The Effect of Previsit Education in Breast Cancer Patients: A Study of a Shared-decision-making Tool

Abstract

To enhance shared decision-making for patients with breast cancer, we developed an evidence-based educational breast cancer video (BCV) providing an overview of breast cancer biology, prognostic indicators, and surgical treatment options while introducing health care choice. By providing patients access to a BCV with information necessary to make informed surgical decisions before seeing a surgeon, we aimed to increase patient participation in the decision-making process, while decreasing distress. Patients with a new diagnosis of breast cancer were provided a link to the BCV. Group 1 participated in online pre- and postvideo questionnaires, with the BCV embedded in between. The questionnaires evaluated self-reported baseline knowledge of breast cancer and perceived distress related to the diagnosis. Changes in self-reported responses were analyzed using the Wilcoxon matched pairs test. Group 2 received a survey collecting demographics, decision-making information, and perceptions of the BCV at the time of clinic visit before meeting the surgeon. Group 1 included 69 subjects with 62 per cent reporting improved knowledge and 30 per cent reporting reduced distress in regard to their breast cancer diagnosis. Group 2 included 87 subjects; 94 to 98 per cent felt the BCV provided information and stimulated thoughts and questions to assist in breast cancer treatment decision-making. The BCV was positively received by participants and feasible to implement into clinical practice. Evidence-based media tools improve knowledge and reduce distress in patients with a new diagnosis of breast cancer as well as contributing to the shared decision-making process.

How Well Informed Do Patients Feel about Their Breast Cancer Surgery Options? Findings from a Nationwide Survey of Women after Lumpectomy and/or Mastectomy

“…Previous studies have shown that most breast cancer patients feel more informed than they actually are. 19,23,43 So, consistent with past research 18,19,23,[43][44][45] and the Institute of Medicine special report, 21 there appears to be a substantial deficiency in the informing of women about their breast cancer treatment options. Some patients (and therefore some doctors too) might feel that being "somewhat informed" is sufficient and satisfactory.…”

“…We also found that the vast majority of women were turning to other sources for information about treatment options (Table 2), consistent with past research. 19,44,45 Another large survey, conducted a decade ago with women in Los Angeles, CA and Detroit, MI, who had mostly undergone breast-conserving operations, also asked about what sources of information the women used. 19 Despite somewhat lower education levels, that survey's sample reported higher use rates of books (60%), scientific journal papers (52%), and magazines (51%) compared with our survey's lumpectomy-only patients' use of books or magazines (28%), and slightly lower rates of internet use (48% vs 58%), probably all due to the shift from print to digital during the past decade, and perhaps also due to culturally declining interest in reading.…”

“…44 Whatever the reasons might be, the use of those other sources of information might not always be beneficial because some of those sources might be providing misinformation or otherwise be confusing and counterproductive (Table 3). 19,45,46 In addition, most patients lack sufficient research skills to locate all of the best information available and lack sufficient medical knowledge to evaluate the quality of the information they find. Therefore, healthcare providers should be prepared to provide vetted, medically reliable information in a variety of formats.…”

A personalized, web-based breast cancer decision making application: a pre-post survey

“…While our approach incorporated a web-based educational tool that was reviewed after the initial consultation, an alternative or complementary approach is provision of education materials prior to the initial consultation with the aim of preparing the patient for discussion at the first visit. The feasibility of pre-visit educational videos in patients with breast cancer has been demonstrated elsewhere with favorable patient attitudes [23]. We are currently piloting the approach of a series of concise pre-visit videos in our clinic as an adjunct to the application.…”

Combined Detection of HER2, Ki67, and GSTP1 Genes on the Diagnosis and Prognosis of Breast Cancer

“…Therefore, the combination of different genetic assays benefits diagnosis and prognostic prediction of BC. 18 HER2 gene encodes proteins, which are specifically coupled with ligands to form heterodimers, which cause conformational change of HER2 proteins, and autophosphorylation of tyrosine kinase inside the cytoplasm to activate signal pathways. The activity of this heterodimer is advantageous over heterodimers that are formed by other members in EGFR family, causing a cascade reaction.…”