RECONJOINT: A Preference Elicitation Tool to Improve Shared Decision Making for Breast Reconstruction Surgery

/ABSTRACT Breast reconstruction is a critical component of comprehensive breast cancer care, offering physical and emotional restoration after mastectomy. However, 40% of women undergoing breast reconstruction report dissatisfaction and decisional regret due to low involvement with treatment decisions and poor alignment between treatment preferences and the chosen reconstructive technique. Current approaches to shared decision-making (SDM) often fail to elicit and integrate individual-level preferences into treatment planning. This serves as a barrier to effective SDM and patient-centered care. To address this gap, we developed a web- based decision tool that uses adaptive choice–based conjoint (ACBC) analysis to elicit patient-level preferences for breast reconstruction. Preliminary studies indicate that the decision tool is acceptable and usable; patients wanted to view their results and use the tool in clinic, which we could not accommodate at the time because the decision tool currently lacks a structured method for clinical integration. We propose to develop an implementation toolkit for the decision tool to facilitate clinical integration and then test the feasibility, acceptability, and implementation of the intervention, RECONJOINT (decision tool and toolkit). In Aim 1, we will design an implementation toolkit informed by focus groups and developed with input from key partners, including patients, providers, and patient advocates. Candidate elements for the implementation toolkit include components developed for site-level implementation: treatment preferences report, video introducing the tool and existing evidence, and recommendations for patients and providers to incorporate preferences into SDM. In Aim 2, we will evaluate the feasibility, acceptability, and preliminary efficacy of the intervention in a pilot cluster-randomized hybrid type 1 trial conducted at two cancer centers (Memorial Sloan Kettering and Duke University). Our primary outcome of interest is the feasibility of the intervention. Secondary outcomes include acceptability and preliminary efficacy. Using a hybrid design, we will simultaneously evaluate facilitators, barriers, and strategies to implementation and how these factors influence the feasibility and acceptability of the intervention. The Consolidated Framework for Implementation Research and the Theoretical Domains Framework will serve as conceptual frameworks. This study is innovative as it leverages ACBC analysis to elicit patient preferences, designs an intervention with multilevel input from clinical and community partners, and uses a hybrid trial design to simultaneously evaluate feasibility, acceptability, preliminary efficacy, and implementation. By addressing critical barriers to SDM and enhancing patient–provider communication, this research aligns with the goals of PA-25-253 and the National Cancer Plan to deliver high quality, patient-centered cancer care. Findings from this study will inform a full-scale multi-site trial to evaluate the efficacy of the intervention and implementation outcomes (e.g., reach). Project Number: 1R21CA309323-01 | Fiscal Year: 2026 | NIH Institute/Center: National Cancer Institute (NCI) | Principal Investigator: EVAN MATROS (+1 co-PI) | Institution: SLOAN-KETTERING INST CAN RESEARCH, NEW YORK, NY | Award Amount: $457,252 | Activity Code: R21 | Study Section: Special Emphasis Panel[ZRG1 HSS-D (90)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11286428