Patient-reported outcome measures for post-mastectomy breast reconstruction: A systematic review of development and measurement properties

Background: Breast reconstruction (BR) is performed to improve outcomes for patients undergoing mastectomy. A recently developed core outcome set for BR includes six patient-reported outcomes that should be measured and reported in all future studies. It is vital that any instrument used to measure these outcomes as part of a core measurement set has been robustly developed and validated so data are reliable and accurate. The aim of this systematic review was to evaluate the development and measurement properties of existing BR patient-reported outcome measures (PROMs) to inform instrument selection for future studies.

Methods: A PRISMA-compliant systematic review of development and validation studies of BR PROMs was conducted to assess their measurement properties. PROMs with adequate content validity were assessed using 3 steps: 1) The methodological quality of each identified study was assessed using the COSMIN Risk of Bias checklist, 2) criteria were applied for assessing good measurement properties and 3) evidence was summarized and the quality of evidence assessed using a modified GRADE approach.

Results: 14 articles reported the development and measurement properties of six PROMs. Of these, only three (BREAST-Q, BRECON-31 and EORTC QLQ-BRECON-23) were considered to have adequate content validity and proceeded to full evaluation. This showed that all three PROMs had been robustly developed and validated and demonstrated adequate quality.

Conclusion: The BREAST-Q, BRECON-31 and EORTC QLQ-BRECON-23 have been well-developed and demonstrate adequate measurement properties. Work with key stakeholders is now needed to generate consensus regarding which PROM should be recommended for inclusion in a core measurement set.