Patient-Provider Relationships Influence Reception of Postmastectomy Breast Reconstruction: An Analysis of the All of Us Research Program

Abstract

Background

Although existing literature has comprehensively investigated socioeconomic disparities in postmastectomy breast reconstruction, the effect of patient-provider relationships on the receipt of breast reconstruction is still not completely described. This study incorporates a large national data platform to investigate the effect of such interactions on the likelihood of reconstruction after mastectomy.

Methods

Patients who underwent mastectomy were identified in the All of Us Research Program, a large and diverse United States patient registry. Patient-provider relationships were quantified through a series of survey questions assessing themes of respect, understanding, and apprehension from patient-provider interactions. The main outcome of interest was the receipt of breast reconstruction, which was assessed with multivariable logistic regression (P < .05).

Results

The final cohort included 547 patients with complete survey data. The rate of postmastectomy breast reconstruction was 47.3%. Patient perceptions of receiving respectful treatment by providers “most of the time” (OR: 0.47, 95% CI, 0.30-0.74, P = .0012) and “some of the time” (OR: 0.21, 95% CI, 0.05-0.89, P = .034) predicted lower odds of breast reconstruction when compared to “always.” Nervousness about seeing a health care provider was also associated with lower odds of breast reconstruction (OR: 0.51, 95% CI, 0.27-0.96, P = .034).

Conclusion

Despite increasing volume of breast reconstruction in the United States, the receipt of such reconstruction may still be influenced by aspects of the patient-provider relationship. This analysis supports the importance of cultivating patient-centered relationships for patients with breast cancer.