Annelotte van Bommel

134 this information, even if this means that she has to be referred to another hospital to undergo the type of IBR she desires. Only after knowing and understanding all options, a well-informed decision can be made by the patient. Ideally, all patients should be referred to a plastic surgeon for a completely balanced weighing of the decision whether or not to perform IBR, because another study recently conducted in the Netherlands revealed surgeons informed patients differently compared to plastic surgeons. 50 Physician education is important to accomplish continuity of care and proper referral. Furthermore, more implant IBR than autologous IBR can be performed within the same amount of time; thus, financial incentives made performing implant IBR more attractive for hospitals than autologous IBR 55 , explaining the relative low number of respondents with autologous reconstruction. As IBR is covered by every patients’ health insurance (except for the obligatory deductible excess of Euro 385, - (2017)) 56 , this does not hinder access. CONCLUSIONS Patients who received IBR had been better informed about IBR as a treatment option, more often had discussed advantages and disadvantages of IBR, and felt significantly more involved in SDM than patients without IBR. After correction for patient, tumor, treatment, and hospital factors, being informed about IBR significantly increased the odds of receiving IBR fourteen-fold. Our results highlight the importance of providing sufficient information on all relevant treatment options.