Health literacy, decisional conflict, and body image in patients eligible for breast-conserving surgery: A comparison between mastectomy and breast-conserving surgery groups
Abstract
Objective: The aim was to evaluate the relationship between health literacy, decision conflict, and body image in early-stage breast cancer patients eligible for breast-conserving surgery (BCS) who opted for either breast-conserving surgery or mastectomy.
Methods: This prospective, cross-sectional study included 60 female patients eligible for BCS (30 mastectomy, 30 BCS). Health literacy was assessed using the European Health Literacy Survey Questionnaire-6 (HLS-EU-Q6); decision conflict was evaluated using the SURE and the Decision Conflict Scale (DCS); and body image was assessed using the Body Image Scale. The groups were compared using appropriate statistical methods, and factors associated with decisional conflict were explored using logistic regression analysis.
Results: The groups were similar in terms of age, marital status, and education level (p > 0.05). The level of health literacy was significantly higher in the mastectomy group compared to the BCS group (median 3.52 vs. 2.36; p < 0.001). In contrast, body image satisfaction was higher in the BCS group (3.50 vs. 2.00; p < 0.001), while body image-related anxiety was lower (2.00 vs. 4.00; p < 0.001). While SURE scores were higher in the mastectomy group (4.00 vs. 2.00; p < 0.001), the total DCS score was higher in the BCS group (47.65 vs. 14.66; p < 0.001). In the multivariable analysis, age and health literacy were not found to be significant independent predictors of decision conflict (p > 0.05).
Conclusion: Health literacy, decisional conflict, and body image differed significantly between patients who underwent mastectomy and those who underwent breast-conserving surgery. Because these variables were assessed after the surgical decision had already been finalized, these findings should be interpreted as associations rather than causal determinants of surgical choice; larger, longitudinal studies assessing these factors before the decision is made are needed to clarify their role in shared decision-making.Keywords
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