Skip to main content

Advertisement

SpringerLink
Log in

A Randomized Controlled Trial Evaluating the Impact of Pre-Consultation Information on Patients’ Perception of Information Conveyed and Satisfaction with the Decision-Making Process

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Patient participation in treatment decision-making is a health care priority. This study hypothesized that providing a decision aid before surgical consultation would better prepare patients for decision-making. The objective was to examine the impact of a decision aid versus high-quality websites on patients’ perceptions of information conveyed during surgical consultation and satisfaction with the decision process.

Methods

Patients with stages 0 to 3 breast cancer were randomized. Surveys assessed perceptions of information conveyed, being asked surgical preference, and satisfaction with the decision process. Multivariable logistic regression assessed associations between outcomes and randomization arm, patient factors, and surgeon. Change in Pseudo-R2 assessed the comparative effect of these factors on perceptions of the information conveyed.

Results

The median patient age was 59 years. Most of the patients (98%) were white, and 62% were college educated (n = 201). The findings showed no association between randomization arm and perceptions of information conveyed, being asked surgical preference, or satisfaction with the decision process. Most of the patients reported discussing both breast-conserving therapy and mastectomy (69%) and being asked their surgical preference (65%). The surgeon seen was more important than the randomization arm or the patient factors in predicting patients’ perceptions of information conveyed (explained 64-69% of the variation), and 63% of the patients were satisfied with the decision process.

Conclusion

Use of a decision aid compared with high-quality websites did not increase patients’ perceptions of information conveyed or satisfaction with the decision process. Although the surgeon seen influenced aspects of the patient experience, the surgeon was not associated with satisfaction. Understanding the factors driving low satisfaction is critical because this is increasingly used as a marker of health care quality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Lantz PM, Janz NK, Fagerlin A, et al. Satisfaction with surgery outcomes and the decision process in a population-based sample of women with breast cancer. Health Serv Res. 2005;40:745–767.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Presson AP, Zhang C, Abtahi AM, Kean J, Hung M, Tyser AR. Psychometric properties of the Press Ganey(R) Outpatient Medical Practice Survey. Health Qual Life Outcomes. 2017;15:32.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Services CfMaM. Hospital Value-Based Purchasing. Medicare Learning Network Booklet 2017. Retrieved 16 Mar 2018 at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf.

  4. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.

    Article  PubMed  Google Scholar 

  5. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.

    Article  PubMed  Google Scholar 

  6. Poggi MM, Danforth DN, Sciuto LC, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute Randomized Trial. Cancer. 2003;98:697–702.

    Article  PubMed  Google Scholar 

  7. Lee CN, Chang Y, Adimorah N, et al. Decision-making about surgery for early-stage breast cancer. J Am Coll Surg. 2012;214:1–10.

    Article  PubMed  Google Scholar 

  8. Waljee JF, Rogers MA, Alderman AK. Decision aids and breast cancer: do they influence choice for surgery and knowledge of treatment options? J Clin Oncol. 2007;25:1067–73.

    Article  PubMed  Google Scholar 

  9. Tucholka JL, Yang DY, Bruce JG, et al. A randomized controlled trial evaluating the impact of web-based information on breast cancer patients’ knowledge of surgical treatment options. J Am Coll Surg. 2018;226:126–33.

    Article  PubMed  Google Scholar 

  10. Bruce JG, Tucholka JL, Steffens NM, Neuman HB. Quality of online information to support patient decision-making in breast cancer surgery. J Surg Oncol. 2015;112:575–80.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kind AJ, Jencks S, Brock J, et al. Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study. Ann Intern Med. 2014;161:765–74.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Singh GK. Area deprivation and widening inequalities in US mortality, 1969–1998. Am J Pub Health. 2003;93:1137–43.

    Article  Google Scholar 

  13. Sepucha KR, Belkora JK, Chang Y, et al. Measuring decision quality: psychometric evaluation of a new instrument for breast cancer surgery. BMC Med Informat Decision-Making. 2012;12:51.

    Article  Google Scholar 

  14. Degner LF, Sloan JA, Venkatesh P. The Control Preferences Scale. Can J Nurs Res. 1997;29:21–43.

    CAS  PubMed  Google Scholar 

  15. Greenberg CC, Lipsitz SR, Hughes ME, et al. Institutional variation in the surgical treatment of breast cancer: a study of the NCCN. Ann Surg. 2011;254:339–45.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Obeidat R, Finnell DS, Lally RM. Decision aids for surgical treatment of early-stage breast cancer: a narrative review of the literature. Patient Educ Couns. 2011;85:e311–21.

    Article  PubMed  Google Scholar 

  17. Stacey D, Legare F, Lewis K, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2017;4:Cd001431.

  18. Whelan T, Levine M, Willan A, et al. Effect of a decision aid on knowledge and treatment decision-making for breast cancer surgery: a randomized trial. JAMA. 2004;292:435–41.

    Article  CAS  PubMed  Google Scholar 

  19. Molenaar S, Oort F, Sprangers M, et al. Predictors of patients’ choices for breast-conserving therapy or mastectomy: a prospective study. Br J Cancer. 2004;90:2123–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Bruce JG, Tucholka JL, Steffens NM, Mahoney JE, Neuman HB. Feasibility of providing web-based information to breast cancer patients prior to a surgical consult. J Cancer Educ. 2018;33:1069–74.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgment

The project was supported in part by NIH T32 Grant, NCI P30 CA014520, the BIRCWH Scholars Program (K12 HD055894), and the MT-DIRC Fellowship (R25CA171994).

Author information

Authors and Affiliations

  1. Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin, Madison, WI, USA

    Trista J. Stankowski-Drengler MD, Jennifer L. Tucholka BS, Jessica R. Schumacher PhD, Caprice C. Greenberg MD, MPH, Lee G. Wilke MD, Bret Hanlon PhD & Heather B. Neuman MD, MS

  2. Department of Surgery, Washington University, St. Louis, MO, USA

    Jordan G. Bruce MD

  3. Denver Public Health, Denver Health and Hospital Authority, Denver, CO, USA

    Nicole M. Steffens MPH

  4. Carbone Cancer Center, University of Wisconsin, Madison, WI, USA

    Caprice C. Greenberg MD, MPH, Lee G. Wilke MD & Heather B. Neuman MD, MS

  5. Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    Jennifer Steiman MD

Authors
  1. Trista J. Stankowski-Drengler MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer L. Tucholka BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jordan G. Bruce MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nicole M. Steffens MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jessica R. Schumacher PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Caprice C. Greenberg MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lee G. Wilke MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bret Hanlon PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jennifer Steiman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Heather B. Neuman MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Heather B. Neuman MD, MS.

Ethics declarations

Disclosures

There are no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stankowski-Drengler, T.J., Tucholka, J.L., Bruce, J.G. et al. A Randomized Controlled Trial Evaluating the Impact of Pre-Consultation Information on Patients’ Perception of Information Conveyed and Satisfaction with the Decision-Making Process. Ann Surg Oncol 26, 3275–3281 (2019). https://doi.org/10.1245/s10434-019-07535-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-019-07535-0

Search

Navigation