Annelotte van Bommel

131 Information provision of immediate breast reconstruction reconstructive possibilities at the same time when mastectomy is offered to the patient by the surgeon. 17,36 It has already been found that low satisfaction with preoperative information is associated with an increased likelihood of decisional regret. 37 However, in our questionnaire almost 70%of patients without IBR stated they preferred not to have IBR, and 10% indicated their physician advised this. After analyzing the free text field in the survey of the latter patients, it became evident the advice to postpone breast reconstruction was based on severity of tumor characteristics or the increased risk of surgical complications. This suggests that mainly those patients with strong contra-indications for IBR were recommended mastectomy without IBR by their physician; therefore, we would be jumping to conclusions by merely stating that patients without IBR were not informed about IBR. Patients knowing about IBR as a treatment option, could have rejected this option immediately, therefore not receiving any further information. Contradictory to this, patients without IBR less often felt they shared the decision with their physician. Since patients without IBR in our study were older and lower educated, it could well be these patients did not want to share the decision, which was found in patients with these characteristics before. 38,39 A previous study reported that surgeons tend to predict their patients’ preferences fairly accurately. 34 For one fifth of the mastectomy patients in our study, the choice had not been based on their preferences or on a medical necessity; these patients possibly may have missed their chance of receiving IBR. As women vary in information seeking behaviour 40 tailoring information to individual patients 41 may be helpful here. Furthermore, we suggest that it should be documented in every patient’s file whether and which breast reconstruction options were discussed; this is already recommended in the national guideline on breast reconstruction as well. 17 Often, this documentation is lacking, while it could help the physician in revealing unmet needs in patient information as well as education. 42 Harcourt et al. reported that only 15% of respondents searched for further information before making a decision, while 82% made “instant” decisions (during the consultation where the reconstruction was first discussed). 35 Opting 7