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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.

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Sarah T. Hawley, Jennifer J. Griggs, Lisa Newman, and Steven J. Katz conceptualized the study. These authors plus Mary Ann Kosir designed and implemented the study. Sarah T. Hawley conducted the data analysis. All authors assisted in interpreting the results. The complete first draft of the paper was written by Sarah T. Hawley, with assistance from Jennifer J. Griggs and Steven J. Katz. All authors commented on the complete first draft as well as subsequent drafts and revisions. All authors approved the final version. The authors acknowledge the assistance of Rebecca Morrison in editing and formatting versions of the manuscript. Sarah T. Hawley acts as guarantor for the manuscript.

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Correspondence to Sarah T. Hawley.

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This work was funded by Grant Number R21 CA129859 to the University of Michigan.

Conflict of interest

Sarah T. Hawley, Jennifer J. Griggs, Lisa Newman, Mary Ann Kosir, and Steven J. Katz declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Hawley, S.T., Newman, L., Griggs, J.J. et al. Evaluating a Decision Aid for Improving Decision Making in Patients with Early-stage Breast Cancer. Patient 9, 161–169 (2016).

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