Purpose: An earlier study of decision support for women diagnosed with early stage breast cancer involved two novel strategies: 1) assessing decisional needs and providing systematic decision support prior to the surgical consultation; 2) real-time electronic communication used to report initial observations to the surgical oncologist. This approach resulted in high knowledge scores, significant associations between patient values and treatment choice, and low decisional conflict (Collins et al., JCO, 2009). The current study extends these innovations into a study of decision support for women considering post-surgical adjuvant therapy for breast cancer.
Method: In November 2008, enrollment began for a prospective cohort study of women considering post-surgical adjuvant therapy (hormone therapy or chemotherapy) for breast cancer. Prior to their medical oncology appointment, patients: 1) complete a computerized questionnaire asking about their current clinical status, their initial understanding about adjuvant therapy, and their readiness to engage in decision making; 2) watch a video-based decision aid (DA); and 3) complete a post-DA questionnaire about their understanding, attitudes, and satisfaction with the decision support intervention. Questionnaire responses are summarized and electronically provided to the oncologist prior to the appointment.
Result: To date, after viewing the DA, all women (n = 19) report higher levels of understanding about: a) the benefits and risks of each option (pre-DA 11% vs. post-DA 95%); b) the goals of adjuvant chemotherapy (pre- 69% vs. post-100%); c) recurrence rates without adjuvant therapy (pre-26%, post-85%); and d) the relationship between tumor size and effectiveness of adjuvant therapy (pre-DA 10% vs. post-DA 85%). Detailed debriefing with a sub-set of participants (n = 10) revealed positive opinions about the relevance of the DA’s information (100%) and its ability to prepare them for their medical oncology consultation (80%), as well as overall satisfaction with the decision support intervention (100%).
Conclusion: Preliminary results suggest that a systematic support program that - 1) is provided before the consultation with the medical oncologist; and 2) incorporates an electronic communication tool to feed forward real-time data for use during the consultation is feasible and effectively helps prepare women to make informed treatment decisions for adjuvant therapy.
Candidate for the Lee B. Lusted Student Prize Competition