# Implementing a Breast Reconstruction Decision Support Tool in Diverse Practice Settings

> **NIH AHRQ R18** · WASHINGTON UNIVERSITY · 2020 · $399,840

## Abstract

Project Summary/Abstract
Breast cancer is the most common non-cutaneous cancer among women in the United States. For women
undergoing mastectomy for breast cancer, breast reconstruction may improve quality of life, body image,
satisfaction with appearance and physical, psychosocial and sexual well-being. However, the risk of a major
complication following mastectomy with breast reconstruction is approximately 23%, exceeding that of most
elective procedures. Patient and procedure characteristics predispose patients to reconstruction complications,
yet many patients and surgeons lack adequate knowledge of risk information to make informed decisions.
Decisions about whether to have reconstruction, when to have it, and what type of reconstruction are often
discordant with patients' personal preferences about risk, appearance, recovery, and number of surgeries.
There are currently no reliable methods for integrating patient-specific information into the clinician-patient
encounter to personalize these decisions. Incomplete or insufficient information could lead to unexpected
complications, additional operations, and decision regret. Finally, there are documented disparities in receipt of
reconstruction that are not clearly linked to patients' preferences. The long-term objective of this research is to
improve the quality of care for patients considering breast reconstruction. The specific objectives of this
proposal are to refine a clinical decision support (CDS) tool, BREASTChoice, and test its effectiveness. The
central hypothesis is that a workflow-aware CDS tool that incorporates risk prediction at the point-of-care is
more effective than a control website, at improving the quality of reconstruction decisions (i.e., informed and
preference-concordant choices). We will accomplish our objectives by pursuing the following aims: Aim 1: Elicit
key stakeholder input to evaluate the implementation potential of the BREASTChoice CDS tool; Aim 2: Modify
BREASTChoice based on stakeholder input and usability testing and prepare it for implementation into routine
care; Aim 3: Evaluate the effects of BREASTChoice on decision quality, decisional conflict, and treatment
choice in a multi-site randomized trial in a diverse population. This proposal will address the “5 Rights”
framework of delivering the right information, to the right person(s), using the right format, in the right channel,
and at the right time during workflow, for breast reconstruction after mastectomy.

## Key facts

- **NIH application ID:** 10004641
- **Project number:** 5R18HS026699-02
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** Clara Nan-hi Lee
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $399,840
- **Award type:** 5
- **Project period:** 2019-09-01 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10004641

## Citation

> US National Institutes of Health, RePORTER application 10004641, Implementing a Breast Reconstruction Decision Support Tool in Diverse Practice Settings (5R18HS026699-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10004641. Licensed CC0.

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