Utilizing the Total Design Method in medicine: maximizing response rates in long, non-incentivized, personal questionnaire postal surveys

Introduction: Maximizing response rates in questionnaires can improve their validity and quality by reducing non-response bias. A comprehensive analysis is essential for producing reasonable conclusions in patient-reported outcome research particularly for topics of a sensitive nature. This often makes long (≥7 pages) questionnaires necessary but these have been shown to reduce response rates in mail surveys. Our work adapted the “Total Design Method,” initially produced for commercial markets, to raise response rates in a long (total: 11 pages, 116 questions), non-incentivized, very personal postal survey sent to almost 350 women. Patients and methods: A total of 346 women who had undergone mastectomy and immediate breast reconstruction from 2008–2014 (inclusive) at Addenbrooke’s University Hospital were sent our study pack (Breast-Q satisfaction questionnaire and support documents) using our modified “Total Design Method.” Participants were sent packs and reminders according to our designed schedule. Results: Of the 346 participants, we received 258 responses, an overall response rate of 74.5% with a useable response rate of 72.3%. One hundred and six responses were received before the week 1 reminder (30.6%), 120 before week 3 (34.6%), 225 before the week 7 reminder (64.6%) and the remainder within 3 weeks of the final pack being sent. The median age of patients that the survey was sent to, and the median age of the respondents, was 54 years. Conclusion: In this study, we have demonstrated the successful implementation of a novel approach to postal surveys. Despite the length of the questionnaire (nine pages, 116 questions) and limitations of expenses to mail a survey to ~350 women, we were able to attain a response rate of 74.6%

Patient-Reported Satisfaction following mastectomy and immediate reconstruction does not change with time

Background: Patients undergoing mastectomy and immediate breast reconstruction (IBR) for cancer may be expected to reflect differently on their procedure with time. As time from the surgery increases, their perceptions of self and their satisfaction with the procedure could change. Method: Patients undergoing mastectomy and reconstruction from 2008–2014 at the Cambridge Breast Unit were retrospectively identified from a prospective register and their notes audited. The Breast-Q™ questionnaire was posted to participants using the “total Dillman method” in January 2016. Q-SCORE software was utilised to analyse patient satisfaction scores. Linear regressions were conducted with respect to time since procedure and satisfaction scores. Results: Of the 346 participants, we received 258 responses leading to an overall response rate of 74.5% and useable response rate of 72.3%. Across all satisfaction domains (breast, outcome, psychosocial, sexual well-being, physical symptoms, information), patient scores were independent of time since procedure. Conclusion: This study demonstrates that patients’ satisfaction with their procedure does not change significantly between 1 and 8 years post-operatively. It highlights that a patient’s reflection of self at 12 months is maintained in subsequent years. This suggests the importance of complementary intervention to improve outcome before this point

Patient-Reported Satisfaction following mastectomy and immediate reconstruction does not change with time

Background: Patients undergoing mastectomy and immediate breast reconstruction (IBR) for cancer may be expected to reflect differently on their procedure with time. As time from the surgery increases, their perceptions of self and their satisfaction with the procedure could change. Method: Patients undergoing mastectomy and reconstruction from 2008–2014 at the Cambridge Breast Unit were retrospectively identified from a prospective register and their notes audited. The Breast-Q™ questionnaire was posted to participants using the “total Dillman method” in January 2016. Q-SCORE software was utilised to analyse patient satisfaction scores. Linear regressions were conducted with respect to time since procedure and satisfaction scores. Results: Of the 346 participants, we received 258 responses leading to an overall response rate of 74.5% and useable response rate of 72.3%. Across all satisfaction domains (breast, outcome, psychosocial, sexual well-being, physical symptoms, information), patient scores were independent of time since procedure. Conclusion: This study demonstrates that patients’ satisfaction with their procedure does not change significantly between 1 and 8 years post-operatively. It highlights that a patient’s reflection of self at 12 months is maintained in subsequent years. This suggests the importance of complementary intervention to improve outcome before this point

A comparison of patient satisfaction (using the BREAST-Q questionnaire) with bilateral breast reconstruction following risk-reducing or therapeutic mastectomy

Introduction: Patients undergoing mastectomy and immediate breast reconstruction for cancer may be expected to have different perceptions of long-term outcomes compared with those who have this operation prophylactically. Methods: Patients who underwent bilateral mastectomy and breast reconstruction from 2008 to 2014 at the Cambridge Breast Unit were identified from a prospective register and their notes were audited. They were classified according to their indication for surgery as follows: bilaterally therapeutic, bilaterally risk-reducing or combination. The BREAST-Q™ questionnaire was posted to participants using the ‘total Dillman method’. Q-SCORE software was utilised to analyse patient satisfaction scores. Results: Sixty-five (58%) responses were received, of which 8 were excluded, leaving 57 usable for the study. The therapeutic group had higher patient satisfaction than the risk-reducing group across most domains including breast, outcome, psychosocial, sexual, physical and information. The combination group scored lower and BRCA gene mutation-positive patients scored the lowest. Physical well-being was maintained across all groups but psychosocial/sexual well-being varied. Good psychosocial well-being was linked to a higher satisfaction with the outcome in the combination and risk-reducing groups. Conclusion: This study highlights the need for clinicians to take into account the indication for surgery as a major psychological factor in patients’ perception of self and experience of surgery. It demonstrates that bilateral immediate reconstruction patients report similar physical symptoms irrespective of indication for mastectomy, but the decision-making process in terms of risk-balancing and diagnosis influences satisfaction with self and surgery. It underlines the importance of preoperative management of expectations for patients undergoing risk-reducing procedures