Priority 2 from the Post Mastectomy Breast Reconstruction PSP

UNCERTAINTY: How can timely access to breast reconstruction services be improved across Canada for immediate and delayed breast reconstruction? (JLA PSP Priority 2)
Overall ranking	2
JLA question ID	0109/2
Explanatory note	Prior research has shown that breast cancer reconstruction surgical delivery is both inadequate and inequitable across the country with many variations in patterns of care that are not consistent with clinical indications. In many parts of the country, patients are not being informed of the possible options for breast cancer reconstruction before or after mastectomy. Timely and appropriate access to see a plastic surgery in consultation for consideration of breast cancer reconstruction can be limited by the knowledge and practice pattern of the referring physician, availability of the plastic surgeon to perform reconstruction, and availability of the operating room resources if both mastectomy and reconstruction are needed at the same time. In our unique healthcare system, how can we find creative and enduring methods to ensure that timely and appropriate access to breast cancer reconstruction are provided to our breast cancer patients?
Evidence	Early and locally advanced breast cancer: diagnosis and management. Evidence-based recommendations on diagnosing and managing early and locally advanced breast cancer. NICE guideline Published July 2018
Health Research Classification System category	Cancer

Extra information provided by this PSP
Original uncertainty examples	I am not familiar with wait times in our province nor how many ~ physicians actually do the procedure. ~ why is there a 3 year wait list in Nova Scotia for reconstruction, with no dedicated reconstruction team? ~ In metropolitan Montreal, once you are outside the Island of Montreal, you end up in a "region" (North Shore, South Shore) and therefore immediate breast reconstruction (with or without an expander) is rarely available. However, when we read in women's magazines or attend BRA Day, we feel that reconstructions are also available everywhere. ~ How can we improve multidisciplinary access
Submitted by	17 Patients and Care-givers, 15 Clinicians

Extra information provided by this PSP

Original uncertainty examples

I am not familiar with wait times in our province nor how many ~ physicians actually do the procedure. ~ why is there a 3 year wait list in Nova Scotia for reconstruction, with no dedicated reconstruction team? ~ In metropolitan Montreal, once you are outside the Island of Montreal, you end up in a "region" (North Shore, South Shore) and therefore immediate breast reconstruction (with or without an expander) is rarely available. However, when we read in women's magazines or attend BRA Day, we feel that reconstructions are also available everywhere. ~ How can we improve multidisciplinary access

Submitted by

17 Patients and Care-givers, 15 Clinicians

PSP information
PSP unique ID	0109
PSP name	Post Mastectomy Breast Reconstruction
Total number of uncertainties identified by this PSP.	86 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	2 July 2019