Assessing the Role of Presurgical Information on Patient-Reported Outcomes: A Causal Analysis

Objectives: Breast cancer poses a global burden on individuals and healthcare systems, with millions of women undergoing surgery annually. Recently, there has been growing recognition of the importance of patient-centered care, leading to increased interest in patient-reported outcome measures. In oncology, this has translated into the use of validated tools, such as the BREAST-Q survey, which is designed for a range of breast surgery procedures, and it is specifically applicable in breast cancer. Using BREAST-Q data collected at the University Hospital of Pisa (Italy) between 2018 and 2022 from a sample of 482 women, this study explores the causal relationship between the preoperative information provided by the breast surgeon and patients’ postsurgery satisfaction. Methods: We use Item Response Theory models to estimate patient-level satisfaction with presurgery information and with breast outcomes. Using these estimated latent traits, we assess the causal effect of satisfaction with presurgery information on postsurgery breast satisfaction through an exposure-response curve, accounting for various preexposure individual characteristics. Results: Findings show a strong, positive, and statistically significant causal relationship between preoperative information and postoperative satisfaction. Conclusions: In a healthcare landscape increasingly constrained by time and resources, healthcare organizations should note the causal link between communication and patient-reported outcomes and strive to create environments that support meaningful patient-centered interactions.