Effect of a Decision Aid on Knowledge and Treatment Decision Making for Breast Cancer Surgery

TLDR

Randomized trials show that mastectomy and breast‑conserving therapy have equivalent long‑term survival for early‑stage breast cancer. The study aimed to assess whether a decision aid influences patients’ knowledge, decisional conflict, satisfaction, and treatment choice. In a cluster‑randomized trial, 208 women with stage I/II breast cancer were assigned to surgeons who either used a decision board or provided usual care, with 94 in the decision‑aid arm and 107 in the control arm. Use of the decision board increased knowledge scores, reduced decisional conflict, improved satisfaction, and led more women to choose breast‑conserving therapy (94% vs 76%).

Abstract

ContextThe 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.ObjectiveTo evaluate the impact of a decision aid regarding the different surgical treatment options on patient decision making.Design and SettingA 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.ParticipantsTwenty 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.InterventionThe 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 MeasuresPatient knowledge about the surgical treatment of breast cancer; decisional conflict; satisfaction with decision making; and the treatment decision following the consultation.ResultsPatients 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).ConclusionsThe 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.