Evaluating a Decision Aid for Improving Decision Making in Patients with Early-stage Breast Cancer

  • Sarah T. Hawley
  • Lisa Newman
  • Jennifer J. Griggs
  • Mary Ann Kosir
  • Steven J. Katz
Original Research Article

Abstract

Background

Early-stage breast cancer patients face a series of complex treatment decisions, with the first typically being choice of locoregional treatment. There is a need for tools to support patients in this decision-making process.

Methods

We developed an innovative, online locoregional treatment tool based on International Patient Decision Aids Standards criteria. We evaluated its impact on patient knowledge about treatment and appraisal of decision making in a pilot study using a clinical sample of newly diagnosed, breast cancer patients who were randomized to view the decision aid website first or complete a survey prior to viewing the decision aid. Differences in knowledge and decision appraisal between the two groups were compared using t-tests and chi-square tests. Computer-generated preferences for treatment were compared with patients’ stated preferences using chi-square tests.

Results

One hundred and one newly diagnosed patients were randomized to view the website first or take a survey first. Women who viewed the website first had slightly higher, though not significantly, knowledge about surgery (p = 0.29) and reconstruction (p = 0.10) than the survey-first group. Those who viewed the website first also appraised their decision process significantly more favorably than did those who took the survey first (p < 0.05 for most decision outcomes). There was very good concordance between computer-suggested and stated treatment preferences.

Conclusion

This pilot study suggests that an interactive decision tool shows promise for supporting early-stage breast cancer patients with complicated treatment decision making.

References

  1. 1.
    Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, Aguilar M, Marubini E. Twenty year follow up of a randomized study of breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227–32.CrossRefPubMedGoogle Scholar
  2. 2.
    EBCTCG. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomized trials. Lancet. 2005;366(9503):2087–106.Google Scholar
  3. 3.
    Morrow M. Rational local therapy for breast cancer. N Engl J Med. 2002;347(16):1270–1.CrossRefPubMedGoogle Scholar
  4. 4.
    Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N. 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(16):1233–41.CrossRefPubMedGoogle Scholar
  5. 5.
    Clinical Practice Guidelines. Mastectomy or lumpectomy? The choice of operation for clinical stages I and II breast cancer. CMAJ. 1998;158(Suppl 3):S15–21.Google Scholar
  6. 6.
    Morrow M, Strom EA, Bassett LW, Dershaw DD, Fowble B, Giuliano A, Harris JR, O’Malley F, Schnitt SJ, Singletary SE, Winchester DP. Standard for breast conservation therapy in the management of invasive breast carcinoma. CA Cancer J Clin. 2002;52(5):277–300.CrossRefPubMedGoogle Scholar
  7. 7.
    Opatt D, Morrow M, Hawley S, Schwartz K, Janz NK, Katz SJ. Conflicts in decision making for breast cancer surgery. Annals Surg Oncol 2007;14(9):3463–9.Google Scholar
  8. 8.
    Morrow M, Jagsi R, Alderman AK, Griggs JJ, Hawley ST, Hamilton AS, Graff JJ, Katz SJ. Surgeon recommendations and receipt of mastectomy for treatment of breast cancer. JAMA 2009;302(14):1551–6.Google Scholar
  9. 9.
    Molenaar S, Oort F, Sprangers M, Rutgers E, Luiten E, Mulder J, de Haes H. Predictors of patients’ choices for breast-conserving therapy or mastectomy: a prospective study. Br J Cancer. 2004;90(11):2123–30.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Hawley ST, Griggs JJ, Hamilton AS, Graff JJ, Janz NK, Morrow M, Jagsi R, Salem B, Katz SJ. Decision involvement and receipt of mastectomy among racially and ethnically diverse breast cancer patients. J Natl Cancer Inst. 2009;101(19):1337–47.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Collins ED, Moore CP, Clay KF, Kearing SA, O’Connor AM, Llewellyn-Thomas HA, Barth RJ Jr, Sepucha KR. Can women with early-stage breast cancer make an informed decision for mastectomy? J Clin Oncol. 2009;27(4):519–25.CrossRefPubMedGoogle Scholar
  12. 12.
    Tuttle TM, Abbott A, Arrington A, Rueth N. The increasing use of prophylactic mastectomy in the prevention of breast cancer. Curr Oncol Rep. 2010;12(1):16–21.CrossRefPubMedGoogle Scholar
  13. 13.
    Kurian AW, Lichtensztajn DY, Keegan TH, Nelson DO, Clarke CA, Gomez SL. Use of and mortality after bilateral mastectomy compared with other surgical treatments for breast cancer in California, 1998–2011. JAMA. 2014;312(9):902–14.CrossRefPubMedGoogle Scholar
  14. 14.
    Kummerow KL, Du L, Penson DF, Shyr Y, Hooks MA. Nationwide trends in mastectomy for early stage breast cancer. JAMA Surg. 2015;150(1):9–16.CrossRefPubMedGoogle Scholar
  15. 15.
    Pesce CE, Liederbach E, Czechura T, Winchester DJ. Yao Km. Changing surgical trends in young patients with early stage breast cancer, 2003 to 2010: a report from the National Cancer Data Base. J Am Coll Surg. 2014;219(1):19–28.CrossRefPubMedGoogle Scholar
  16. 16.
    Fagerlin A, Lakhani I, Lantz PM, Janz NK, Morrow M, Schwartz K, Deapen D, Salem B, Liu L, Katz SJ. An informed decision? Breast cancer patients and their knowledge about treatment. Patient Educ Couns. 2006;64(1–3):303–12.CrossRefPubMedGoogle Scholar
  17. 17.
    Covelli AM, Baxter NN, Fitch MI, McCready DR, Wright FC. ‘Taking control of cancer’: understanding women’s choice for mastectomy. Ann Surg Oncol. 2015;22(2):383–91.CrossRefPubMedGoogle Scholar
  18. 18.
    Rosenberg SM, Partridge AH. Contralateral prophylactic mastectomy: an opportunity for shared decision making. JAMA Surg. 2014 (Epub ahead of print).Google Scholar
  19. 19.
    Sepucha KR, Belkora JK, Chang Y, Cosenza C, Levin CA, Moy B, Partridge A, Lee CN. Measuring decision quality: psychometric evaluation of a new instrument for breast cancer surgery. BMC Med Inform Decis Mak. 2012;12:51.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Hawley ST, Fagerlin A, Janz NK, Lantz PM, Katz SJ. Racial/ethnic disparities in knowledge about risks and benefits of breast cancer treatment: does it matter where you go? Health Serv Res. 2008;43(4):1366–87.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Nold RJ, Beamer RL, Helmer SD, McBoyle MF. Factors influencing a woman’s choice to undergo breast conserving surgery versus modified radical mastectomy. Am J Surg. 2000;180(6):413–8.CrossRefPubMedGoogle Scholar
  22. 22.
    O’Leary KA, Estabrooks CA, Olson K, Cumming C. Information acquisition for women facing surgical treatment for breast cancer: influencing factors and selected outcomes. Patient Educ Couns. 2007;69(1–3):5–19.CrossRefPubMedGoogle Scholar
  23. 23.
    Janz NK, Wren PA, Copeland LA, Lowery JC, Goldfarb SL, Wilkins EG. Patient-physician concordance: preferences, perceptions, and factors influencing the breast cancer surgical decision. J Clin Oncol. 2004;22(15):3091–8.CrossRefPubMedGoogle Scholar
  24. 24.
    O’Brien MA, Charles C, Whelan TJ, Ellis PM, Gafni A, Lovrics P. Women’s perceptions of their involvement in treatment decision making for early stage breast cancer. Support Care Cancer. 2013;21(6):1717–23.CrossRefPubMedGoogle Scholar
  25. 25.
    O’Brien MA, Ellis PM, Whelan TJ, Charles C, Gafni A, Lovrics P, Mukherjee SD, Hodgson N. Physician-related facilitators and barriers to patient involvement in treatment decision making in early stage breast cancer: perspectives of physicians and patients. Health Expect. 2013;21(6):1717–23.Google Scholar
  26. 26.
    Keating NL, Guadagnoli E, Landrum MB, Borbas C, Weeks JC. Treatment decision making in early-stage breast cancer: should surgeons match patients’ desired level of involvement? J Clin Oncol. 2002;20(6):1473–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Whelan T, Levine M, Willan A, Gafni A, Sanders K, Mirsky D, Chambers S, O’Brien MA, Reid S, Dubois S. Effect of a decision aid on knowledge and treatment decision making for breast cancer surgery: a randomized trial. JAMA. 2004;292(4):435–41.CrossRefPubMedGoogle Scholar
  28. 28.
    Goel V, Sawka CA, Thiel EC, Gort EH, O’Connor AM. Randomized trial of a patient decision aid for choice of surgical treatment for breast cancer. Med Decis Making. 2001;21(1):1–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Molenaar S, Sprangers MA, Rutgers EJ, Luiten EJ, Mulder J, Bossuyt PM, van Everdingen JJ, Oosterveld P, de Haes HC. Decision support for patients with early-stage breast cancer: effects of an interactive breast cancer CDROM on treatment decision, satisfaction, and quality of life. J Clin Oncol. 2001;19(6):1676–87.PubMedGoogle Scholar
  30. 30.
    Jibaja-Wess M, Volk RJ, Granchi TS, Neff NE, Robinson EK, Spann SJ, Aoki N, Friedman LC, Beck JR. Entertainment education for breast cancer surgery decisions: a randomized trial among patients with low health literacy. Patient Educ Couns. 2011;84(1):41–8.CrossRefGoogle Scholar
  31. 31.
    Ottawa Hospital Research Institute: Catalogue of decision aids. Available at http://decisionaid.ohri.ca/index.html. Accessed 26 May 2015.
  32. 32.
    Sivell S, Edwards A, Manstead AS, Reed MW, Caldon L, Collins K, Clements A, Elwyn G, BresDex Group. Increasing readiness to decide and strengthening behavioral intentions: evaluating the impact of a web-based patient decision aid for breast cancer treatment options (BresDex: http://www.bresdex.com). Patient Educ Couns. 2012;88(2):209–17.CrossRefPubMedGoogle Scholar
  33. 33.
    Elwyn G, O’Connor A, Stacey D, Volk R, Edwards A, Coulter A, Thomson R, Barratt A, Barry M, Bernstein S, Butow P, Clarke A, Entwistle V, Feldman-Stewart D, Holmes-Rovner M, Llewellyn-Thomas H, Moumjid N, Mulley A, Ruland C, Sepucha K, Sykes A, Whelan T, International Patient Decision Aids Standards (IPDAS) Collaboration. Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ. 2006;333(7565):417.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Alderman AK, Hawley ST, Waljee J, Mujahid M, Morrow M, Katz SJ. Understanding the impact of breast reconstruction on the surgical decision-making process for breast cancer. Cancer. 2008;112(3):489–94.CrossRefPubMedGoogle Scholar
  35. 35.
    Green PE, Rao VR. Conjoint measurement for quantifying judgemental data. J Market Res. 1971;8:355–63.CrossRefGoogle Scholar
  36. 36.
    Ramirez JM. Measuring: from conjoint analysis to integrated conjoint experiments. J Quant Methods Econ Bus Admin. 2009;9:28–43.Google Scholar
  37. 37.
    Ryan M, Bate A, Eastmond CJ, Ludbrook A. Use of discrete choice experiments to elicit preferences. Qual Health Care. 2001;10(Suppl 1):i55–60.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Bridges JF, Hauber AB, Marshall D, Lloyd A, Prosser LA, Regier DA, Johnson FR, Mauskopf J. Conjoint analysis applications in health: a checklist: a report of the ISPOR Good Research Practices for Conjoint Analysis Task Force. Value Health. 2011;14(4):403–13.CrossRefPubMedGoogle Scholar
  39. 39.
    Wouters H, Maatman GA, Van Dijk L, Bouvy ML, Vree R, Van Geffen EC, Nortier JW, Stiggelbout AM. Trade-off preferences regarding adjuvant endocrine therapy among women with estrogen receptor-positive breast cancer. Ann Oncol. 2013;24(9):2324–9.Google Scholar
  40. 40.
    Phillips KA, Maddala T, Johnson FR. Measuring preferences for health care interventions using conjoint analysis: an application to HIV testing. Health Serv Res. 2002;37(6):1681–705.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Ryan M. Using conjoint analysis to take account of patient preferences and go beyond health outcomes: an application to in vitro fertilization. Soc Sci Med. 1999;48(4):535–46.CrossRefPubMedGoogle Scholar
  42. 42.
    Mac Bride MB, Neal L, Dilaveri CA, Sandhu NP, Hieken TJ, Ghosh K, Wahner-Roedler DL. Factors associated with surgical decision making in women with early-stage breast cancer: a literature review. J Womens Health (Larchmt). 2013;22(3):236–42.Google Scholar
  43. 43.
    Rendle KA, Halley MC, May SG, Frosch DL. Redefining risk and benefit: understanding the decision to undergo contralateral prophylactic mastectomy. Qual Health Res. 2014 (pii: 1049732314557085, Epub ahead of print).Google Scholar
  44. 44.
    Hamelinck VC, Bastiaannet E, Pieterse AH, Jannink I, van de Velde CJ, Liefers GJ, Stiggelbout AM. Patients’ preferences for surgical and adjuvant systemic treatment in early breast cancer: a systematic review. Cancer Treat Rev. 2014;40(8):1005–18.CrossRefPubMedGoogle Scholar
  45. 45.
    Pignone MP, Brenner AT, Hawley ST, Sheridan SL, Lewis CL, Jonas DE, Howard K. Conjoint analysis versus rating and ranking for values elicitation and clarification in colorectal cancer screening. J Gen Intern Med. 2012;27(1):45–50.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Holmes-Rovner M, Kroll J, Schmitt N, Rovner DR, Breer ML, Rothert ML, Padonu G, Talarczyk G. Patient satisfaction with health care decisions: the satisfaction with decision scale. Med Decis Making. 1996;16(1):58–64.CrossRefPubMedGoogle Scholar
  47. 47.
    StataCorp. Stata Statistical Software: Release 11. C ollege Station: StataCorp LP; 2009.Google Scholar
  48. 48.
    Elwyn G, Scholl I, Tietbohl C, Mann M, Edwards AG, Clay C, Légaré F, van der Weijden T, Lewis CL, Wexler RM, Frosch DL. “Many miles to go …”: a systematic review of the implementation of patient decision support interventions into routine clinical practice. BMC Med Inform Decis Mak. 2013;13(Suppl 2):S14.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    The challenge of individualizing treatment for breast cancer. National Cancer Institute P01 (P01 CA 163233), S. Katz, PI.Google Scholar
  50. 50.
    Katz SJ, Hawley ST, Morrow M, Griggs JJ, Jagsi R, Hamilton AS, Graff JJ, Friese CR, Hofer TP. Coordinating cancer care: patient and practice management processes among surgeons who treat breast cancer. Med Care. 2010;48(1):45–51.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Caldon LJ, Collins KA, Reed MW, Sivell S, Austoker J, Clements AM, Patnick J, Elwyn G, BresDex Group. Clinicians’ concerns about decision support interventions for patients facing breast cancer surgery options: understanding the challenge of implementing shared decision-making. Health Expect. 2011;14(2):133–46. doi:10.1111/j.1369-7625.2010.00633.x (Epub 2010 Oct 28).
  52. 52.
    Guiliano AE, Chung AP. Long term follow up confirms the oncologic safely of sentinel node biopsy without axillary dissetion in node negative breast cancer patients. Ann Surg. 2010;251(4):601–3.CrossRefGoogle Scholar
  53. 53.
    Recht A, Edge SB, Solin LJ, Robinson DS, Estabrook A, Fine RE, Fleming GF, Formenti S, Hudis C, Kirshner JJ, Krause DA, Kuske RR, Langer AS, Sledge GW Jr, Whelan TJ, Pfister DG, American Society of Clinical Oncology. Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol. 2001;19(5):1539–69.PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland (outside the USA) 2015

Authors and Affiliations

  • Sarah T. Hawley
    • 1
    • 4
  • Lisa Newman
    • 2
  • Jennifer J. Griggs
    • 1
  • Mary Ann Kosir
    • 3
  • Steven J. Katz
    • 1
  1. 1.Department of Internal MedicineUniversity of MichiganAnn ArborUSA
  2. 2.Department of SurgeryUniversity of MichiganAnn ArborUSA
  3. 3.Karmanos Cancer InstituteDetroitUSA
  4. 4.Ann Arbor VA Healthcare SystemAnn ArborUSA

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