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

[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.