A. Gozali1, D. Soroudi1, J. A. Knox1, J. Wilson1, M. Piper1 1University Of California – San Francisco, Division Of Plastic Surgery, Department Of Surgery, San Francisco, CA, USA
Introduction: Patients undergoing breast reconstruction require a firm understanding of treatment options to make informed decisions. Yet, patients undergoing mastectomy have major knowledge deficits about breast reconstruction despite the availability of educational materials. While the NIH recommends a maximum of 6th-7th grade reading level to optimize understandability, the national average readability of breast reconstruction materials is at an 11th-14th grade level. We aim to qualitatively analyze patient-provider perioperative communications to identify gaps in knowledge and improve education for patients undergoing post-mastectomy autologous breast reconstruction.
Methods: Patients who underwent immediate post-mastectomy autologous reconstruction at a single academic institution from January 2020 to September 2022 were included. Patient-generated calls and messages in the perioperative period (defined as the time of referral to plastic surgery to the first postoperative visit) were extracted from the medical record and qualitatively analyzed. Patient characteristics (distance traveled, insurance type, primary language) and treatment details were also recorded. Additionally, three readability algorithms (CL [Coleman-Liau Index], SMOG [Simplified Measure of Gobbledygook Readability Formula], and FK [Flesch-Kincaid Grade Level]) were used to assess the reading level of breast reconstruction resources on the institution’s website.?
Results: Of the 80 patients identified, 57 (71.3%) underwent DIEP flap reconstruction. English was the primary language for 79 (98.8%) patients. 416 communications were extracted, and the subject of inquiry and encounter resolutions were recorded. 66.8% (n=278) of communications were in the postoperative period. The most common subjects of inquiry were surgical site concerns (27.3%), followed by postoperative recovery (12.5%), medications (11.3%), symptoms (9.6%), surgery details (8.2%), and preoperative optimization (4.9%). The most common encounter resolution was patient re-education (55.7%), which included: question answered (22.8%), reassurance (17.5%), and instructions given (15%). 34 (12%) postoperative communications required unplanned clinic visits, of which 38.2% led to a change in management. Breast reconstruction information on the institution’s website is at a 10th-11th grade reading level (CL=10, SMOG =10.7, FK=11.4). Notably, the information was only available in English.
Conclusion:
Our findings indicate that most encounters were resolved through patient re-education, highlighting the need for improved patient education to reduce unnecessary clinic visits and potentially reduce patient stress. The subjects of inquiry identified can inform targeted improvement in patient education materials to address the most common patient concerns. Furthermore, the limited availability of non-English resources and higher-than-recommended reading level of materials should be addressed to improve patient care.?