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Med Decis Making. 2019 Jan;39(1):5-20. doi: 10.1177/0272989X18803879.

Feasibility and Efficacy of Decision Aids to Improve Decision Making for Postmastectomy Breast Reconstruction: A Systematic Review and Meta-analysis.

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Section of Plastic Surgery, University of Michigan, Ann Arbor, MI.
Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
Center for Health Communications and Research, University of Michigan, Ann Arbor, MI.
Taubman Health Sciences Library, University of Michigan School of Medicine, Ann Arbor, MI.
Department of Plastic and Reconstructive Surgery, College of Medicine, Ohio State University, Columbus, OH.
Division of Health Services Management and Policy, College of Public Health, Ohio State University, Columbus, OH.



The decision-making process for women considering breast reconstruction following mastectomy is complex. Research suggests that fewer than half of women undergoing mastectomy have adequate knowledge and make treatment decisions that are concordant with their underlying values. This systematic review assesses the feasibility and efficacy of preoperative decision aids (DAs) to improve the patient decision-making process for breast reconstruction.


A systematic review was performed using PubMed, Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Databases published prior to January 4, 2018. Studies that assessed the impact of a DA on patient decision making for breast reconstruction were identified. The effect of preoperative DAs on decisional conflict in randomized controlled trials (RCTs) was measured with inverse variance-weighted mean differences (mean difference [MD] ± 95% confidence interval [CI]).


Among 1299 unique articles identified, 1197 were excluded after reviewing titles and abstracts against selection criteria. Among the 17 studies included in this review, 11 assessed the efficacy of DAs for breast reconstruction and 6 additional studies described the development and usability of these DAs. Studies suggest that DAs reduce patient-reported decisional conflict (MD, -4.55 [95% CI, -8.65 to -0.45], P = 0.03 in the fixed-effects model and MD, -4.70 [95% CI, -10.75 to 1.34], P = 0.13 in the random-effects model). Preoperative DAs also improved patient satisfaction with information and perceived involvement in the decision-making process.


The existing literature suggests that DAs reduce decisional conflict, improve self-reported satisfaction with information, and improve perceived involvement in the decision-making process for women considering breast reconstruction.


breast reconstruction; decision aid; decision making; patient-reported outcomes; shared decision making


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