UNC scientist to study post-mastectomy breast reconstruction surgery decision making

Chapel Hill - Deciding whether or not to have breast reconstruction after mastectomy is highly challenging for many patients. Clara Lee, MD, MPP, a UNC School of Medicine physician/scientist, has received a five-year grant award to examine patients’ decision-making process about reconstruction and the effects of reconstruction on quality of life and body image. The $862,700.00 career development award to the plastic and reconstructive surgeon is from the National Institutes of Health.

Lee, an associate professor of surgery, explains, “The decision about whether or not to have breast reconstruction should depend almost completely on a patient’s personal preferences. And yet we find that rates of breast reconstruction in the United States vary greatly by race, socioeconomic status, and geography. In this study, we will evaluate the decision making process and the quality of decisions about reconstruction.”

Lee and her colleagues also intend to study some novel psychological aspects of patients’ decisions. “Deciding about breast reconstruction requires a patient to predict how she would feel after the procedure, a process called affective forecasting. Extensive psychological research has shown that people have difficulty making accurate predictions about how they will feel, tending to overestimate the effects of disease and treatments on their well-being and to underestimate their ability to adapt to change and the effects of other aspects of their lives.”

Lee is a member of UNC Lineberger Comprehensive Cancer Center. She is a recipient of a 2010 Lineberger Population Sciences Award, which enabled her team to conduct some of the preliminary research that supports the NIH project.

Lee says, “ Our study is unique in several ways. We will be using a technique from marketing research called “conjoint analysis”. Market researchers have been using conjoint analysis for many years to understand consumers’ preferences about purchasing decisions. We will use it to better understand women’s preferences about breast reconstruction. We also plan to evaluate the ability of breast cancer patients to predict how they will feel after surgery, which is so critical to decision making yet largely unexplored.”

Her hope is that “this research will eventually lead to more patients receiving the treatments they prefer and ultimately to better quality of life for women with breast cancer.”

Lee will be mentored during the grant period by Michael Pignone, MD, MPH, a professor of medicine, chief of the division of general medicine and clinical epidemiology, and a member of UNC Lineberger Comprehensive Cancer Center; and Peter Ubel, MD, John O. Blackburn Professor of Marketing, Fuqua School of Business, and professor, Sanford School of Public Policy at Duke University. Both are national experts in medical decision making.

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