Evaluating a Decision Aid for Improving Decision Making in Patients with Early-stage Breast Cancer
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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.
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.
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.
This pilot study suggests that an interactive decision tool shows promise for supporting early-stage breast cancer patients with complicated treatment decision making.
- 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
- 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.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
- 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.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
- 18.Rosenberg SM, Partridge AH. Contralateral prophylactic mastectomy: an opportunity for shared decision making. JAMA Surg. 2014 (Epub ahead of print).Google Scholar
- 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
- 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
- 31.Ottawa Hospital Research Institute: Catalogue of decision aids. Available at http://decisionaid.ohri.ca/index.html. Accessed 26 May 2015.
- 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.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
- 36.Ramirez JM. Measuring: from conjoint analysis to integrated conjoint experiments. J Quant Methods Econ Bus Admin. 2009;9:28–43.Google Scholar
- 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
- 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.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
- 47.StataCorp. Stata Statistical Software: Release 11. C ollege Station: StataCorp LP; 2009.Google Scholar
- 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.The challenge of individualizing treatment for breast cancer. National Cancer Institute P01 (P01 CA 163233), S. Katz, PI.Google Scholar
- 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).
- 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