This presentation is part of: Oral Concurrent Session A - Judgment and Decision Making
DIFFERENTIAL EFFECT OF A BREAST CANCER DECISION AID BY MARITAL STATUS
Rachel Hess, MD1, Amber E. Barnato, MD, MPH, MS1, and Pamela B. Peele, PhD2. (1) University of Pittsburgh School of Medicine, Medicine, Pittsburgh, PA, (2) University of Pittsburgh Graduate School of Public Health, Health Policy and Management, Pittsburgh, PA
Purpose: To evaluate the effect of a breast cancer treatment decision aid (DA) on a woman’s perceived decision satisfaction, knowledge, uncertainty, and regret. Methods: 14 oncology practices were randomized to have their consenting breast cancer patients receive either an informational pamphlet about adjuvant therapy (AT) (N=160 women) or an evidence-based, risk-tailored DA (N=226 women). Women were recruited upon presentation to the oncologist for discussion of AT after primary surgical treatment. A health educator administered the intervention (pamphlet or DA) after the physician’s history and physical, but before completion of the oncology consultation. Immediately after the consultation and 3 months later patients completed an interviewer-administered questionnaire. From these data we used principal components analysis to develop scales for decision satisfaction (7 items, α=0.933), subjective knowledge of treatment risks and outcomes (5 items, α=0.793), and decision uncertainty (5 items, α=0.790) at the time of the initial consultation and treatment decision, and for decision regret 3 months later (5 items, α=0.830). We used hierarchical ordered logistic regression (patients clustered within oncology practices) to evaluate the effect of the DA on each decision outcome rounded to the nearest integer, controlling for patient demographics, decision making style preference (independent, collaborative, deference to physician), and breast cancer severity. Results: The study acceptance rate was 85%. The 386 women had a mean age of 61.8 years, 81% were white, 37% single (widowed, divorced, or separated), and 65% had low severity breast cancer. As reported elsewhere, the DA resulted in a very large reduction in the use of AT among women with low severity breast cancer. Based on a scale of 1 (strong agreement) to 5 (strong disagreement), the women had high decision satisfaction (1.7) and subjective knowledge (1.8), moderate uncertainty (3.4), and low regret (4.4). The DA had no effect upon these outcomes among married women, but improved satisfaction (p=0.001) and subjective knowledge (p=0.024), and decreased uncertainty (p<0.001) among single women, without affecting regret. Conclusion: Despite having a large effect on actual treatment decisions among all women, the DA improved subjective measures of decision quality only among single women. This unexpected finding deserves further exploration.
