Development of a patient decision aid for choice of surgical treatment for breast cancer

Abstract

Purpose A patient decision aid for the surgical treatment of early stage breast cancer was developed and evaluated. The rationale for its development was the knowledge that breast conserving therapy (lumpectomy followed by breast radiation) and mastectomy produce equivalent outcomes, and the current general agreement that the decision for the type of surgery should rest with the patient. Methods A decision aid was developed and evaluated in sequential pilot studies of 18 and 10 women with newly diagnosed breast cancer who were facing a decision for breast conserving therapy or mastectomy. Both qualitative (general reaction, self‐reported anxiety, clarity, satisfaction) and quantitative (knowledge and decisional conflict) measures were assessed. Results The decision aid consists of an audiotape and workbook and takes 36 min to complete. Based on qualitative comments and satisfaction ratings, 17 of 18 women reported a positive reaction to the decision aid, and all 18 reported that it helped clarify information given by the surgeon. Women did not report an increase in anxiety and 17 of 18 women were either satisfied or very satisfied with the decision aid. Conclusion This pilot study supports the hypothesis that this decision aid may be a helpful adjunct in the decision for surgical management of early stage breast cancer. We are currently conducting a randomized trial of the decision aid versus a simple educational pamphlet to evaluate its efficacy as measured by knowledge, decisional conflict, anxiety and post‐decisional regret.

Contextual factors in shared decision making: a randomised controlled trial in women with a strong suspicion of breast cancer

“…Variance constriction because of a ceiling effect may have contributed to the lack of a group difference. Results are in line with other studies, which reported null effects of decision aids on satisfaction judgements (Sawka et al, 1998;Whelan et al, 1999), whereas some studies demonstrated short (Whelan et al, 2004) or long-term effects (Molenaar et al, 2001). Discrepant findings may be related to individual differences in cognitive processing of the decision making phase on which the decision aids also have an impact.…”

“…However, on the 'information' subscale of the decisional conflict scale which is considered as one of two indicators of decision quality (O'Connor et al, 2003), patients who underwent the decision aid intervention reported feeling better informed than participants in the control arm. Effects on informational levels have been also shown in other studies in women with newly diagnosed breast cancer (Sawka et al, 1998;Whelan et al, 2003Whelan et al, , 2004.…”

“…Although essentially null effects were reported in a meta-analysis of intervention effects on satisfaction measures (O'Connor et al, 2003), some studies of breast cancer patients found positive effects of decision aid interventions (Sawka et al, 1998;Whelan et al, 2004). Consequently, we assessed whether the intervention influenced either decision specific or overall patient satisfaction with treatment.…”

“…Although not all studies showed benefits (Goel et al, 2001), intervention studies in patients with newly diagnosed breast cancer found that decision aids increase patient knowledge (Sawka et al, 1998;Whelan et al, 2003Whelan et al, , 2004 and affect surgical (Street et al, 1995;Molenaar et al, 2001;Katz et al, 2005;Lantz et al, 2005) as well as adjuvant treatment decision making (Peele et al, 2005;Siminoff et al, 2006).…”

Design Features of Explicit Values Clarification Methods

“…Sawka et 1 Choice between lumpectomy with radiation and mastectomy al. 109,110 for early breast cancer. Schapira et al 111 1…”