Abstract: The Influence of Dispositional Optimism On Decision Regret to Undergo Major Breast Reconstructive Surgery (Plastic Surgery 2013)

Saturday, October 12, 2013: 1:30 PM

Kunaal Jindal, MD FRCSC , Plastic Surgery, University of Toronto, Toronto, ON, Canada

Toni Zhong, MD, FRCSC , Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada

Shaghayegh Bagher, MSc , Plastics Surgery, University of Toronto, Toronto, ON, Canada

Delong Zeng , Plastics Surgery, University of Toronto, Toronto, ON, Canada

Anne O'Neill, MD PhD , Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada

Sheina A Macadam, MD, FRCSC, MHS , Division of Plastic Surgery, University of British Columbia, Vancouver, BC, Canada

Kate Butler, MHSc , Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada

Stefan Hofer, MD PhD , Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada

Kelly Metcalfe, RN PhD , Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada

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Purpose:

Optimism improves patient reported outcomes in breast cancer survivors; however, the degree to which it influences a patient’s regret to undergo major reconstructive breast surgery is unknown. We examined the relationship of dispositional optimism and major complications on decision regret in patients undergoing microsurgical breast reconstruction.

Methodology:

A retrospective cross sectional survey was conducted of 290 consecutive patients who underwent microsurgical abdominally-based breast reconstruction at a single tertiary care institution with a minimum follow up of 1 year. The two independent variables were: 1) dispositional optimism measured by the Life Orientation Test-Revised (LOT-R) and 2) major complications. The primary outcome was measured using the Decision Regret Scale, a validated tool in breast reconstruction. A multivariate regression analysis determined the relationship between the independent variables, confounders and decision regret.

Results:

Of the 181(62%) patients have completed the survey, 93% underwent DIEP /SIEA reconstruction and 31% had one or more major complications. No regret was found in 63% of patients, mild regret in 26% and moderate to severe regret in 11%. On the multivariate analysis, major complications did not have a significant effect on decision regret. The effect of dispositional optimism on decision regret was not significant in Caucasians. However, for every increase in dispositional optimism LOT-R score (greater optimism) in the non-Caucasians, the odds of developing mild regret was significantly reduced by 0.72(0.50-0.95) and by 0.67 (CI 0.28-0.97) in the moderate to severe regret category.

Conclusions:

This is the first paper to identify a highly vulnerable subgroup of pessimistic non-Caucasian patients who may be at the greatest risk for developing regret. In women who underwent microsurgical breast reconstruction, the effect dispositional optimism was significantly correlated with their level of decision regret. Ethnicity was found to be an independent contributor of regret. The effect of dispositional optimism among Caucasian women was insignificant in predicting decision regret; however, this effect significantly reduced the probability of mild to severe decision regret in non-Caucasian patients. Major complications were not found to have a significant relationship with regret. Possible strategies to mitigate regret may involve addressing cultural and language barriers, setting realistic expectations for surgical outcomes, and providing more supports during the pre-operative decision-making phase.

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