Evidence map›Paper›PMID 38801247›Full record

ArticleAnnals of surgery2024

A Randomized Controlled Trial of the Implementation of BREASTChoice , a Multilevel Breast Reconstruction Decision Support Tool With Personalized Risk Prediction.

Mary C Politi, Terence M Myckatyn, Krista Cooksey, Margaret A Olsen, Rachel M Smith, Randi Foraker, Katelyn Parrish, Crystal Phommasathit, Guy Brock, Sarah Janse and 5 more

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In one paragraph

Article in Annals of surgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Review
  4. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

15 authors.

Mary C PolitiDepartment of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Terence M MyckatynDepartment of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Krista CookseyDepartment of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Margaret A OlsenDepartment of Medicine, Washington University School of Medicine, Saint Louis, MO, USA.
Rachel M SmithDivision of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH.
Randi ForakerDepartment of Medicine, Washington University School of Medicine, Saint Louis, MO, USA.
Katelyn ParrishDepartment of Medicine, Washington University School of Medicine, Saint Louis, MO, USA.
Crystal PhommasathitDivision of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH.
Guy BrockDivision of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH.
Sarah JanseDivision of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH.
Janine GuglielminoLiving Beyond Breast Cancer, Bala Cynwyd, PA, USA.
Anne PeledSutter Health, San Francisco, CA, USA.
Paul B MillsRenaissance Plastic Surgery, St. Peters, MO, USA.
Sherrill JacksonThe Breakfast Club, Inc., St. Louis, MO, USA.
Clara N LeeDivision of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH.

Funding

Implementing a Breast Reconstruction Decision Support Tool in Diverse Practice SettingsR18HS026699 · AHRQ · WASHINGTON UNIVERSITY · PI LEE, CLARA NAN-HI, POLITI, MARY C · 2019 to 2021
$1.2M
AHRQ HHS R18 HS026699
6 · The paper itself

Abstract

objectiveTo implement the BREASTChoice decision tool into the electronic health record and evaluate its effectiveness.

backgroundBREASTChoice , is a multilevel decision tool that: 1) educates patients about breast reconstruction; 2) estimates personalized risk of complications; 3) clarifies patient preferences; and 4) informs clinicians about patients' risk and preferences.

methodsA multisite randomized controlled trial enrolled adult women with stage 0-III breast malignancy undergoing mastectomy. Participants were randomized to BREASTChoice or a control website. A survey assessed knowledge, preferences, decisional conflict, shared decision-making, preferred treatment, and usability. We conducted intent-to-treat (ITT), per-protocol (PP) analyses (those randomized to BREASTChoice who accessed the tool), and stratified analyses.

results23/25 eligible clinicians enrolled. 369/761 (48%) contacted patients enrolled and were randomized. Patients' average age was 51 years; 15% were older than 65. BREASTChoice participants had higher knowledge than control participants (ITT: mean 70.6 vs. 67.4, P =0.08; PP: mean 71.4 vs. 67.4, P =0.03), especially when stratified by site (ITT: P =0.04, PP: P =0.01), age (ITT: P =0.04, PP: P =0.02), and race (ITT: P =0.04, PP: P =0.01). BREASTChoice did not improve decisional conflict, match between preferences and treatment, or shared decision-making. In PP analyses, fewer high-risk patients using BREASTChoice chose reconstruction. BREASTChoice had high usability.

conclusionsBREASTChoice is a novel decision tool incorporating risk prediction, patient education, and clinician engagement. Patients using BREASTChoice had higher knowledge; older adults and those from racially minoritized backgrounds especially benefitted. There was no impact on other decision outcomes. Future studies should overcome implementation barriers and specifically examine decision outcomes among high-risk patients.

Identifiers

PMID38801247
PMCPMC11599463

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.