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Stacey D, Lewis KB, Smith M, Carley M, Volk R, Douglas EE, Pacheco-Brousseau L, Finderup J, Gunderson J, Barry MJ, Bennett CL, Bravo P, Steffensen K, Gogovor A, Graham ID, Kelly SE, Légaré F, Sondergaard H, Thomson R, Trenaman L, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2024; 1:CD001431. [PMID: 38284415 PMCID: PMC10823577 DOI: 10.1002/14651858.cd001431.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Patient decision aids are interventions designed to support people making health decisions. At a minimum, patient decision aids make the decision explicit, provide evidence-based information about the options and associated benefits/harms, and help clarify personal values for features of options. This is an update of a Cochrane review that was first published in 2003 and last updated in 2017. OBJECTIVES To assess the effects of patient decision aids in adults considering treatment or screening decisions using an integrated knowledge translation approach. SEARCH METHODS We conducted the updated search for the period of 2015 (last search date) to March 2022 in CENTRAL, MEDLINE, Embase, PsycINFO, EBSCO, and grey literature. The cumulative search covers database origins to March 2022. SELECTION CRITERIA We included published randomized controlled trials comparing patient decision aids to usual care. Usual care was defined as general information, risk assessment, clinical practice guideline summaries for health consumers, placebo intervention (e.g. information on another topic), or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened citations for inclusion, extracted intervention and outcome data, and assessed risk of bias using the Cochrane risk of bias tool. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made (informed values-based choice congruence) and the decision-making process, such as knowledge, accurate risk perceptions, feeling informed, clear values, participation in decision-making, and adverse events. Secondary outcomes were choice, confidence in decision-making, adherence to the chosen option, preference-linked health outcomes, and impact on the healthcare system (e.g. consultation length). We pooled results using mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs), applying a random-effects model. We conducted a subgroup analysis of 105 studies that were included in the previous review version compared to those published since that update (n = 104 studies). We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the certainty of the evidence. MAIN RESULTS This update added 104 new studies for a total of 209 studies involving 107,698 participants. The patient decision aids focused on 71 different decisions. The most common decisions were about cardiovascular treatments (n = 22 studies), cancer screening (n = 17 studies colorectal, 15 prostate, 12 breast), cancer treatments (e.g. 15 breast, 11 prostate), mental health treatments (n = 10 studies), and joint replacement surgery (n = 9 studies). When assessing risk of bias in the included studies, we rated two items as mostly unclear (selective reporting: 100 studies; blinding of participants/personnel: 161 studies), due to inadequate reporting. Of the 209 included studies, 34 had at least one item rated as high risk of bias. There was moderate-certainty evidence that patient decision aids probably increase the congruence between informed values and care choices compared to usual care (RR 1.75, 95% CI 1.44 to 2.13; 21 studies, 9377 participants). Regarding attributes related to the decision-making process and compared to usual care, there was high-certainty evidence that patient decision aids result in improved participants' knowledge (MD 11.90/100, 95% CI 10.60 to 13.19; 107 studies, 25,492 participants), accuracy of risk perceptions (RR 1.94, 95% CI 1.61 to 2.34; 25 studies, 7796 participants), and decreased decisional conflict related to feeling uninformed (MD -10.02, 95% CI -12.31 to -7.74; 58 studies, 12,104 participants), indecision about personal values (MD -7.86, 95% CI -9.69 to -6.02; 55 studies, 11,880 participants), and proportion of people who were passive in decision-making (clinician-controlled) (RR 0.72, 95% CI 0.59 to 0.88; 21 studies, 4348 participants). For adverse outcomes, there was high-certainty evidence that there was no difference in decision regret between the patient decision aid and usual care groups (MD -1.23, 95% CI -3.05 to 0.59; 22 studies, 3707 participants). Of note, there was no difference in the length of consultation when patient decision aids were used in preparation for the consultation (MD -2.97 minutes, 95% CI -7.84 to 1.90; 5 studies, 420 participants). When patient decision aids were used during the consultation with the clinician, the length of consultation was 1.5 minutes longer (MD 1.50 minutes, 95% CI 0.79 to 2.20; 8 studies, 2702 participants). We found the same direction of effect when we compared results for patient decision aid studies reported in the previous update compared to studies conducted since 2015. AUTHORS' CONCLUSIONS Compared to usual care, across a wide variety of decisions, patient decision aids probably helped more adults reach informed values-congruent choices. They led to large increases in knowledge, accurate risk perceptions, and an active role in decision-making. Our updated review also found that patient decision aids increased patients' feeling informed and clear about their personal values. There was no difference in decision regret between people using decision aids versus those receiving usual care. Further studies are needed to assess the impact of patient decision aids on adherence and downstream effects on cost and resource use.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Meg Carley
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robert Volk
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elisa E Douglas
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael J Barry
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | - Carol L Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Paulina Bravo
- Education and Cancer Prevention, Fundación Arturo López Pérez, Santiago, Chile
| | - Karina Steffensen
- Center for Shared Decision Making, IRS - Lillebælt Hospital, Vejle, Denmark
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec, Canada
| | - Ian D Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Shannon E Kelly
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Université Laval, Quebec, Canada
| | | | - Richard Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
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Addressing Antimicrobial Stewardship in Primary Care—Developing Patient Information Sheets Using Co-Design Methodology. Antibiotics (Basel) 2023; 12:antibiotics12030458. [PMID: 36978323 PMCID: PMC10044618 DOI: 10.3390/antibiotics12030458] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/12/2023] [Accepted: 02/18/2023] [Indexed: 03/03/2023] Open
Abstract
Antibiotic resistance is a threat to global health, and inappropriate antibiotic use can be associated with adverse effects. Developing tools to encourage better communication between patients and general practitioners may reduce inappropriate use of antibiotics. The aim of the study was to develop shared decision support tools on common infections using a co-design methodology to address antimicrobial stewardship (AMS) in primary care. Three co-design/interview sessions were conducted with primary care providers and consumers between October 2019–April 2020 in Melbourne, Australia. Participants critiqued existing AMS tools, identified key elements required and optimised resulting prototypes. Primary care providers and consumers prioritised information to include in the AMS tools, such as when to see a doctor, management options, disease symptoms and cause of infection differently. However, both agreed content should be communicated in a plain, concise and logical manner, using inclusive and simple language accompanied by illustrations. Information sheets should be single-sided and A4-sized, appropriate for use before, during or after consultations. Co-design provided a collaborative forum to systematically design and develop products that meet the needs of both primary care providers and consumers. This resulted in the development of seven patient information sheets on common infections that encourage discussion of these infections, conservative management options and appropriate antibiotic use in primary care.
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Riggio E, Alfieri S, Toffoli E, Borreani C. A descriptive comparison of satisfaction and well-being between expander-based and direct-to-implant breast reconstruction after Nipple-Sparing Mastectomy. Aesthetic Plast Surg 2023; 47:30-39. [PMID: 36018329 DOI: 10.1007/s00266-022-03061-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/04/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The literature that has explored differences between direct-to-implant (DTI) and expander-based (EB) breast reconstruction has mainly focused on complications, with results not always unambiguous. Moreover, there are limited data 1) comparing DTI and EB breast reconstruction after nipple-sparing mastectomy (NSM) and 2) from the patient's perspective. AIM The aim of this study was to compare satisfaction and well-being in patients undergoing DTI and EB reconstruction after NSM in a Comprehensive Cancer Center, exploring what factors can be related to satisfaction and well-being. METHOD The study design is monocentric, observational and retrospective. The participants completed an online questionnaire containing the Breast-Q and some socio-demographic variables (year of birth, level of education, civil status). Clinical information was obtained from the institutional database. Surgical techniques in the two branches of NSM were similar: all skin incisions, lateral to the areola; all implants, subpectoral (EB: conventionally submuscular; DTI: dual-plane pocket); all without synthetic mesh or acellular tissue matrix. RESULTS A total of 120 patients (45% with EB and 55% with DTI) completed the questionnaire. We found that there are no differences between EB and DTI concerning the satisfaction and well-being of NSM patients, except for satisfaction with information, which is greater in the DTI group. In EB patients, no variables among those explored are related to satisfaction and well-being. In DTI patients, level of education is positive related to satisfaction with implants and physical well-being, Tumor-Node-Metastasis (TNM) and body mass index (BMI) are negative related to satisfaction with information and TNM also with satisfaction for plastic surgery. CONCLUSION EB and DTI do not differ in terms of patient well-being, but EB requires a more careful counselling by the surgeon. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Egidio Riggio
- Unit of Plastic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Alfieri
- Clinical Psychology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Elisa Toffoli
- Unit of Plastic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Borreani
- Clinical Psychology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Ma Z, Huang S, Wu X, Huang Y, Chan SWC, Lin Y, Zheng X, Zhu J. Development of a Prognostic Application to Predict Survival for Chinese Women with Breast Cancer (Preprint). J Med Internet Res 2021; 24:e35768. [PMID: 35262503 PMCID: PMC8943552 DOI: 10.2196/35768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/28/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Zhuo Ma
- Department of Nursing, School of Medicine, Xiamen University, Xiamen, China
| | - Sijia Huang
- Department of Nursing, School of Medicine, Xiamen University, Xiamen, China
| | - Xiaoqing Wu
- Department of Chronic Non-infectious Diseases and Endemic Diseases Control, Xiamen Center for Disease Control and Prevention, Xiamen, China
| | - Yinying Huang
- Department of Nursing, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | | | - Yilan Lin
- Department of Chronic Non-infectious Diseases and Endemic Diseases Control, Xiamen Center for Disease Control and Prevention, Xiamen, China
| | - Xujuan Zheng
- School of Nursing, Health Science Centre, Shenzhen University, Shenzhen, China
| | - Jiemin Zhu
- Department of Nursing, School of Medicine, Xiamen University, Xiamen, China
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Manne SL, Smith BL, Frederick S, Mitarotondo A, Kashy DA, Kirstein LJ. B-Sure: a randomized pilot trial of an interactive web-based decision support aid versus usual care in average-risk breast cancer patients considering contralateral prophylactic mastectomy. Transl Behav Med 2021; 10:355-363. [PMID: 30608607 DOI: 10.1093/tbm/iby133] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The use of contralateral prophylactic mastectomy (CPM) is increasing among breast cancer patients who are at average or "sporadic" risk for contralateral breast cancer. Because CPM provides no survival benefit for these patients, it is not medically recommended for them. Decision support aids may facilitate more informed, higher quality CPM decision. The purpose of this study was to evaluate the feasibility and acceptability of B-Sure, an online decision support aid to facilitate informed decisions regarding CPM, and to compare the impact of B-Sure in increasing CPM knowledge, reducing decisional conflict, and increasing preparedness to make the CPM decision among breast cancer patients at sporadic risk who are considering CPM. Ninety-three patients with unilateral, nonhereditary breast cancer considering CPM completed a baseline survey, were randomized to receive B-Sure or Usual care, and completed a 4-week follow-up survey assessing decisional conflict, preparedness to make the CPM decision, and CPM knowledge as well as self-efficacy, perceived risk, worry, CPM motivations, and the surgical decision. Study participation was high. B-Sure was viewed by almost 80% of the participants and was evaluated positively. At follow-up, patients assigned to B-Sure reported significantly higher clarity regarding the personal values relevant to the CPM decision and higher knowledge about CPM. B-Sure had smaller effects on other aspects of decisional conflict. B-Sure improved CPM knowledge and reduced decisional conflict. Patients considering CPM may benefit from an online decision support aid, but may be sensitive to approaches that they perceive as biased against CPM.
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Affiliation(s)
- Sharon L Manne
- Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Barbara L Smith
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Sara Frederick
- Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Anna Mitarotondo
- Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Deborah A Kashy
- Department of Psychology, Michigan State University, East Lansing, MI, USA
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Hodges-Wills T, Ma S, Stockwell E, Pedroso J, Brotherton J, Medina W, Howard D. Developing a visual aid to improve women's knowledge of hysterectomy. PATIENT EDUCATION AND COUNSELING 2021; 104:715-719. [PMID: 33549386 DOI: 10.1016/j.pec.2021.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/21/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Female reproductive anatomy and physiology, compounded by low health literacy, can result in limited patient understanding of gynecologic procedures, complicating the already challenging patient decision-making process. OBJECTIVE Describe a process of developing an effective visual aid that accurately communicates the risks, benefits, and possible outcomes of hysterectomy surgical approaches. PATIENT INVOLVEMENT None. METHODS This qualitative study was performed in a private practice and an academic institution with a total of 8 female non-clinical employees in the English-speaking group and 9 non-employees in the Spanish-speaking group. A 5-minute video focusing on the hysterectomy procedure was developed and shown to focus group participants. A discussion led by a sociologist obtained feedback regarding understanding and perceptions of video content to validate the tool, which was analyzed to extract themes that could guide refinements. RESULTS Focus group participants wanted more information on post-hysterectomy quality of life and desired a longer video that included more general information about hysterectomies. All participants felt the video would be a valuable aid if watched prior to undergoing a hysterectomy and would be an effective tool for improving patient communication. DISCUSSION While there was strong support for the video-based patient education program, participants found some elements confusing (e.g., type and magnitude of risk, scope of aftercare) and expressed interest in more in-depth information. Our development process would have been enhanced by involving patients before the initial version of the video was created, holding more and more diverse focus groups and ensuring that translation was both accurate and culturally appropriate. PRACTICAL VALUE This study offers lessons learned in the process of developing a video-based visual aid for improving women's knowledge of hysterectomy and may inform other efforts to help patients understand complex medical pathology and procedures.
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Affiliation(s)
- Toni Hodges-Wills
- Department of Obstetrics and Gynecology, Sunrise Health GME Consortium, Las Vegas, NV, USA
| | - Stephanie Ma
- Department of Obstetrics and Gynecology, Sunrise Health GME Consortium, Las Vegas, NV, USA
| | - Erica Stockwell
- Department of Obstetrics and Gynecology, Sunrise Health GME Consortium, Las Vegas, NV, USA
| | - Jasmine Pedroso
- Department of Obstetrics and Gynecology, Sunrise Health GME Consortium, Las Vegas, NV, USA
| | - Joy Brotherton
- Department of Obstetrics and Gynecology, Harbor UCLA Medical Center, CA, USA
| | - Wendy Medina
- Department of Obstetrics and Gynecology, Harbor UCLA Medical Center, CA, USA
| | - David Howard
- Department of Obstetrics and Gynecology, Sunrise Health GME Consortium, Las Vegas, NV, USA.
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Connors SK, Leal IM, Nitturi V, Iwundu CN, Maza V, Reyes S, Acquati C, Reitzel LR. Empowered Choices: African-American Women's Breast Reconstruction Decisions. Am J Health Behav 2021; 45:352-370. [PMID: 33888195 PMCID: PMC8383809 DOI: 10.5993/ajhb.45.2.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives: Breast reconstruction (BR) potentially can improve quality of life in postmastectomy breast cancer survivors (BCS); however, African-American women are less likely to undergo BR than Caucasian women. This qualitative study was undertaken to explore individual, sociocultural, and contextual factors influencing African-American women's BR decision-making processes and preferences. Methods: Postmastectomy African-American BCS with and without BR participated in semi-structured interviews. We adopted a grounded theory approach using the constant comparison method to understand the contexts and processes informing participants' BR decision-making. Results: Twenty-three women participated, of whom 17 elected BR and 6 did not. Whereas women's primary reasons for deciding for or against BR differed, our core category, "empowered choices ," describes both groups' decision-making as a process focused on empowering themselves physically and/or psychologically, through self-advocacy, informed and shared decision-making, and giving back/receiving communal and spiritual support from church and African-American survivor groups. Socioeconomic factors influenced women's access to BR. Women preferred autologous BR and expressed the need for greater culturally-matched resources and support to inform treatment and shared BR decision-making. Conclusions: Understanding and supporting African-American women's BR preferences and empowerment is essential to ensuring equal access, and culturally-relevant, high-quality, and informed patient-centered care.
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Affiliation(s)
- Shahnjayla K Connors
- Shahnjayla K. Connors, Assistant Professor, Department of Social Sciences, University of Houston-Downtown, Houston, TX, United States
| | - Isabel Martinez Leal
- Isabel Martinez Leal, Research Associate II, Social and Behavioral Science, Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, United States;,
| | - Vijay Nitturi
- Vijay Nitturi, Research Assistant, Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, United States
| | - Chisom N Iwundu
- Chisom N. Iwundu, Postdoctoral Fellow, Department of Psychological Health and Learning Sciences, University of Houston, Houston, TX, United States
| | - Valentina Maza
- Valentina Maza, Research Assistant, Department of Psychological, Health, and Learning Sciences, University, Houston, Houston, TX, United States
| | - Stacey Reyes
- Stacey Reyes, Research Assistant, Department of Social Sciences, University of Houston-Downtown, Houston, TX, United States
| | - Chiara Acquati
- Chiara Acquati, Assistant Professor, Graduate College of Social Work, University of Houston, Houston, TX, United States
| | - Lorraine R Reitzel
- Lorraine R. Reitzel, Professor, Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, United States
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Varelas L, Egro FM, Evankovich N, Nguyen V. A Randomized Controlled Trial to Assess the Use of a Virtual Decisional Aid to Improve Knowledge and Patient Satisfaction in Women Considering Breast Reconstruction Following Mastectomy. Cureus 2020; 12:e12018. [PMID: 33457123 PMCID: PMC7797415 DOI: 10.7759/cureus.12018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background The decisional process of navigating breast reconstruction surgery is very challenging for patients with a breast cancer diagnosis. This study aims to assess the impact of a virtual breast reconstruction decision aid program on the decision-making process of breast cancer patients considering breast reconstruction. Methods A two-arm, randomized, controlled trial was conducted at the University of Pittsburgh. Patients were blindly assigned to one of two arms: Emmi Decide (Emmi Solutions LLC, Chicago, IL) program prior to traditional consultation (intervention) and traditional consultation alone (control). All patients completed a baseline pre- and post-intervention questionnaire to evaluate knowledge, patient satisfaction, and psychological status. Surgeons' satisfaction and consultation time were also recorded. Results A total of 26 patients participated in the study (n=13 in each arm). Patients in the intervention group reported a greater BREAST-Q reconstruction module score (control=47.9±8.2, intervention=56.8±4.2, p=0.0017), lower decisional conflict scale score (control=30.2±11.8, intervention=14.5±8.8, p=0.017), and improved patient knowledge (control=70.8±15.5%, intervention=83.1±13.8%, p=0.018). No difference was noted in consultation time (control=51.0±7.8 min, intervention=47.8±13.7 min, p=0.46) and psychological testing (control=49.7±16.0, intervention=44.6±15.2, p=0.26). However, surgeons reported greater satisfaction with their consultations with interventional group participants (control=3.4±0.7, intervention=4.8±0.4, p=0.000056). Conclusions The use of a virtual decisional aid program to assist the decision-making of breast reconstruction patients was shown to significantly benefit both patients and surgeons, by improving patient knowledge and satisfaction without placing an additional psychological burden on them. This supports the notion that this resource is a promising tool that can improve the difficult process of breast reconstruction in the vulnerable population of breast cancer patients.
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Affiliation(s)
- Lee Varelas
- Plastic Surgery, University of Pittsburgh, Pittsburgh, USA
| | | | | | - Vu Nguyen
- Plastic Surgery, University of Pittsburgh, Pittsburgh, USA
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Yao K, Belkora J, Lee C, Kuchta K, Pesce C, Kopkash K, Rabbitt S, Barrera E, Simovic S, Sepucha K. An In-Visit Decision Aid for Surgeons to Address Decision Making for Bilateral Mastectomy for Newly Diagnosed Breast Cancer Patients. Ann Surg Oncol 2019; 26:4372-4380. [DOI: 10.1245/s10434-019-07912-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Indexed: 11/18/2022]
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Aminaie N, Lehto R, Negarandeh R. Iranian Women’s Decision Making: Preferred Roles, Experienced Involvement, and Decisional Conflict When Undergoing Surgery for Early-Stage Breast Cancer. Clin J Oncol Nurs 2019; 23:529-536. [DOI: 10.1188/19.cjon.529-536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Pathak S, George N, Monti D, Robinson K, Politi MC. Evaluating Adaptation of a Cancer Clinical Trial Decision Aid for Rural Cancer Patients: A Mixed-Methods Approach. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:803-809. [PMID: 29862441 PMCID: PMC6277228 DOI: 10.1007/s13187-018-1377-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Rural-residing cancer patients often do not participate in clinical trials. Many patients misunderstand cancer clinical trials and their rights as participant. The purpose of this study is to modify a previously developed cancer clinical trials decision aid (DA), incorporating the unique needs of rural populations, and test its impact on knowledge and decision outcomes. The study was conducted in two phases. Phase I recruited 15 rural-residing cancer survivors in a qualitative usability study. Participants navigated the original DA and provided feedback regarding usability and implementation in rural settings. Phase II recruited 31 newly diagnosed rural-residing cancer patients. Patients completed a survey before and after using the revised DA, R-CHOICES. Primary outcomes included decisional conflict, decision self-efficacy, knowledge, communication self-efficacy, and attitudes towards and willingness to consider joining a trial. In phase I, the DA was viewed positively by rural-residing cancer survivors. Participants provided important feedback about factors rural-residing patients consider when thinking about trial participation. In phase II, after using R-CHOICES, participants had higher certainty about their choice (mean post-test = 3.10 vs. pre-test = 2.67; P = 0.025) and higher trial knowledge (mean percentage correct at post-test = 73.58 vs. pre-test = 57.77; P < 0.001). There was no significant change in decision self-efficacy, communication self-efficacy, and attitudes towards or willingness to join trials. The R-CHOICES improved rural-residing patients' knowledge of cancer clinical trials and reduced conflict about making a trial decision. More research is needed on ways to further support decisions about trial participation among this population.
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Affiliation(s)
- Swati Pathak
- Division of Hematology-Oncology, Department of Internal Medicine, SIU School of Medicine, Springfield, IL, USA.
- Simmons Cancer Institute, 315, West Carpenter Street, Springfield, IL, 62702, USA.
| | - Nerissa George
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Denise Monti
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Kathy Robinson
- Division of Hematology-Oncology, Department of Internal Medicine, SIU School of Medicine, Springfield, IL, USA
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
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Sepucha KR, Langford AT, Belkora JK, Chang Y, Moy B, Partridge AH, Lee CN. Impact of Timing on Measurement of Decision Quality and Shared Decision Making: Longitudinal Cohort Study of Breast Cancer Patients. Med Decis Making 2019; 39:642-650. [PMID: 31354095 DOI: 10.1177/0272989x19862545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose.The objective of this study was to examine whether scores of shared decision-making measures differ when collected shortly after (1 month) or long after (1 year) breast cancer surgical treatment decisions. Methods. Longitudinal, multisite survey of breast cancer (BC) patients, with measurements at 1 month and 1 year after surgery at 4 cancer centers. Patients completed the BC Surgery Decision Quality Instrument (used to generate a knowledge score, ratings of goals, and concordance with treatment preferences) and Shared Decision Making (SDM) Process survey at both time points. We tested several hypotheses related to the scores over time, including whether the scores discriminated between sites that did and did not offer formal decision support services. Exploratory analyses examined factors associated with large increases and decreases in scores over time. Results. Across the 4 sites, 229 patients completed both assessments. The mean total knowledge scores (69.2% [SD 16.6%] at 1 month and 69.4% [SD 17.7%] at 1 year, P = 0.86), SDM Process scores (2.7 [SD 1.1] 1 month v. 2.7 [SD 1.2] 1 year, P = 0.68), and the percentage of patients receiving their preferred treatment (92% at 1 month and 92% at 1 year, P = 1.0) were not significantly different over time. The site using formal decision support had significantly higher knowledge and SDM Process scores at 1 month, and only the SDM Process scores remained significantly higher at 1 year. A significant percentage of patients had large changes in their individual knowledge and SDM Process scores, with increases balancing out decreases. Conclusion. For population-level assessments, it is reasonable to survey BC patients up to a year after the decision, greatly increasing feasibility of measurement. For those evaluating decision support interventions, shorter follow-up is more likely to detect an impact on knowledge scores.
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Affiliation(s)
- Karen R Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aisha T Langford
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU School of Medicine, New York, NY, USA
| | | | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Beverly Moy
- Division of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Clara N Lee
- The Ohio State University, Columbus, OH, USA
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Vromans R, Tenfelde K, Pauws S, van Eenbergen M, Mares-Engelberts I, Velikova G, van de Poll-Franse L, Krahmer E. Assessing the quality and communicative aspects of patient decision aids for early-stage breast cancer treatment: a systematic review. Breast Cancer Res Treat 2019; 178:1-15. [PMID: 31342311 PMCID: PMC6790198 DOI: 10.1007/s10549-019-05351-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/05/2019] [Indexed: 12/12/2022]
Abstract
Purpose Decision aids (DAs) support patients in shared decision-making by providing balanced evidence-based treatment information and eliciting patients’ preferences. The purpose of this systematic review was to assess the quality and communicative aspects of DAs for women diagnosed with early-stage breast cancer. Methods Twenty-one currently available patient DAs were identified through both published literature (MEDLINE, Embase, CINAHL, CENTRAL, and PsycINFO) and online sources. The DAs were reviewed for their quality by using the International Patient Decision Aid Standards (IPDAS) checklist, and subsequently assessed to what extent they paid attention to various communicative aspects, including (i) information presentation, (ii) personalization, (iii) interaction, (iv) information control, (v) accessibility, (vi) suitability, and (vii) source of information. Results The quality of the DAs varied substantially, with many failing to comply with all components of the IPDAS criteria (mean IPDAS score = 64%, range 31–92%). Five aids (24%) did not include any probability information, 10 (48%) presented multimodal descriptions of outcome probabilities (combining words, numbers, and visual aids), and only 2 (10%) provided personalized treatment outcomes based on patients and tumor characteristics. About half (12; 57%) used interaction methods for eliciting patients’ preferences, 16 (76%) were too lengthy, and 5 (24%) were not fully accessible. Conclusions In addition to the limited adherence to the IPDAS checklist, our findings suggest that communicative aspects receive even less attention. Future patient DA developments for breast cancer treatment should include communicative aspects that could influence the uptake of DAs in daily clinical practice. Electronic supplementary material The online version of this article (10.1007/s10549-019-05351-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ruben Vromans
- Department of Communication and Cognition, Tilburg University, Warandelaan 2, 5035 AB Tilburg, The Netherlands
| | - Kim Tenfelde
- Department of Communication and Cognition, Tilburg University, Warandelaan 2, 5035 AB Tilburg, The Netherlands
| | - Steffen Pauws
- Department of Communication and Cognition, Tilburg University, Warandelaan 2, 5035 AB Tilburg, The Netherlands
- Chronic Disease Management, Philips Research, Eindhoven, The Netherlands
| | - Mies van Eenbergen
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Ingeborg Mares-Engelberts
- Department of Medical Ethics and Philosophy of Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Surgery, Sint Franciscus Vlietland Group, Rotterdam, The Netherlands
| | - Galina Velikova
- Leeds Institute of Medical Research at St Jame’s, University of Leeds, Leeds, UK
| | - Lonneke van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Emiel Krahmer
- Department of Communication and Cognition, Tilburg University, Warandelaan 2, 5035 AB Tilburg, The Netherlands
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Pieterse AH, Kunneman M, van den Hout WB, Baas-Thijssen M, Geijsen ED, Ceha HM, Muller KM, van der Linden YM, Marijnen CAM, Stiggelbout AM. Patient explicit consideration of tradeoffs in decision making about rectal cancer treatment: benefits for decision process and quality of life. Acta Oncol 2019; 58:1069-1076. [PMID: 30971150 DOI: 10.1080/0284186x.2019.1594363] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: Patient preferences are often not discussed in treatment decisions in oncology. We introduced an online values clarification method (VCM) to help newly diagnosed rectal cancer patients participate in shared decision making about short-course preoperative radiotherapy. Material and Methods: We offered a link to the VCM to a subset of consecutive patients before the pretreatment consultation with the radiation oncologist. Consultations were audiotaped and coded for expressions of patient preferences. Patients were asked to complete pre- and post-consultation questionnaires. Questionnaires assessed values clarity, decision regret and presence and impact of fecal incontinence and sexual problems. Results: Of 135 patients who had their consultation audiotaped and completed questionnaires, 35 received and accessed the VCM-link. Patients in the VCM-group slightly more often expressed preferences during consultations. Questionnaire data showed that patients in the VCM-group did not differ in how clear their values were, but experienced lower regret and less impact of treatment harms at 6 months follow-up; differences were non-significant but in the same direction at 12 months. Discussion: This is the first study to assess the effect of an adaptive conjoint analysis-based VCM on actual patient-clinician communication, and long-term decision regret and impact of treatment harms. Being explicitly invited to think about treatment benefits and harms seems to help patients to live with treatment consequences.
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Affiliation(s)
- Arwen H. Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Marleen Kunneman
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilbert B. van den Hout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique Baas-Thijssen
- Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Elisabeth D. Geijsen
- Department of Radiotherapy, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Heleen M. Ceha
- Department of Radiotherapy, Haaglanden Medical Center, The Hague, The Netherlands
| | | | | | - Corrie A. M. Marijnen
- Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne M. Stiggelbout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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Moiel D, Thompson J, Larsen KD. Mastectomy or Breast-Conserving Therapy: Which Factors Influence A Patient's Decision? Perm J 2019; 23:18-049. [PMID: 31314719 PMCID: PMC6636508 DOI: 10.7812/tpp/18-049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The choice between mastectomy and breast-conserving therapy (BCT) is a first step for patients with breast cancer who are confronting decisions about treatment. OBJECTIVE To identify the most important determinants in treatment decision making by patients with breast cancer. METHODS Between 2003 and 2013, a total of 5258 patients with breast cancer were recorded in Kaiser Permanente Northwest's cancer registry. Patients had similar clinical-pathologic profiles, education, and insurance coverage, and were managed by 1 surgical group. A total of 2604 patients with invasive breast cancer chose mastectomy or BCT as they met unambiguous criteria for equivalent outcomes with either option. We examined the influence of the patient's surgeon on patient preferences. RESULTS Our retrospective analyses examined a study population that had similar risk profiles (age, family history of breast cancer, T category on tumor-node-metastasis staging system, tumor size, physical examination findings), surgeons consulting on similar patient types, and managed by surgeons with similar surgical performance patterns (case volumes, reexcision rates, number of reoperations, and ability to meet patient's expectations). Patients who preferred mastectomy were strongly influenced by tumor size (p < 0.001) and abnormal physical examination findings (palpable mass; p = 0.004), rather than age, family history of breast cancer, T category, or surgeon. CONCLUSION Physical examination findings and tumor size were statistically significant determinants influencing patients to choose mastectomy. Because geographic and practice style explanations fail to explain these variations, surgeons can identify, anticipate, and consider these factors when counseling patients about mastectomy and BCT therapeutic equivalency.
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Affiliation(s)
- David Moiel
- Retired, Department of Surgery, Kaiser Permanente Northwest, Portland, OR
| | - John Thompson
- Retired, Department of Pathology, Kaiser Permanente Northwest, Portland, OR
| | - Kenneth D Larsen
- Retired, Department of Anesthesiology, Kaiser Permanente Northwest, Portland, OR
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Berlin NL, Tandon VJ, Hawley ST, Hamill JB, MacEachern MP, Lee CN, Wilkins EG. Feasibility and Efficacy of Decision Aids to Improve Decision Making for Postmastectomy Breast Reconstruction: A Systematic Review and Meta-analysis. Med Decis Making 2018; 39:5-20. [DOI: 10.1177/0272989x18803879] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. The decision-making process for women considering breast reconstruction following mastectomy is complex. Research suggests that fewer than half of women undergoing mastectomy have adequate knowledge and make treatment decisions that are concordant with their underlying values. This systematic review assesses the feasibility and efficacy of preoperative decision aids (DAs) to improve the patient decision-making process for breast reconstruction. Methods. A systematic review was performed using PubMed, Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Databases published prior to January 4, 2018. Studies that assessed the impact of a DA on patient decision making for breast reconstruction were identified. The effect of preoperative DAs on decisional conflict in randomized controlled trials (RCTs) was measured with inverse variance-weighted mean differences (mean difference [MD] ± 95% confidence interval [CI]). Results. Among 1299 unique articles identified, 1197 were excluded after reviewing titles and abstracts against selection criteria. Among the 17 studies included in this review, 11 assessed the efficacy of DAs for breast reconstruction and 6 additional studies described the development and usability of these DAs. Studies suggest that DAs reduce patient-reported decisional conflict (MD, –4.55 [95% CI, –8.65 to –0.45], P = 0.03 in the fixed-effects model and MD, –4.70 [95% CI, –10.75 to 1.34], P = 0.13 in the random-effects model). Preoperative DAs also improved patient satisfaction with information and perceived involvement in the decision-making process. Conclusions. The existing literature suggests that DAs reduce decisional conflict, improve self-reported satisfaction with information, and improve perceived involvement in the decision-making process for women considering breast reconstruction.
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Affiliation(s)
| | | | - Sarah T. Hawley
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Center for Health Communications and Research, University of Michigan, Ann Arbor, MI
| | | | - Mark P. MacEachern
- Taubman Health Sciences Library, University of Michigan School of Medicine, Ann Arbor, MI
| | - Clara N. Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, Ohio State University, Columbus, OH
- Division of Health Services Management and Policy, College of Public Health, Ohio State University, Columbus, OH
| | - Edwin G. Wilkins
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI
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Jabbour J, Dhillon HM, Shepherd HL, Sundaresan P, Milross C, Clark JR. The relationship between role preferences in decision-making and level of psychological distress in patients with head and neck cancer. PATIENT EDUCATION AND COUNSELING 2018; 101:1736-1740. [PMID: 29866431 DOI: 10.1016/j.pec.2018.05.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/20/2018] [Accepted: 05/27/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Is there a relationship between decision-making preferences and psychological distress? METHODS Patients who had received treatment for head and neck cancer (HNC) at four institutions within NSW, Australia were invited to complete a single questionnaire. RESULTS Five hundred and ninety-seven patients completed the questionnaire. The majority of patients (308, 54%) preferred shared decision making. Significant predictors of a preference towards active decision making were education level (OR 2.1 for tertiary, p < 0.001), primary cancer site (OR 1.9 for thyroid compared to salivary gland, p = 0.024) and gender (OR 1.4 for female, p = 0.028). Mean psychological distress score on Kessler 6 (K6) was 9 (Range: 0-28). Significant predictors of psychological distress were age (p < 0.001), gender (p < 0.001), primary site (p < 0.01), and decision preference (p < 0.01). CONCLUSION HNC patients who are either tertiary educated or female are more likely to prefer active involvement in decision-making. Psychological distress is more likely in patients actively involved in decision making, younger patients, and in females. PRACTICE IMPLICATIONS Patients experienced paternalistic decision-making, but most preferred active or a shared approached. Clinicians need to be aware of potential for psychological distress in active decision-makers and refer patients for psychosocial support.
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Affiliation(s)
- Joe Jabbour
- St Vincent's Hospital, Sydney, NSW, Australia; Central Clinical School, University of Sydney, NSW, Australia.
| | - Haryana M Dhillon
- Psycho-Oncology Cooperative Research Group (POCOG), School of Psychology, The University of Sydney, Camperdown, NSW, Australia; Centre for Medical Psychology & Evidence-Based Decision-making, The University of Sydney, Camperdown, NSW, Australia
| | - Heather L Shepherd
- Psycho-Oncology Cooperative Research Group (POCOG), School of Psychology, The University of Sydney, Camperdown, NSW, Australia; Centre for Medical Psychology & Evidence-Based Decision-making, The University of Sydney, Camperdown, NSW, Australia
| | - Puma Sundaresan
- Central Clinical School, University of Sydney, NSW, Australia; Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW, Australia
| | - Chris Milross
- Central Clinical School, University of Sydney, NSW, Australia; Department of Radiation Oncology and Medical Services, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Jonathan R Clark
- Central Clinical School, University of Sydney, NSW, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, NSW, Australia; South West Clinical School, University of New South Wales, NSW, Australia
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Weernink MG, van Til JA, Witteman HO, Fraenkel L, IJzerman MJ. Individual Value Clarification Methods Based on Conjoint Analysis: A Systematic Review of Common Practice in Task Design, Statistical Analysis, and Presentation of Results. Med Decis Making 2018; 38:746-755. [PMID: 29592585 PMCID: PMC6587358 DOI: 10.1177/0272989x18765185] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 02/09/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND There is an increased practice of using value clarification exercises in decision aids that aim to improve shared decision making. Our objective was to systematically review to which extent conjoint analysis (CA) is used to elicit individual preferences for clinical decision support. We aimed to identify the common practices in the selection of attributes and levels, the design of choice tasks, and the instrument used to clarify values. METHODS We searched Scopus, PubMed, PsycINFO, and Web of Science to identify studies that developed a CA exercise to elicit individual patients' preferences related to medical decisions. We extracted data on the above-mentioned items. RESULTS Eight studies were identified. Studies included a fixed set of 4-8 attributes, which were predetermined by interviews, focus groups, or literature review. All studies used adaptive conjoint analysis (ACA) for their choice task design. Furthermore, all studies provided patients with their preference results in real time, although the type of outcome that was presented to patients differed (attribute importance or treatment scores). Among studies, patients were positive about the ACA exercise, whereas time and effort needed from clinicians to facilitate the ACA exercise were identified as the main barriers to implementation. DISCUSSION There is only limited published use of CA exercises in shared decision making. Most studies resembled each other in design choices made, but patients received different feedback among studies. Further research should focus on the feedback patients want to receive and how the CA results fit within the patient-physician dialogue.
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Affiliation(s)
- Marieke G.M. Weernink
- Department of Health Technology and Services Research, MIRA—Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Janine A. van Til
- Department of Health Technology and Services Research, MIRA—Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Holly O. Witteman
- />Department of Family and Emergency Medicine, Office of Education and Professional Development, Laval University, Quebec City, QC, Canada
- />Population Health and Optimal Health Practices Research Unit, CHU de Québec, Quebec City, QC, Canada
| | | | - Maarten J. IJzerman
- Department of Health Technology and Services Research, MIRA—Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
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Hawley ST, Li Y, An LC, Resnicow K, Janz NK, Sabel MS, Ward KC, Fagerlin A, Morrow M, Jagsi R, Hofer TP, Katz SJ. Improving Breast Cancer Surgical Treatment Decision Making: The iCanDecide Randomized Clinical Trial. J Clin Oncol 2018; 36:659-666. [PMID: 29364772 DOI: 10.1200/jco.2017.74.8442] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose This study was conducted to determine the effect of iCanDecide, an interactive and tailored breast cancer treatment decision tool, on the rate of high-quality patient decisions-both informed and values concordant-regarding locoregional breast cancer treatment and on patient appraisal of decision making. Methods We conducted a randomized clinical trial of newly diagnosed patients with early-stage breast cancer making locoregional treatment decisions. From 22 surgical practices, 537 patients were recruited and randomly assigned online to the iCanDecide interactive and tailored Web site (intervention) or the iCanDecide static Web site (control). Participants completed a baseline survey and were mailed a follow-up survey 4 to 5 weeks after enrollment to assess the primary outcome of a high-quality decision, which consisted of two components, high knowledge and values-concordant treatment, and secondary outcomes (decision preparation, deliberation, and subjective decision quality). Results Patients in the intervention arm had higher odds of making a high-quality decision than did those in the control arm (odds ratio, 2.00; 95% CI, 1.37 to 2.92; P = .0004), which was driven primarily by differences in the rates of high knowledge between groups. The majority of patients in both arms made values-concordant treatment decisions (78.6% in the intervention arm and 81.4% in the control arm). More patients in the intervention arm had high decision preparation (estimate, 0.18; 95% CI, 0.02 to 0.34; P = .027), but there were no significant differences in the other decision appraisal outcomes. The effect of the intervention was similar for women who were leaning strongly toward a treatment option at enrollment compared with those who were not. Conclusion The tailored and interactive iCanDecide Web site, which focused on knowledge building and values clarification, positively affected high-quality decisions largely by improving knowledge compared with static online information. To be effective, future patient-facing decision tools should be integrated into the clinical workflow to improve decision making.
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Affiliation(s)
- Sarah T Hawley
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yun Li
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lawrence C An
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kenneth Resnicow
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nancy K Janz
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael S Sabel
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kevin C Ward
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Angela Fagerlin
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Monica Morrow
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Reshma Jagsi
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Timothy P Hofer
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Steven J Katz
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
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Lee CNH, Deal AM, Huh R, Ubel PA, Liu YJ, Blizard L, Hunt C, Pignone MP. Quality of Patient Decisions About Breast Reconstruction After Mastectomy. JAMA Surg 2017; 152:741-748. [PMID: 28467530 DOI: 10.1001/jamasurg.2017.0977] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance Breast reconstruction has the potential to improve a person's body image and quality of life but has important risks. Variations in who undergoes breast reconstruction have led to questions about the quality of patient decisions. Objective To assess the quality of patient decisions about breast reconstruction. Design, Setting, and Participants A prospective, cross-sectional survey study was conducted from June 27, 2012, to February 28, 2014, at a single, academic, multidisciplinary oncology clinic among women planning to undergo mastectomy for stage I to III invasive ductal or lobular breast cancer, ductal carcinoma in situ, or prophylaxis. Exposures Mastectomy only and mastectomy with reconstruction. Main Outcome and Measures Knowledge, as ascertained using the Decision Quality Instrument; preference concordance, based on rating and ranking of key attributes; and decision quality, defined as having knowledge of 50% or more and preference concordance. Results During the 20-month period, 214 patients were eligible, 182 were approached, and 32 missed. We enrolled 145 patients (79.7% enrollment rate), and received surveys from 131 patients (72.0% participation rate). Five participants became ineligible. The final study population was 126 patients. Among the 126 women in the study (mean [SD] age, 53.2 [12.1] years), the mean (SD) knowledge score was 58.5% (16.2%) and did not differ by treatment group (mastectomy only, 55.2% [15.0%]; mastectomy with reconstruction, 60.5% [16.5%]). A total of 82 of 123 participants (66.7%) had a calculated treatment preference of mastectomy only; 39 of these women (47.6%) underwent mastectomy only. A total of 41 participants (32.5%) had a calculated treatment preference of mastectomy with reconstruction; 36 of these women (87.8%) underwent mastectomy with reconstruction. Overall, 52 of 120 participants (43.3%) made a high-quality decision. In multivariable analysis, white race/ethnicity (odds ratio [OR], 2.72; 95% CI, 1.00-7.38; P = .05), having private insurance (OR, 1.61; 95% CI, 1.35-1.93; P < .001), having a high school education or less (vs some college) (OR, 4.84; 95% CI, 1.22-19.21; P = .02), having a college degree (vs some college) (OR, 1.95; 95% CI, 1.53-2.49; P < .001), and not having a malignant neoplasm (eg, BRCA carriers) (OR, 3.13; 95% CI, 1.25-7.85; P = .01) were independently associated with making a high-quality decision. Conclusions and Relevance A minority of patients undergoing mastectomy in a single academic center made a high-quality decision about reconstruction. Shared decision making is needed to support decisions about breast reconstruction.
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Affiliation(s)
- Clara Nan-Hi Lee
- Department of Plastic Surgery, College of Medicine, The Ohio State University, Columbus.,Richard J. Solove Research Institute, Comprehensive Cancer Center-Arthur G. James Cancer Hospital, The Ohio State University, Columbus.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center Biostatistics Core Facility, University of North Carolina-Chapel Hill
| | - Ruth Huh
- Lineberger Comprehensive Cancer Center Biostatistics Core Facility, University of North Carolina-Chapel Hill
| | - Peter Anthony Ubel
- Duke-Margolis Center for Health Policy, Fuqua School of Business, Duke University, Durham, North Carolina.,Duke-Margolis Center for Health Policy, Sanford School of Public Policy, Duke University, Durham, North Carolina.,Duke-Margolis Center for Health Policy, Duke University School of Medicine, Durham, North Carolina
| | - Yuen-Jong Liu
- Department of Surgery, University of North Carolina Hospitals, University of North Carolina-Chapel Hill
| | - Lillian Blizard
- Gastrointestinal Unit, Massachusetts General Hospital, Boston
| | - Caprice Hunt
- Department of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina-Chapel Hill
| | - Michael Patrick Pignone
- Department of Internal Medicine, Dell Medical School, University of Texas at Austin.,Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina
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21
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Woodhouse KD, Tremont K, Vachani A, Schapira MM, Vapiwala N, Simone CB, Berman AT. A Review of Shared Decision-Making and Patient Decision Aids in Radiation Oncology. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:238-245. [PMID: 28138917 DOI: 10.1007/s13187-017-1169-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cancer treatment decisions are complex and may be challenging for patients, as multiple treatment options can often be reasonably considered. As a result, decisional support tools have been developed to assist patients in the decision-making process. A commonly used intervention to facilitate shared decision-making is a decision aid, which provides evidence-based outcomes information and guides patients towards choosing the treatment option that best aligns with their preferences and values. To ensure high quality, systematic frameworks and standards have been proposed for the development of an optimal aid for decision making. Studies have examined the impact of these tools on facilitating treatment decisions and improving decision-related outcomes. In radiation oncology, randomized controlled trials have demonstrated that decision aids have the potential to improve patient outcomes, including increased knowledge about treatment options and decreased decisional conflict with decision-making. This article provides an overview of the shared-decision making process and summarizes the development, validation, and implementation of decision aids as patient educational tools in radiation oncology. Finally, this article reviews the findings from decision aid studies in radiation oncology and offers various strategies to effectively implement shared decision-making into clinical practice.
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Affiliation(s)
- Kristina Demas Woodhouse
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, TRC 2 West, Philadelphia, PA, 19104, USA.
| | - Katie Tremont
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, TRC 2 West, Philadelphia, PA, 19104, USA
| | - Anil Vachani
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Marilyn M Schapira
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, TRC 2 West, Philadelphia, PA, 19104, USA
| | - Charles B Simone
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, TRC 2 West, Philadelphia, PA, 19104, USA
| | - Abigail T Berman
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, TRC 2 West, Philadelphia, PA, 19104, USA
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22
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Pope TM, Lessler D. Revolutionizing Informed Consent: Empowering Patients with Certified Decision Aids. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 10:537-539. [PMID: 28364386 DOI: 10.1007/s40271-017-0230-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Thaddeus Mason Pope
- Mitchell Hamline School of Law, 875 Summit Avenue (Room 320), Saint Paul, MN, 55105-3076, USA.
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23
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Hawley ST, Li Y, Jeanpierre LA, Goodell S, Jagsi R, Ward KC, Sabel MS, Katz SJ. Study protocol: A Randomized Controlled Trial of a Comprehensive Breast Cancer Treatment Patient Decision Tool (iCanDecide). Contemp Clin Trials Commun 2017; 5:123-132. [PMID: 29152598 PMCID: PMC5685533 DOI: 10.1016/j.conctc.2017.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Patients newly diagnosed with breast cancer face a series of complex decisions regarding locoregional and systemic treatment. There is a need to improve the quality of locoregional and systemic decisions for breast cancer patients, and to help patients understand the role of evaluative tests in this decision process. We are now conducting a randomized controlled trial (RCT) of an online decision tool—called iCanDecide, which we expect will help patients with these difficult decisions. Furthermore, the results of this RCT will be highly relevant to future breast cancer patients making these decisions and to their clinicians. Methods This is a two-arm randomized controlled trial with the target of 222 participants per arm. Participants are recruited from 25 surgical practices (total 40 surgeons) and 2 medical oncology practices (total 2 oncologists) in Michigan, Georgia, Tennessee, and California. Participants are newly-diagnosed female breast cancer patients between 21 and 84 years, with stage I-II invasive breast cancer or ductal carcinoma in situ (DCIS) and who are eligible for and considering either mastectomy or lumpectomy with radiation, and who may be eligible for adjuvant systemic treatment. The RCT tests an interactive, tailored website, called iCanDecide (intervention arm), compared to a static version of the website (control arm). The static control arm is designed to include the same basic content as the intervention version, but without tailoring and interactive features. The primary outcome includes the rate of making a high-quality decision. The hypothesis is that patients randomized to the interactive version of iCanDecide will have higher rates of high quality decisions (informed and values-concordant), and will appraise their decision-making process more positively, for both surgical and systemic treatment. Discussion The goal of this study is to evaluate the impact of the iCanDecide interactive website on decision-making for locoregional and systemic breast cancer treatments. The results of this study will be important for future breast cancer patients and their clinicians as we determine how to better individualize decision making across this complex treatment landscape. Trial registration ClinicalTrials.gov ID NCT01840163.
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Affiliation(s)
- Sarah T Hawley
- University of Michigan, Department of Internal Medicine, Division of General Medicine, North Campus Research Complex, 2800 Plymouth Rd, Ann Arbor, MI 48109, USA.,University of Michigan, Department of Health Management and Policy, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA.,Veterans Administration Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Yun Li
- University of Michigan, Department of Biostatistics School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - L Alexandra Jeanpierre
- University of Michigan, Department of Internal Medicine, Division of General Medicine, North Campus Research Complex, 2800 Plymouth Rd, Ann Arbor, MI 48109, USA
| | - Stefanie Goodell
- University of Michigan, Department of Internal Medicine, Division of General Medicine, North Campus Research Complex, 2800 Plymouth Rd, Ann Arbor, MI 48109, USA
| | - Reshma Jagsi
- University of Michigan, Department of Radiation Oncology, University Hospital, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Kevin C Ward
- Emory University, Rollins School of Public Health, Department of Epidemiology, 1518 Clifton Road NE, Atlanta, GA 30033, USA
| | - Michael S Sabel
- University of Michigan, Department of Surgery, Comprehensive Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Steven J Katz
- University of Michigan, Department of Internal Medicine, Division of General Medicine, North Campus Research Complex, 2800 Plymouth Rd, Ann Arbor, MI 48109, USA.,University of Michigan, Department of Health Management and Policy, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
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