Purpose: Effective decision support can help patients to improve their knowledge levels, clarify what is personally important (i.e., their “values”), and choose a treatment that is consistent with personal values. Our goal is to describe the longitudinal effects of decision support on breast cancer patients’ knowledge, values, and readiness to engage with the adjuvant therapy decision-making process.
Method: In November 2008, we began enrolling women considering post-surgical adjuvant therapy (hormone therapy or chemotherapy) in a prospective cohort study. Prior to their medical oncology appointment, patients: 1) complete a computerized questionnaire 2) watch a video-based decision aid (DA) and 3) complete a post-DA questionnaire. Within 1 week after meeting with the oncologist, patients complete a follow-up questionnaire. Measures: clinical and demographic characteristics, treatment intention, patient knowledge (multiple choice), value scores (0: Not at all important – 10: Extremely important), decisional conflict (4-item SURE scale).
Result: 47 women have completed questionnaires at the 3 time points. Knowledge. Compared to baseline scores (42% accurate), knowledge scores were higher immediately after watching the decision aid (79%; p ≤ 0.001) and 1 week later (63%, p ≤ 0.001). Values. “Minimizing recurrence” was the most important attribute (mean value score: 9.6-9.8) at all 3 time points. No across-time differences (p ≥ 0.09) were observed in value scores before and after viewing the DA. However, for “Avoiding chemotherapy and hormone therapy risks”, the mean importance scores after viewing the DA and after meeting with the medical oncologist were different (mean score = 9 and 6.5, respectively; p ≤ 0.001). Decision Readiness. After the DA, more patients felt informed (from 24% pre-DA to 84%) and reported they were clear about their personal values (from 50% pre-DA to 78%). After meeting with their oncologist, all patients felt informed (100%), clear about values (100%), supported (98%), and sure about their choice (94%).
Conclusion: These findings suggest the DA helped these patients understand key facts regarding adjuvant therapy risks and benefits and gain clarity about personal values associated with the treatment decisions. These patients were prepared to discuss their specific questions and concerns with the oncologist resulting in a personal treatment decision they felt certain about implementing.
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