Empowering women considering reconstructive breast surgery – a Danish cohort study on decisional conflict and regret

Backround: Breast reconstructive surgery following mastectomy or lumpectomy presents a significant decisional challenge for patients. The emotional weight of a cancer diagnosis and the complexity of surgical options necessitate a comprehensive support system to guide patients through their choices. This study investigates the implementation of a structured information process using patient decision aids (PtDAs) to enhance the decision-making process, increase patient engagement, and reduce decisional conflict and regret. Methods: From 2018 to 2021, Vejle Hospital, Denmark, invited 104 patients at risk or diagnosed with breast cancer to participate in a study of shared decision making in reconstructive surgery. Participants were offered two independent consultations with a plastic surgeon, and in the intervention group, a PtDA, which included a paper folder and short films on breast surgery. Outcomes were measured with validated questionnaires. Results: The study found no significant difference in decisional conflict or regret between patients who used shared decision making and the PtDA and those who did not. However, there was a significant reduction in decisional conflict within both groups between the first and second consultations. Conclusion: The results indicate that our consultations, with the structured information process, successfully reflected patient engagement and supported patients in making informed decisions about breast reconstruction, leading to low levels of decision conflict and regret in both groups. This approach could serve as a model for other institutions aiming to improve patient-centered care.