factors in deciding when they would like to discuss reconstruction. Conclusions: Most patients in our study indicated a preference for delay between initial consultation with a breast surgeon and initial consultation with a plastic surgeon. Incorporating patient preferences into the preoperative evaluation and planning process allows patients to optimize available support from loved ones and to begin coping with their diagnosis. ª 2015 Elsevier Inc. All rights reserved.
1.
Introduction
Access to breast reconstruction has been recognized as a critical component of comprehensive breast cancer care. Several potential barriers exist during the pretreatment
period, including availability of general or breast surgeons as well as plastic and reconstructive surgeons. Breast cancer treatment is unique in the level of patient involvement in both the oncologic and reconstructive aspects of care and has become increasingly consumer-driven. Enabling patients to
* Corresponding author. Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, 110 Francis St., Suite 5A, Boston, MA 02215. Tel.: þ1 617 632 7835; fax: þ1 617 632 7840. E-mail address: [email protected] (B.T. Lee). 0022-4804/$ e see front matter ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2015.02.014
413
j o u r n a l o f s u r g i c a l r e s e a r c h 1 9 5 ( 2 0 1 5 ) 4 1 2 e4 1 7
be successful in making critical decisions about their treatment frequently requires considerable coordination and co-management between multiple specialists. Providers in breast and plastic surgery at our institution have expressed differing opinions regarding ideal methods of coordination during this process, and no published data exist regarding what patients prefer. The current process for referrals to breast reconstruction surgeons at our institution is not standardized: many patients are referred from outside providers, some are referred from the affiliated breast center, and a number self-refer from other locations [1]. As a result, the timing between the initial diagnosis of breast cancer to a consultation with a reconstructive surgeon varies considerably and in some cases is accompanied by the need for transfer of oncologic care. Occasionally, patients are sent directly to a reconstructive surgeon immediately after the initial diagnosis and consultation with a breast surgeon; others are scheduled in the following days to weeks depending on patient and physician availability. New consultations for breast reconstruction typically last between 30 min and 2 h depending on the individual patient and surgeon. Some patients choose their reconstructive procedure and schedule surgery the same day; most call back in the following days after additional consideration of the available options. The importance of incorporating patient needs and perspectives during the consultation process should not be underestimated. Previously published studies have demonstrated that patient engagement increases efficiency and improves satisfaction [2,3]. Patients have a desire to participate in shared-decision making and have become increasingly informed healthcare consumers in recent decades [2,4]. This study aims to elucidate patient preferences for the timing of plastic surgery consultation as part of the preoperative evaluation and planning process that follow a new diagnosis of breast cancer.
Surveys were administered in the plastic surgery office at the time of the initial visit and before consultation with the plastic surgeon. The clinic nurse administered the Web-based surveys on a private consultation room computer before filling out the standard office intake forms. The answers were collected anonymously and required 5e10 min to complete. Participation was voluntary, and all data were collected anonymously. All patients completed the survey and this represented 31 consecutive patients approached for the study. After data collection, descriptive analysis was performed for each survey question to aid in interpretation.
3.
Results
A total of 31 unique patient responses were collected during the study period. Participants ranged in age from 30e69, with two-thirds between the ages of 30 and 49. The majority (58%) were married. The largest proportion of patients reported being employed full-time (39%), followed by homemakers (26%), and those who were employed part-time (19%). Place of residence ranged from
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofSurgicalResearch.com
Association for Academic Surgery
Patient preferences in access to breast reconstruction Christina R. Vargas, MD,a Oren Ganor, MD,b Maria Semnack, RN,b Samuel J. Lin, MD,b Adam M. Tobias, MD,b and Bernard T. Lee, MD, MBA, MPHa,b,* a
Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
b
article info
abstract
Article history:
Background: Patient access to breast reconstruction is an important component of
Received 13 December 2014
comprehensive breast cancer care. There is currently considerable variability in the timing
Received in revised form
of consultation with a plastic and reconstructive surgeon after the initial diagnosis of
29 January 2015
breast cancer. This study aims to elucidate patients’ preferences for the timing of plastic
Accepted 10 February 2015
surgery consultation as part of the preoperative evaluation and planning process.
Available online 14 February 2015
Methods: A 16-question electronic survey instrument was developed based on formative patient comments and discussion between the breast oncology and plastic surgery teams.
Keywords:
The survey was administered to all patients referred to the plastic and reconstructive
Breast reconstruction
surgery clinic for initial reconstructive consultation during the study period.
Access to care
Results: A total of 31 responses were collected. The largest number of patients (48%) indicated
Patient preferences
they would prefer to see a plastic surgeon 1 wk after their first consultation with a breast surgeon. Only one patient reported a desire to see both surgeons on the same day. Most patients indicated that having a family member or friend accompany them to the appointment (45%) and having time to process their cancer diagnosis before seeing the plastic surgeon (32%) were key factors in deciding when they would like to discuss reconstruction. Conclusions: Most patients in our study indicated a preference for delay between initial consultation with a breast surgeon and initial consultation with a plastic surgeon. Incorporating patient preferences into the preoperative evaluation and planning process allows patients to optimize available support from loved ones and to begin coping with their diagnosis. ª 2015 Elsevier Inc. All rights reserved.
1.
Introduction
Access to breast reconstruction has been recognized as a critical component of comprehensive breast cancer care. Several potential barriers exist during the pretreatment
period, including availability of general or breast surgeons as well as plastic and reconstructive surgeons. Breast cancer treatment is unique in the level of patient involvement in both the oncologic and reconstructive aspects of care and has become increasingly consumer-driven. Enabling patients to
* Corresponding author. Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, 110 Francis St., Suite 5A, Boston, MA 02215. Tel.: þ1 617 632 7835; fax: þ1 617 632 7840. E-mail address: [email protected] (B.T. Lee). 0022-4804/$ e see front matter ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2015.02.014
413
j o u r n a l o f s u r g i c a l r e s e a r c h 1 9 5 ( 2 0 1 5 ) 4 1 2 e4 1 7
be successful in making critical decisions about their treatment frequently requires considerable coordination and co-management between multiple specialists. Providers in breast and plastic surgery at our institution have expressed differing opinions regarding ideal methods of coordination during this process, and no published data exist regarding what patients prefer. The current process for referrals to breast reconstruction surgeons at our institution is not standardized: many patients are referred from outside providers, some are referred from the affiliated breast center, and a number self-refer from other locations [1]. As a result, the timing between the initial diagnosis of breast cancer to a consultation with a reconstructive surgeon varies considerably and in some cases is accompanied by the need for transfer of oncologic care. Occasionally, patients are sent directly to a reconstructive surgeon immediately after the initial diagnosis and consultation with a breast surgeon; others are scheduled in the following days to weeks depending on patient and physician availability. New consultations for breast reconstruction typically last between 30 min and 2 h depending on the individual patient and surgeon. Some patients choose their reconstructive procedure and schedule surgery the same day; most call back in the following days after additional consideration of the available options. The importance of incorporating patient needs and perspectives during the consultation process should not be underestimated. Previously published studies have demonstrated that patient engagement increases efficiency and improves satisfaction [2,3]. Patients have a desire to participate in shared-decision making and have become increasingly informed healthcare consumers in recent decades [2,4]. This study aims to elucidate patient preferences for the timing of plastic surgery consultation as part of the preoperative evaluation and planning process that follow a new diagnosis of breast cancer.
Surveys were administered in the plastic surgery office at the time of the initial visit and before consultation with the plastic surgeon. The clinic nurse administered the Web-based surveys on a private consultation room computer before filling out the standard office intake forms. The answers were collected anonymously and required 5e10 min to complete. Participation was voluntary, and all data were collected anonymously. All patients completed the survey and this represented 31 consecutive patients approached for the study. After data collection, descriptive analysis was performed for each survey question to aid in interpretation.
3.
Results
A total of 31 unique patient responses were collected during the study period. Participants ranged in age from 30e69, with two-thirds between the ages of 30 and 49. The majority (58%) were married. The largest proportion of patients reported being employed full-time (39%), followed by homemakers (26%), and those who were employed part-time (19%). Place of residence ranged from
