Health literacy, decisional conflict, and body image in patients eligible for breast-conserving surgery: A comparison between mastectomy and breast-conserving surgery groups

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.