Background: All of our patients newly diagnosed with early stage breast cancer view a video-decision aid (DA) and complete a “decision quality” questionnaire (DQQ) which assesses their 1) understanding of key facts 2) personal values about possible outcomes, and 3) initial treatment preference prior to their surgical appt. Having successfully integrated this process with pre-surgical patients, we hoped to apply the same model to patients considering adjuvant chemo and/or hormonal therapy.

Purpose: To assess the acceptability & feasibility of providing a DA & DQQ prior to the first medical oncology consultation.

Methods: Pts were provided with a DA and DQQ prior to their appt. in medical oncology. Additional items assessed satisfaction with the DA content and the process. We also conducted f/u interviews with 8 patients.

Results: 141 videos were distributed with a return rate of 89%. Of those, 58/126 completed the questionnaire. The majority of pts indicated that the DA was “completely balanced” (80%) and somewhat (36%) to very (54%) “helpful in making a decision”. 25 pts. wrote in comments. The dominant themes related to suggestions for 1.) more DA information re: radiation & pathology and 2). the need for more information about their personal pathology results. Pts. were also bothered by items in the DQQ about preconsultation treatment choices. All 8 pts. who were subsequently interviewed voiced confusion & frustration with the DQQ, whereas most (6/8) liked receiving the DA in advance & 7/8 felt the video was helpful in the subsequent consultation.

Conclusions: We found that providing a DA and DQQ prior to the first medical oncology consultation is feasible. However, pts. were less prepared make even preliminary treatment decisions, compared those facing a surgical decision. In contrast to the surgical decision, pathology results and provider recommendations appear to play a larger role in the choices related hormonal and/or chemotherapy. Additionally, the surgical decision involves tradeoffs between two clear options, whereas the adjuvant decision comprises highly variable benefits and risks, complex statistical data and multiple treatment combinations. We are revising our DQQ to include questions on knowledge & personal values, but excluding questions on treatment choice.