Effect of a Decision Aid on Knowledge and Treatment Decision Making for Breast Cancer Surgery: A Randomized Trial

• Published in: JAMA : the journal of the American Medical Association Vol. 292; no. 4; pp. 435 - 441
• Main Authors: Whelan, Timothy, Levine, Mark, Willan, Andrew, Gafni, Amiram, Sanders, Ken, Mirsky, Doug, Chambers, Shelley, O'Brien, Mary Ann, Reid, Susan, Dubois, Sacha
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 28-07-2004
• Subjects: Biological and medical sciences; Breast cancer; Breast Neoplasms - surgery; Decision Making; Decision Support Techniques; Female; General aspects; General Surgery; Gynecology. Andrology. Obstetrics; Health Knowledge, Attitudes, Practice; Humans; Mammary gland diseases; Mastectomy; Mastectomy, Segmental; Medical sciences; Medical treatment; Middle Aged; Patient Education as Topic; Patient Participation; Patient Satisfaction; Physician-Patient Relations; Referral and Consultation; Surgery; Tumors; Medicine; Mammary gland diseases; Treatment; Surgery; Decision aid; Clinical trial; Breast cancer; Mammary gland; Malignant tumor; Knowledge
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.292.4.435

CONTEXT The long-term results of randomized trials have demonstrated equivalent
survival rates for mastectomy and breast-conserving therapy for the treatment
of early stage breast cancer. Consequently, the choice of treatment should
be based on a patient's preferences. OBJECTIVE To evaluate the impact of a decision aid regarding the different surgical
treatment options on patient decision making. DESIGN AND SETTING A cluster randomized trial for which general surgeons in the communities
of central-west, and eastern Ontario, Canada, were randomly assigned to use
the decision aid or not in the surgical consultation. Patients received the
decision aid or not based on the surgeon seen. PARTICIPANTS Twenty surgeons participated in the study. Of the 208 eligible women
with newly diagnosed clinical stage I or II breast cancer seen by study surgeons,
201 agreed to be evaluated: 94 were assigned to the decision board and 107
to usual practice. Patients were recruited from November 1999 to April 2002. INTERVENTION The decision board is a decision aid designed to help physicians inform
their patients about different treatment options and to enable patients to
express a preference for treatment. MAIN OUTCOME MEASURES Patient knowledge about the surgical treatment of breast cancer; decisional
conflict; satisfaction with decision making; and the treatment decision following
the consultation. RESULTS Patients in the decision board group had higher knowledge scores about
their treatment options (66.9 vs 58.7; P<.001),
had less decisional conflict (1.40 vs 1.62, P = .02),
and were more satisfied with decision making (4.50 vs 4.32, P = .05) following the consultation. Patients who used the decision
board were more likely to choose BCT (94% vs 76%, P =
.03). CONCLUSIONS The decision board was helpful in improving communication and enabling
women to make a choice regarding treatment. Such instruments should be considered
by surgeons when communicating the different surgical options to women with
breast cancer.