Purpose: To evaluate a preference-tailored decision tool for improving the quality of surgical treatment decisions for patients with early stage breast cancer.
Method: A web-based decision tool was developed over a one-year period with input from health communication experts, breast cancer clinicians, and women with breast cancer . The tool included an interactive conjoint-analysis based preference elicitation exercise that provided users with feedback about their preferences for treatment attributes in real time. Newly diagnosed early stage breast cancer patients of a comprehensive cancer center were recruited and randomized to view the tool before or after completing a survey. Mean scores for key outcome measures, including surgical treatment knowledge (4 true/false questions), decision satisfaction (12 questions each with a 5-point Likert scale from strongly agree to strongly disagree), and preference-concordant decisions, were compared between the groups using t-tests. Concordance between preferences and surgical choices was evaluated using the chi-square test.
Result: To date, 70 subjects have been recruited with complete information available for 58. Their mean age was 57 years, 60% had a college degree or more, and 86% were white. Those viewing the website first had higher scores on several decision outcomes than those taking the survey first (Table). Knowledge scores were also higher among those viewing the website before the survey (3.0 vs. 2.61, p=.23). The risk of recurrence was the most important treatment attribute, followed by retaining the natural breast, in both groups. Concordance between treatment choice and conjoint-analysis generated treatment was 65% for website first and 61% for survey first groups.
| Website before survey | Survey before website | |
| Response 1-5 (strongly agree – strongly disagree) | ||
| I’m unsure what decision to make | 4.12 | 3.35* |
| The surgical treatment decision is hard for me | 3.76 | 2.80 |
| I’m aware of the choices I have to treat my breast cancer | 1.61 | 1.83* |
| I am satisfied with my surgical treatment decision | 1.44 | 1.65 |
| I feel the surgical treatment decision matches my values | 1.32 | 1.77^ |
| *P<0.05, ^P<0.10 | ||
Conclusion: A tool designed to improve the quality of surgical breast cancer treatment decisions by focusing on improving knowledge and preference-concordant decisions appears effective in this pilot study. Further work to assess the impact of the tool in larger and more diverse populations is needed.