ARE BREAST CANCER PATIENTS GETTING THE "GIST" IN COMMUNICATION ABOUT TREATMENT RISKS?

Purpose: Many oncologists use a validated prognostic software model, Adjuvant!, to estimate the 10-year recurrence and mortality outcomes associated with adding chemotherapy, hormone therapy, both, or neither to local therapy for breast cancer. Some oncologists print Adjuvant!

screenshots to use during patient visits. No study has reported how communication of information in Adjuvant! printouts affects patient beliefs.

Methods: We recruited a convenience sample of 20 patients seen by 2 senior oncologists using Adjuvant! printouts in an academic medical center. The oncologist showed the patient a printout from Adjuvant with bar graphs of mortality risk estimates for four different therapies. The oncologist also discussed treatment options with the patient during this session. We asked patients for their estimates of mortality risks both before and after this risk communication session. We examined patient risk estimates for individual therapies alone and considered it to be accurate if it was within 5% of the Adjuvant! estimate. We also examined how patients ranked the risks of the therapies to see if patients understood the key messages of the risk communication.

Results: When using the 5% threshold, more patients improved their estimates of individual therapy risks than worsened their estimates after the consultation. Nine patients improved at least one of their estimates of mortality with one of the therapeutic options, whereas five got worse with one or more of their estimates. However, the improvements were not statistically significant. Overall the accuracy of patient rankings did not improve. The number of patients with more accurate rankings after the consultation (4) was matched by the number of patients with less accurate rankings after the consultation (4).

Conclusions: Although some patients improved their understanding of risks, the majority of patients were still poorly informed. Many patients may be confused by the complexity of the information presented. They may also face significant emotional barriers to absorbing information. The presentation of risk information may need to be sensitive to the patient's ability to absorb information and tailored to specific patient cognitive styles and numeracy. More research is needed to make patient risk communication more effective.