Development and Usability Testing of a Decision Support App for Women Considering Breast Reconstruction Surgery


Women with breast cancer have difficulty deciding whether to undergo breast reconstruction when mastectomy is necessary. A computer-based decision aid that can be individualized to provide both surgery information and value clarification may be helpful for women considering breast reconstruction surgery. The objectives of this study are to program a prototype of an application (app) with a value clarification exercise and to evaluate the pilot usability, feasibility, and efficacy of the app. In phase 1, a prototype app called Pink Journey for use on the iPhone OS (IOS) platform was created following the framework of shared decision making. In phase 2, 11 women who were given the option of reconstruction by a breast surgeon were recruited from July 2017 to December 2017. A pretest-posttest design was adopted to test the usability and feasibility of the app. The results showed that the women who used the app reported significantly less decisional conflict after intervention on each subscale of the Decision Conflict scale, i.e., “being informed”, “uncertainty”, “social support”, “effective decision”, and “value clarification”. This research provides preliminary data indicating that Pink Journey holds promise for decreasing decision conflict. Most women felt that the app was both helpful and user-friendly. The app increased their participation in decision making, helped them obtain more accurate risk perceptions, and clarified their values. It also helped the women make decisions regarding breast reconstruction more confidently.

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The Ministry of Science and Technology (MOST) provided Research Project Grant no. 106-2314-B-006-010-MY2 and Summer Research Project Grant no. NCKUMCS2017070 and NCKUMCS2016055 from the College of Medicine at National Cheng Kung University.

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Correspondence to Su-Ying Fang.

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Ethical approval was obtained from the committee of National Cheng Kung University Hospital (Taiwan) (IRB number B-ER-106-072). All procedures involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The authors have full control of all primary data and agree to allow the journal to review their data if requested.

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Lin, PJ., Fang, SY. & Kuo, YL. Development and Usability Testing of a Decision Support App for Women Considering Breast Reconstruction Surgery. J Canc Educ 36, 160–167 (2021).

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  • Shared decision making
  • Decision aid
  • Breast reconstruction