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Effect of a Decision Aid on Knowledge and Treatment Decision Making for Breast Cancer Surgery
A Randomized Trial
Timothy Whelan, BM, BCh;
Mark Levine, MD;
Andrew Willan, PhD;
Amiram Gafni, PhD;
Ken Sanders, MD;
Doug Mirsky, MD;
Shelley Chambers, MA;
Mary Ann O'Brien, MSc;
Susan Reid, MD;
Sacha Dubois, BA
JAMA. 2004;292:435-441.
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.
Author Affiliations: Department of Medicine (Drs Whelan and Levine and Mss Chambers and O'Brien), Department of Clinical Epidemiology and Biostatistics (Drs Whelan, Levine, Willian, and Gafni and Mr Dubois), and Department of Surgery, McMaster University (Dr Sanders); Juravinski Cancer Centre (Drs Whelan and Levine), Hamilton Health Sciences (Drs Sanders and Reid and Ms O'Brien), Hamilton; and Queensway-Carleton Hospital (Dr Mirsky), Ottawa, Ontario, Canada.
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