Development of patients' decision aid for older women with stage I breast cancer considering radiotherapy after lumpectomy.

PURPOSE To develop a patient decision aid (PtDA) for older women with Stage I, pathologically node negative, estrogen receptor-positive progesterone receptor-positive breast cancer who are considering adjuvant radiotherapy after lumpectomy and to examine its impact on patients' decision making. METHODS AND MATERIALS A PtDA was developed and evaluated in three steps according to the Ottawa Decision Support Framework: (1) needs assessment (n = 16); (2) Pilot I to examine PtDA acceptability (n = 12); and (3) Pilot II, a pretest posttest (n = 38) with older women with estrogen receptor-positive progesterone receptor-positive breast cancer after lumpectomy who were receiving adjuvant radiation therapy. Measures included patients' satisfaction with the PtDA, self-reported decisional conflict, level of distress, treatment-related knowledge, and choice predisposition. RESULTS The PtDA is a booklet that details each adjuvant treatment option's benefits, risks, and side effects tailored to the patient's clinical profile; includes a values clarification exercise; and includes steps to guide patients towards their decision. On the basis of qualitative comments and satisfaction ratings, all women thought that the PtDA was helpful and informative. In comparison with their baseline scores, patients had a statistically significant (p < 0.05) reduction in decisional conflict (adjusted mean difference [AMD], -7.18; 95% confidence interval [CI], -13.50 to 12.59); increased clarity of the benefits and risks (AMD, -10.86; CI, -20.33 to 21.49); and improved general treatment knowledge (AMD, 8.99; CI, 2.88-10.28) after using the PtDA. General trends were also reported in the patients' choice predisposition scores that suggested potential differences in treatment decision after PtDA use. CONCLUSIONS This study provides evidence that this PtDA may be a helpful educational tool for this group of women. The quality of care for older breast cancer patients may be enhanced by the use of a tailored PtDA to help patients be better informed about their treatment options.

[1]  Amiram Gafni,et al.  Are cancer-related decision aids effective? A systematic review and meta-analysis. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[2]  Paul R Duberstein,et al.  Information needs and decision-making processes in older cancer patients. , 2004, Critical reviews in oncology/hematology.

[3]  Barbara L. Smith,et al.  Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. , 2004, The New England journal of medicine.

[4]  L. Esserman,et al.  Building bridges between physicians and patients: results of a pilot study examining new tools for collaborative decision making in breast cancer. , 2000, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[5]  R. Pötter,et al.  Lumpectomy plus tamoxifen or anastrozole with or without whole breast irradiation in women with favorable early breast cancer. , 2005, International journal of radiation oncology, biology, physics.

[6]  Albert G Mulley,et al.  Standard consultations are not enough to ensure decision quality regarding preference-sensitive options. , 2003, Journal of the National Cancer Institute.

[7]  Amiram Gafni,et al.  Effect of a decision aid on knowledge and treatment decision making for breast cancer surgery: a randomized trial. , 2004, JAMA.

[8]  S. Edge,et al.  Predictors of long-term outcomes in older breast cancer survivors: perceptions versus patterns of care. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[9]  M. Rogers,et al.  Decision aids and breast cancer: do they influence choice for surgery and knowledge of treatment options? , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[10]  Vivek Goel,et al.  Development of a patient decision aid for choice of surgical treatment for breast cancer , 1998, Health expectations : an international journal of public participation in health care and health policy.

[11]  A. Recht,et al.  Radiation therapy plus tamoxifen versus tamoxifen alone after breast-conserving surgery in postmenopausal women with stage I breast cancer: a decision analysis. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[12]  J. Wennberg,et al.  Unwarranted variations in healthcare delivery: implications for academic medical centres , 2002, BMJ : British Medical Journal.

[13]  R B Harris,et al.  The internet and the globalisation of medical education , 2001, BMJ : British Medical Journal.

[14]  D. Streiner,et al.  Breast irradiation postlumpectomy: development and evaluation of a decision instrument. , 1995, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[15]  Melania Pintilie,et al.  Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. , 2004, The New England journal of medicine.

[16]  J. Angus,et al.  What Do Older Patients with Early Breast Cancer Want to Know While Undergoing Adjuvant Radiotherapy? , 2011, Journal of Cancer Education.

[17]  Karen R. Sepucha,et al.  Toward the 'tipping point': decision aids and informed patient choice. , 2007, Health affairs.