Background: Deciding between the different surgical options for early stage breast cancer is difficult.  Results of randomized trials have shown improved decision making in patients exposed to decision aids.  Integrating decision support into the clinical care pathway may help patients decide on a treatment.  

Purpose: To capture the impact of integrated decision support for patients facing the decision of surgical options for early stage breast cancer.

Methods: A cohort of 75 newly diagnosed breast cancer patients completed a computerized intake for breast cancer.  This tool captures, summarizes, and reports the patient's clinical and decision-making data.  Following the intake, patients watched a video decision aid entitled Early Stage Breast Cancer: Choosing Your Surgery, which provides information about early stage invasive breast cancer and the surgery treatment choices.  After the video, patients answered decision process questions; additional process questions were asked after the surgical consultation. Outcome measures: role in decision-making; baseline treatment preference; actual decision following the consultation; decisional conflict; satisfaction with preparation for decision-making; decision self-efficacy.  

Results: After watching the video, patients reported: increased preference for an independent role in decision making (56% vs. 41%); confident [Self-efficacy Mean(SD) = 93(10.2)]; prepared [Sat Prep Mean(SD) = 75(17.2)]; and less decisional conflict. 

                 Decisional Conflict Means(SD) (*p < 0.01; ** p< 0.001)               

	Lack of Knowledge	Unclear Values	Lack of Support	Uncertainty	Total
Before Video	3.4 (0.98)	3.0 (1.12)	2.4 (0.61)	3.6 (1.05)	3.1 (0.74)
After Video	2.3 (0.59)**	2.2 (0.90)**	2.2 (0.64)*	3.4 (1.19)	2.4 (0.61)**
After Consult	1.6 (0.31)**	1.6 (0.42)**	1.6 (0.27)**	1.6 (0.44)**	1.6 (0.26)**

Note that all sub-scale scores were lower after the video except for uncertainty scores (38% of patients were unsure about a treatment preference); after meeting with their physician, these uncertainty scores dropped significantly. Total decisional conflict scores were significantly lower both after the video and after meeting the physician.  

Conclusions: For these women, the DA intervention particularly reduced the knowledge gaps and unclear values that contribute to overall decisional conflict, and helped them feel confident and prepared to make a decision.  We conclude that our integration of decision support into the clinical intake process was successful, in that it helped these patients get ready to discuss their treatment options with their surgeon.