Amie M. Scott

Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q.

Background: Measuring patient-reported outcomes has become increasingly important in cosmetic and reconstructive breast surgery. The objective of this study was to develop a new patient-reported outcome measure to assess the unique outcomes of breast surgery patients. Methods: Patient interviews, focus groups, expert panels, and a literature review were used to develop a conceptual framework and a list of questionnaire items. Three procedure-specific questionnaires (augmentation, reduction, and reconstruction) were developed and cognitive debriefing interviews used to pilot each questionnaire. Revised questionnaires were field tested with 1950 women at five centers in the United States and Canada (response rate, 72 percent); 491 patients also completed a test-retest questionnaire. Rasch measurement methods were used to construct scales, and traditional psychometric analyses, following currently recommended procedures and criteria, were performed to allow for comparison with existing measures. Results: The conceptual framework included six domains: satisfaction with breasts, overall outcome, and process of care, and psychosocial, physical, and sexual well-being. Independent scales were constructed for these domains. This new patient-reported outcome measure “system” (the BREAST-Q) contains three modules (augmentation, reconstruction, and reduction), each with a preoperative and postoperative version. Each scale fulfilled Rasch and traditional psychometric criteria (including person separation index 0.76 to 0.95; Cronbach’s alpha 0.81 to 0.96; and test-retest reproducibility 0.73 to 0.96). Conclusions: The BREAST-Q can be used to study the impact and effectiveness of breast surgery from the patient’s perspective. By quantifying satisfaction and important aspects of health-related quality of life, the BREAST-Q has the potential to support advocacy, quality metrics, and an evidence-based approach to surgical practice.

Impact of Caring for a Child With Cancer on Parents’ Health-Related Quality of Life

PURPOSEnTo compare the health-related quality of life (QOL) of parents of children who are undergoing treatment for cancer with that of Canadian population norms and to identify important parent and child predictors of parental QOL.nnnPATIENTS AND METHODSnA total of 411 respondents of 513 eligible parents were recruited from five pediatric oncology centers in Canada between November 2004 and February 2007. Parents were asked to complete a questionnaire booklet that included a measure of adult QOL (SF-36), a measure of child health status (functional status IIR), and questions to assess health-promoting self-care actions (eg, sleep, diet, and exercise habits) and characteristics of the child with cancer (eg, relapse status, time since diagnosis, prognosis, treatment intensity).nnnRESULTSnCompared with population norms, parents of children with cancer reported poorer physical and psychosocial QOL in all psychosocial domains (effect sizes range, -0.71 to -1.58) and in most physical health domains (effect sizes range, -0.08 to -0.63). Parent characteristics associated with better parental QOL included better eating, exercise and sleep habits, younger age, and higher income. Child characteristics associated with better parental QOL included better child health status (functional status IIR scores), lower treatment intensity, and longer time since diagnosis.nnnCONCLUSIONnParents of children with cancer report poorer QOL compared with population norms. Interventions directed at parents should be included as part of the treatment plan for a child with cancer. Modifiable variables associated with poorer parental QOL, such as sleep quality and diet and exercise habits, indicate those parents most likely to experience poor QOL and may be potential areas for intervention.

The BREAST-Q: further validation in independent clinical samples.

Background: The BREAST-Q is a new patient-reported outcome instrument for cosmetic and reconstructive breast surgery. For it to be used appropriately in clinical research, it is important that its validity is demonstrated. The aim of this study was to test this property. Methods: The authors evaluated the BREAST-Q subscales by using Rasch measurement methods and traditional psychometric methods with a focus on construct validity (including comparisons with existing breast-related, patient-reported outcome measures) and clinical validity (including hypothesis-driven questions with clinical subsamples). Results: A total of 817 women returned completed questionnaires (corrected response rate, 66 percent). Validity was supported by three Rasch analysis findings: the number of item response options was found to be appropriate (thresholds were ordered correctly); item locations in each subscale were spread out (range of logit span, 0.7 to 6.6), indicating that each subscale captures a wide range of issues; and fit to the Rasch model was good. Overall, scale reliability was supported by high Person separation indices (≥0.73). Traditional psychometric scale validity was supported by interscale correlations, comparisons of scores generated from clinically defined subgroups, and correlations with sociodemographic variables. Scale reliability was supported by high Cronbachs alpha coefficients (>0.80), item–total correlations (range of means, 0.58 to 0.87), and intraclass correlation coefficients (>0.80). Conclusions: This study further supports the BREAST-Q as a useful tool to study the impact and effectiveness of breast surgery from the patients perspective. It can be used as the initial building blocks toward establishing the clinical meaning of BREAST-Q scale scores, further supporting an evidence-based approach to surgical practice.

A systematic review of patient-reported outcome measures after facial cosmetic surgery and/or nonsurgical facial rejuvenation.

Background: Patient satisfaction and improved quality of life are the predominant considerations determining success in cosmetic surgery. However, few studies have examined patients perceptions of their appearance following cosmetic facial surgery and/or nonsurgical facial rejuvenation. This study identified patient-reported outcome measures developed and validated for use in patients undergoing surgical and/or nonsurgical cosmetic procedures. Methods: A systematic review of the English-language literature was performed. Patient-reported outcome measures designed to assess patient satisfaction and/or quality of life following surgical and/or nonsurgical cosmetic procedures were identified. Qualifying instruments were assessed for content and adherence to international guidelines for development and validation. Results: From 442 articles, 47 patient-reported outcome measures assessing facial appearance after a cosmetic procedure were identified. Only nine questionnaires satisfied inclusion and exclusion criteria. These measures were subdivided into the following categories: rhinoplasty (Rhinoplasty Outcomes Evaluation, Glasgow Benefit Inventory, Facial Appearance Sorting Test), skin rejuvenation (Facial Lines Treatment Satisfaction Questionnaire, Skin Rejuvenation Outcomes Evaluation, Facial Lines Outcomes Questionnaire), face lift (Facelift Outcomes Evaluation), blepharoplasty (Rhinoplasty Outcomes Evaluation), and general appearance (Derriford Appearance Scale 59). None of these measures satisfied all guidelines. All measures were limited by either their development, their validation, or their content. Conclusions: Valid, reliable, and responsive instruments designed to measure patient-reported outcomes following surgical and nonsurgical facial rejuvenation are lacking. A patient-reported outcome measure that represents perceptions of facial cosmetic surgery patients and satisfies accepted health measurement criteria is needed. It would facilitate comparison of techniques and quantification of positive effects, and aid surgeons seeking to quantify outcomes in their own practices.

Patient satisfaction with postmastectomy breast reconstruction: a comparison of saline and silicone implants.

At a time when the safety and effectiveness of breast implants remains under close scrutiny, it is important to provide reliable and valid evidence regarding patient outcomes. In the setting of postmastectomy reconstruction, patient satisfaction and quality of life may be the most significant outcome variables when evaluating surgical success. The objective of the current study was to identify predictors of patient satisfaction with breast appearance, including implant type, in a large sample of women who underwent breast reconstruction surgery using implants.

Measuring Patient-Reported Outcomes in Facial Aesthetic Patients: Development of the FACE-Q

To support the development of new techniques and technology in facial aesthetics, sophisticated ways of measuring outcomes are needed. The objective of this study was to develop the content of a set of patient-reported outcome (PRO) scales for use with facial aesthetic patients. A literature review, patient interviews, and input from experts working with facial aesthetic patients were used to develop a conceptual framework for the outcomes deemed important to facial aesthetic patients and to construct items and a set of preliminary PRO scales. The conceptual framework includes the following themes: satisfaction with facial appearance; health-related quality of life; recovery, early life impact, and adverse effects; and satisfaction with process of care. Separate scales were developed for all parts of the face (e.g., nose, ears, forehead, cheeks, etc.) rather than for particular facial procedures. This new PRO instrument, called the FACE-Q, contains multiple independently scoreable scales with preoperative and postoperative versions. Once psychometric evaluation is completed, the FACE-Q will provide researchers and physicians with the necessary tools to measure the impact and effectiveness of facial aesthetic procedures from the patients perspective. The FACE-Q has the potential to support advocacy, quality metrics, and an evidence-based approach to facial aesthetic practice.

Satisfaction and quality of life in women who undergo breast surgery: A qualitative study

BackgroundIn cosmetic and reconstructive breast surgery, measurement of patient-reported outcomes has become increasingly important to research efforts and clinical care. We aimed to describe how breast conditions and breast surgery impact on patient satisfaction and quality of life.MethodsWe conducted qualitative, in-depth interviews with 48 women who had undergone either breast reduction (n = 15), breast augmentation (n = 12), or breast reconstruction (n = 21) surgery in order to begin to build a theoretical understanding of patient satisfaction and quality of life in breast surgery patients. Interviews were audio-taped, transcribed verbatim and analyzed thematically.ResultsThe patient interviews revealed that breast conditions and breast surgery impact women in the following six main areas: satisfaction with breasts; satisfaction with overall outcome; psychosocial well-being; sexual well-being; physical well-being; and satisfaction with the process of care. We used these six themes to form the basis of a conceptual framework of patient satisfaction and quality of life in women who undergo breast surgery.ConclusionOur conceptual framework establishes the main issues of concern for breast surgery patients. This new framework can be used to help develop local guidelines for future clinical assessment, management and measurement, establish the validity of the current management strategies, and develop evidence-based guidance for the development of new patient reported outcome measures for future outcomes research.

Patient-Reported Outcome Measures in Plastic Surgery: Use and Interpretation in Evidence-Based Medicine

Summary: Understanding patients perceptions of surgical results and their impacts on quality of life is of primary importance in plastic surgery, as procedures are largely performed to improve either appearance or function. Patient-reported outcome measures are questionnaires specifically designed to quantify aspects of health-related quality of life from the patients perspective. This article presents an overview of patient-reported outcome measures. It also aims to provide plastic surgeons with the necessary critical appraisal skills to interpret and apply evidence from patient-reported outcomes research in their own clinical practice.

Development and Psychometric Evaluation of the FACE-Q Satisfaction with Appearance Scale: A New Patient-Reported Outcome Instrument for Facial Aesthetics Patients

Satisfaction with appearance and improved quality of life are key outcomes for patients undergoing facial aesthetic procedures. The FACE-Q is a new patient-reported outcome (PRO) instrument encompassing a suite of independently functioning scales designed to measure a range of important outcomes for facial aesthetics patients. FACE-Q scales were developed with strict adherence to international guidelines for PRO instrument development. This article describes the development and psychometric evaluation of the core FACE-Q scale, the Satisfaction with Facial Appearance scale. Both modern and traditional psychometric methods were used to confirm that this new 10-item scale is a reliable, valid, and responsive measure.

Satisfaction and Quality-of-Life Issues in Body Contouring Surgery Patients: a Qualitative Study

BackgroundBody contouring, which encompasses a range of surgical procedures on different areas of the body, is one of the most rapidly growing areas of plastic surgery. Little is known about outcomes from the perspective of post-weight loss body contouring patients. The aim of our qualitative study was to identify the health and aesthetic concerns of such patients through in-depth patient interviews.MethodsForty-three bariatric surgery post-weight loss body contouring patients were recruited between September 2009 and January 2011 from the offices of five plastic surgeons located in the USA and Canada. Interviews were used to explore the impact that obesity, weight loss, and body contouring surgery had on all aspects of the patient’s life. Interviews were transcribed and data analysis involved coding and the use of the constant comparison method to develop categories and themes. Interviewing continued until no new themes emerged.ResultsPatients described a range of important health and aesthetic concerns related to body contouring surgery following massive weight loss, including the following: appearance-related concerns, physical health concerns, sexual health concerns, psychological health concerns, and social health concerns. Body contouring surgery played an instrumental role in the completion of the entire weight loss process for patients.ConclusionsThe removal of excess skin leads to improvements in a patient’s appearance and enhanced physical, psychological, and social health and well-being. In order to appropriately measure the impact of body contouring procedures from the patient’s perspective, a well-developed psychometrically sound patient-reported outcome instrument is needed.