Variation in Physician-Patient Discussion of Breast Reconstruction

Published In: Journal of General Internal Medicine, v. 24, no. 1, Jan. 2009, p. 99-104

Posted on RAND.org on December 31, 2008

by Judy Y. Chen, Jennifer Malin, Patricia A. Ganz, Clifford Y. Ko, Diana M. Tisnado, May Lin Tao, Martha J. Timmer, John L. Adams, Katherine L. Kahn

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BACKGROUND: For women with early stage breast cancer, physician-patient discussion of breast reconstruction is an essential step in their participation in the decision-making process for their treatments. This study examines sociodemographic variation of physician-patient discussion of breast reconstruction and explores the impact of this discussion on the use of breast reconstruction. METHODS: The authors used data from the Los Angeles Women?s Study, a population-based study of women 50 years and older with breast cancer. Bivariate and multivariate logistic regression models were used to estimate the impact of patient and hospital characteristics on self-reported receipt of physician-patient discussion and use of breast reconstruction. RESULTS: Of 315 post-mastectomy women, 81% and 27% reported physician-patient discussion and use of breast reconstruction, respectively. In multivariable analysis, women with an annual income <$20,000 were less likely to have physician-patient discussion than women with annual income <$40,000 (OR=0.23, 95% CI 0.07?0.82). Among the subset of women with physician-patient discussion, chest wall radiation, a known characteristic associated with higher rates of reconstruction complications, became an additional significant negative predictor of reconstruction. CONCLUSIONS: Lower income women are at risk of not receiving physician-patient discussion of breast reconstruction. Physician-patient discussion of breast reconstruction appears to decrease the use of breast reconstruction among women with clinical characteristics associated with higher rates of reconstruction complications and failure. This highlights the need for interventions to increase physician-patient discussion of breast reconstruction among lower income women.

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