The Role of Evidence-Based Information in Shared Decision-Making for Breast Reconstruction: Insights from the GRETA-V2 Decision Aid.

Background shared decision-making (SDM) is essential in breast reconstruction following mastectomy, a setting where patients face complex and preference-sensitive choices. Decision aids help patients to understand treatment options by providing evidence-based information in a clear and accessible format. Objective to explore the utility of the GRETA-V2 decision aid in enhancing patient-centered decision-making in post-mastectomy breast reconstruction through expert evaluation and content refinement. Methods GRETA-V2 was developed through a multiphase process involving a core team of breast surgeons and psycho-oncologists. It was iteratively refined using feedback from semi-structured interviews with a multidisciplinary panel, including plastic surgeons, nurses, and patient advocates. Participants assessed the tool's clarity, usefulness, and alignment with patients' values. A qualitative thematic analysis was conducted to identify areas for improvement. Results: Experts highlighted the value of visual aids, accurate data presentation, and inclusive language. Key themes identified were design (visual clarity and realism), data presentation (statistical accuracy and cultural tailoring), and content (informational completeness, psychological aspects, clarity, and integration of patient experiences). The tool was recognized as supportive of SDM, but refinements were suggested to improve understanding of radiotherapy, surgical options, postoperative recovery, and emotional impacts. Conclusions: GRETA-V2 demonstrates potential as a patient-centered DA grounded in evidence and clinical insight. Further refinement based on user testing is recommended to enhance its relevance and effectiveness in real-world settings.