|89th Annual Meeting Abstracts
Validation of the BREAST-Q: a new patient-reported outcome measure for breast surgery patients
Andrea L. Pusic, MD, MHS1, Stefan J. Cano, PhD2, Anne F. Klassen, DPhil3, Amie M. Scott, MPH1, Winton Wedderburn, MPH1, Colleen M. McCarthy, MD, MS1, Nancy Y. VanLaeken, MD4, Peter A. Lennox, MD4, Carolyn L. Kerrigan, MD, MSc5, E. Dale Collins, MD5, Babak J. Mehrara, MD1, Joseph J. Disa, MD1, Peter G. Cordeiro, MD1.
1Memorial Sloan-Kettering Cancer Center, New York, NY, USA, 2University College London, London, United Kingdom, 3McMaster University, Hamilton, ON, Canada, 4The University of British Columbia, Vancouver, BC, Canada, 5Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
As evidence-based practice is rapidly setting a standard for surgical decision-making, the collection of reliable and valid outcome data is essential to plastic surgeons and their patients. Growing pressure from clinical, regulatory and government bodies has spurred the need for scientifically sound, clinically-relevant patient reported outcome measures (PROMs). The BREAST-Q, a new PROM for reconstructive and cosmetic breast surgery patients, was developed to address this need with strict adherence to internationally accepted guidelines (1). The objective of this study was to validate this new measure and report on its psychometric properties.
Breast surgery patients (n=2120) in 3 centers in the United States and Canada received the mailed questionnaire using standard approaches, including incentives and up to 3 reminders. To examine test-retest reliability, patients were asked to complete the questionnaire twice (2 week interval). To assess convergent and discriminant validity, the following scales were completed by patients in addition to the BREAST-Q: SF-36, Physician achievement review, BIS, BIBCQ, EORTC-BR-23, BRSQ, and the BEQ. We assessed the following scientific properties of the BREAST-Q: data quality, scaling assumptions, acceptability, reliability and validity.
A total of 1283 women (152 augmentation, 280 reduction, 851 reconstruction) returned the completed questionnaires (response rate 61%). Analyses showed that high data quality (missing data <10%; scale scores could be computed for > 90%) and excellent reliability (Cronbach's alpha > 0.85; test-retest, intraclass correlations > 0.88). Validity was supported by correlations with other measures and confirmation of hypotheses about group differences (augmentation, reduction, reconstruction).
The BREAST-Q satisfies all recommended psychometric criteria for rigorous measurement. It can provide essential information about the impact and effectiveness of breast surgery from the patient’s perspective. This new questionnaire will complement current clinical outcome measures and facilitate multicenter studies for comparison of surgical techniques and patient populations. The BREAST-Q has the potential to support advocacy, cost-effectiveness analysis, and patient education. It will also provide surgeons with an important metric for documenting clinical performance appraisal and improvement. As quality metrics and “pay for performance” become increasingly central to healthcare reform, such data will be crucial for individual surgeons and for plastic surgery as a specialty.
1. Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg, 2009;124:345-53.