Clinical Benefits of an Interactive Digital Patient Education Aid in Microsurgical Breast Reconstruction

Breast reconstruction options including advanced microsurgical procedures are difficult to explain to patients who must make decisions regarding what method of reconstruction to prefer. To assist patients' better understanding of the different techniques of reconstruction, an interactive digital education aid (IDEA) was developed and a prospective randomized study was conducted to assess its benefits.

The interactive computer program was designed to simulate a question-and-answer discussion during a clinic consultation using video, animated three-dimensional graphics, tabular summaries, printable text, and personal stories from breast cancer survivors. To assess clinical benefit, 131 breast reconstruction candidates were prospectively randomized into two groups. Both received routine preoperative instruction; however, the second group (65 patients) also received the IDEA to use in the clinic and at home. Questionnaires assessing the level of factual knowledge, anxiety (State-Trait Anxiety Inventory — State, STAI-S), and satisfaction were administered at three time points: a) prior to the initial plastic surgery consultation, b) immediately before surgery, and c) one month after surgery. Patients in the IDEA group were asked questions about their experience using the IDEA.

The IDEA successfully ran on multiple types of computer platforms. Patients found it easy to use (82%), understandable (95%), helpful for learning (93%), helpful in making decisions (83%), and would recommend it to other women (91%). The demographic data were similar for both groups. Both showed significantly decreased anxiety, increased factual knowledge, and enhanced satisfaction with decision-making ability associated with preoperative instruction about reconstructive surgery. However, the IDEA group was significantly more satisfied with the method of receiving information compared to the non-IDEA group (96% and 83%, respectively, p =ߙ0.05) and showed significantly greater knowledge of breast reconstruction (b =ߙ3.3; 95% CI, 0.42–6.21; p =ߙ0.03). They tended to have reduced mean anxiety over time (b =ߙ3.7; 95% CI; 7.66–0.22; p =ߙ0.06) and increased mean satisfaction with the treatment choice compared to the non-IDEA group (94% and 81%, respectively; p =ߙ0.07).

Preoperative patient education significantly lowers anxiety, raises the level of knowledge, enhances decision-making satisfaction, and fosters realistic expectations. An IDEA is a clinically beneficial adjunct because patients who use one are more satisfied with the method of receiving information, demonstrate greater factual knowledge, and might experience reduced anxiety and increased postoperative satisfaction compared to patients given preoperative instruction using standard methods alone. The benefit of an IDEA is expected to be higher in a broad-based practice setting outside of a comprehensive cancer center.