Exploring the black box of a decision aid: what information do patients select from an interactive Cd-Rom on treatment options in breast cancer?

The information needs of adult cancer survivors across the cancer continuum: A scoping review

OBJECTIVE

To provide an updated synthesis of the literature that investigates the self-reported information needs of people diagnosed with cancer across the cancer continuum.

METHODS

We conducted a scoping review of the literature published from August 2003 to June 2015 and expanded an existing typology summarizing the information needs of people diagnosed with cancer.

RESULTS

The majority of the included studies (n=104) focused on questions relevant to the diagnosis/active treatment phase of the cancer continuum (52.9%) and thus the most frequently identified information needs related to this phase (33.4%). Information needs varied across the continuum and the results highlight the importance of recognising this fact.

CONCLUSION

People diagnosed with cancer experience discrete information needs at different points from diagnosis to survival. Much of the research conducted in this area has focused on their information needs during the diagnosis and treatment of cancer, and literature relating to information needs following completion of treatment is sparse.

PRACTICE IMPLICATIONS

Further research is needed to discern the specific nature of the treatment concerns and identify the information needs that survivors experience during recurrence of cancer, metastasis or changes in diagnosis, and the end of life phase of the cancer continuum.

The relationship between psychosocial factors in the patient-oncologist relationship and quality of care: A study of breast cancer patients

This study examined the relationship between psychosocial factors in the patient-oncologist relationship and aspects of care among women with breast cancer. Breast cancer patients (N = 118) completed a questionnaire about their relationship with their oncologist, their treatment, and their health. While trust was related to several positive outcomes, physician supportiveness was most strongly related to satisfaction with care, and health care access was most strongly associated with general health. The results suggest that the addition of supportiveness and healthcare access to trust provide a more complete picture of patients' health outcomes.

Information requirements of young women with breast cancer treated with mastectomy or breast conserving surgery: A systematic review

OBJECTIVES

Young women with breast cancer have poorer prognosis, greater lifetime risk of local recurrence, contralateral recurrence, and distant disease, regardless of surgery received. Here we systematically review published evidence relating to the information requirements and preferences of young women diagnosed with early-stage breast cancer offered a choice between mastectomy and Breast Conservation Surgery (BCS). Findings will inform the development of a surgical decision aid for young women.

METHODS

Eight databases were searched to identify research examining information requirements of young women facing breast oncological surgery treatment decisions (MESH headings). Twelve studies met the inclusion criteria. Data were extracted and summarised in a narrative synthesis.

RESULTS

Findings indicate that young women prefer greater and more detailed information regarding treatment side effects, sexuality, and body image. Younger age of diagnosis leads to an increased risk perception of developing a second breast cancer. Young women's choices are influenced by factors associated with family and career. Information is required in a continuum throughout the treatment experience and not only at diagnosis when treatment decisions are made. Young women show differing levels of participation preferences.

CONCLUSION

Young women find decision-making challenging when the characteristics of diagnosis provide a surgical choice between mastectomy and breast conservation surgery. Efforts should be made to provide information regarding sexuality, body image, reconstruction, fertility and likelihood of familial predisposition. Further research is needed to identify the specific level and information requirements of this young-onset group. The low number of studies indicate a need to design studies targeting specifically this age group of breast cancer patients.

Impact of socioeconomic factors on informed decision making and treatment choice in patients with hip and knee OA

It is unclear how socioeconomic (SES) status influences the effectiveness of shared decision making (SDM) tools. The purpose of this study was to assess the impact of SES on the utility of SDM tools among patients with hip and knee osteoarthritis (OA). We performed a secondary analysis of data from a randomized controlled trial of 123 patients with hip or knee OA. Higher education and higher income were independently associated with higher knowledge survey scores. Patients with private insurance were 2.7 times more likely than patients with Medicare to arrive at a decision after the initial office visit. Higher education was associated with lower odds of choosing surgery, even after adjusting for knowledge. Patient knowledge of their medical condition and treatment options varies with SES.

Launching a virtual decision lab: development and field-testing of a web-based patient decision support research platform

BACKGROUND

Over 100 trials show that patient decision aids effectively improve patients' information comprehension and values-based decision making. However, gaps remain in our understanding of several fundamental and applied questions, particularly related to the design of interactive, personalized decision aids. This paper describes an interdisciplinary development process for, and early field testing of, a web-based patient decision support research platform, or virtual decision lab, to address these questions.

METHODS

An interdisciplinary stakeholder panel designed the web-based research platform with three components: a) an introduction to shared decision making, b) a web-based patient decision aid, and c) interactive data collection items. Iterative focus groups provided feedback on paper drafts and online prototypes. A field test assessed a) feasibility for using the research platform, in terms of recruitment, usage, and acceptability; and b) feasibility of using the web-based decision aid component, compared to performance of a videobooklet decision aid in clinical care.

RESULTS

This interdisciplinary, theory-based, patient-centered design approach produced a prototype for field-testing in six months. Participants (n = 126) reported that: the decision aid component was easy to use (98%), information was clear (90%), the length was appropriate (100%), it was appropriately detailed (90%), and it held their interest (97%). They spent a mean of 36 minutes using the decision aid and 100% preferred using their home/library computer. Participants scored a mean of 75% correct on the Decision Quality, Knowledge Subscale, and 74 out of 100 on the Preparation for Decision Making Scale. Completing the web-based decision aid reduced mean Decisional Conflict scores from 31.1 to 19.5 (p < 0.01).

CONCLUSIONS

Combining decision science and health informatics approaches facilitated rapid development of a web-based patient decision support research platform that was feasible for use in research studies in terms of recruitment, acceptability, and usage. Within this platform, the web-based decision aid component performed comparably with the videobooklet decision aid used in clinical practice. Future studies may use this interactive research platform to study patients' decision making processes in real-time, explore interdisciplinary approaches to designing web-based decision aids, and test strategies for tailoring decision support to meet patients' needs and preferences.

Young breast cancer patients' involvement in treatment decisions: the major role played by decision-making about surgery

OBJECTIVE

The objective of this study is to investigate young breast cancer patients' preferred and actual involvement in decision-making about surgery, chemotherapy, and adjuvant endocrine therapy (AET).

METHODS

A total of 442 women aged 18-40 years at the time of the diagnosis participated in the region-wide ELIPPSE40 cohort study (southeastern France). Logistic regression analyses were performed on various factors possibly affecting patients' preferred and perceived involvement in the decisions about their cancer treatment.

RESULTS

The women's mean age was 36.8 years at enrollment. Preference for a fully passive role in decision-making was stated by 20.7% of them. It was favored by regular breast surveillance (p = 0.04) and positive experience of being informed about cancer diagnosis (p = 0.02). Patients' preferences were independently associated with their reported involvement in decision-making about surgery (p = 0.01). A fully passive role in decision-making about chemotherapy and AET was more likely to be reported by patients who perceived their involvement in decision-making about surgery as having been fully passive (adjusted odds ratio = 4.8, CI95% [2.7-8.7], and adjusted odds ratio = 9.8, CI95% [3.3-29.2], respectively). This study shows a significant relationship between the use of antidepressants and involvement in decision-making about surgery, and confirms the relationship between impaired quality of life (in the psychological domain) and a fully passive role in decisions about cancer treatment.

CONCLUSIONS

Patients' involvement in decision-making about chemotherapy and AET was strongly influenced by their experience of decision-making about surgery, regardless of their tumor stage and history of breast or ovarian cancer. When decisions are being made about surgery, special attention should be paid to facilitating breast cancer patients' involvement in the decision-making.

Using decision aids to improve treatment choices for women with breast cancer

SUMMARY Breast cancer is the most frequently diagnosed cancer in women worldwide and decision-making regarding treatment options can be complex; however, patients often desire to be involved in health-related decisions. There has been a growing body of research into decision-support tools such as decision aids (DAs). Generally, DAs outperform standard care over a range of decision-making outcomes and there are some that have been developed for use with breast cancer patients across the treatment trajectory, which have been evaluated for use in practice. There is scope for developing additional DAs for cancer patients, however, there are some limitations and barriers that need to be overcome as part of the implementation process. Consideration for the mechanisms for maintaining relevancy of materials and ease of accessibility is also needed.

The impact of an empowering Internet-based Breast Cancer Patient Pathway programme on breast cancer patients' knowledge: a randomised control trial

OBJECTIVE

The aim of this study was to analyse the effect of Breast Cancer Patient Pathway program.

METHODS

In one Finnish university hospital during 2008-10 newly diagnosed breast cancer patients were randomised to the intervention (n = 50) and the control groups (n = 48). The breast cancer patient's knowledge expectations and perception of received knowledge, knowledge, the source of information and satisfaction in received patient education were measured. Baseline and one year follow up data collection was conducted.

RESULTS

No differences were found in knowledge expectations between the groups at baseline. Patients in the control group evaluated their perception of received knowledge to be higher and they were more satisfied with the patient education they received from the hospital staff. However, the Intervention group's knowledge level was higher. The most important source of information was the healthcare professionals in both groups.

CONCLUSION

The results of study indicate that when patient education increases, patients' knowledge expectations increase as well, while their perceptions of received knowledge decrease. Future research is needed to examine the relationship between patients' knowledge expectations and perception of received knowledge as patients' knowledge level increases.

PRACTICE IMPLICATIONS

Patient education has to be individually adjusted, taking patients' expectations into account.

Decision aids for surgical treatment of early stage breast cancer: a narrative review of the literature

OBJECTIVE

To review and critique the published empirical research on decision aids for women actually facing surgical treatment of early stage breast cancer, synthesize findings across studies related to outcomes of decision aids use with specific attention to the influence of system and client characteristics, and identify opportunities for further research.

METHODS

A systematic and reproducible search was carried out to identify studies evaluating decision aids for women making breast cancer surgical treatment decisions. All included studies were appraised.

RESULTS

Most studies evaluated the outcomes of decision aids use in terms of final treatment decisions, patients' knowledge of treatment options, anxiety, decisional conflict, satisfaction and quality of life. Included studies varied in design, measures used to assess effectiveness, format of the aids, patient populations and clinical settings. Studies yielded mixed results related to the effect of the decision aids on the outcomes measured.

CONCLUSION

Despite the mixed findings of the studies, some support exists for the use of decision aids with women diagnosed with early stage breast cancer.

PRACTICE IMPLICATIONS

To ensure successful implementation of decision aids in clinical practice, healthcare providers should be educated on their use. Greater allocation of time, space and access to decision aids is also needed.

Expression and reception of treatment information in breast cancer support groups: how health self-efficacy moderates effects on emotional well-being

OBJECTIVES

To examine the effects of exchanging treatment information within computer-mediated breast cancer support groups on emotional well-being, and to explore whether this relationship is moderated by health self-efficacy.

SAMPLE

177 breast cancer patients using an electronic Health (eHealth) program with discussion group.

MEASURE

expression and reception of treatment information; emotional well-being scale (0, 4 months).

ANALYSES

hierarchical regression.

RESULTS

Effects of expression and reception of treatment information on emotional well-being were significantly greater for those who have higher health self-efficacy.

CONCLUSIONS

Results conditionally support prior research finding positive effects of treatment information exchanges among breast cancer patients. Such exchanges had a positive impact on emotional well-being for those with higher health self-efficacy, but they had a negative influence for those with lower health self-efficacy.

PRACTICE IMPLICATIONS

Given that the association between emotional well-being and exchanging treatment information was moderated by health self-efficacy, clinicians should explain the role of health self-efficacy before encouraging patients to use eHealth systems for treatment exchanges.

Use and evaluation of a CD-ROM-based decision aid for prostate cancer treatment decisions

The survival advantages associated with different treatments for localized prostate cancer (PCa) continue to be uncertain. We evaluated patients' use of an interactive CD-ROM-based decision aid designed to improve informed decision making about PCa treatment. Newly diagnosed, early-stage PCa patients who had not made a treatment decision completed a baseline telephone interview (N = 132), were mailed the CD-ROM, and completed a one-month follow-up interview (N = 120; 91%). Compared to non-users (21%), CD-users (79%) preferred to make an independent rather than a shared treatment decision (OR = 3.5, CI 1.2,10.5). The majority of users (63%-90%) responded positively regarding the length and clarity of the information. Further, 76% reported using the CD as much/more than other information sources. A preference for having less decisional control predicted greater satisfaction with the CD (F[7,87] = 4.75, p < .05). Electronic utilization data revealed that the topics most accessed concerned treatment information and that users spent over an hour using the CD (median = 72 minutes). This electronic educational tool was well-accepted by patients and may be particularly useful for patients who desire less control over their treatment decisions and who are less proactive in seeking information on their own.

Supporting informed decision making online in 20 minutes: an observational web-log study of a PSA test decision aid

BACKGROUND

Web-based decision aids are known to have an effect on knowledge, attitude, and behavior; important components of informed decision making. We know what decision aids achieve in randomized controlled trials (RCTs), but we still know very little about how they are used and how this relates to the informed decision making outcome measures.

OBJECTIVE

To examine men's use of an online decision aid for prostate cancer screening using website transaction log files (web-logs), and to examine associations between usage and components of informed decision making.

METHODS

We conducted an observational web-log analysis of users of an online decision aid, Prosdex. Men between 50 and 75 years of age were recruited for an associated RCT from 26 general practices across South Wales, United Kingdom. Men allocated to one arm of the RCT were included in the current study. Time and usage data were derived from website log files. Components of informed decision making were measured by an online questionnaire.

RESULTS

Available for analysis were 82 web-logs. Overall, there was large variation in the use of Prosdex. The mean total time spent on the site was 20 minutes. The mean number of pages accessed was 32 (SD 21) out of a possible 60 pages. Significant associations were found between increased usage and increased knowledge (Spearman rank correlation [rho] = 0.69, P < .01), between increased usage and less favorable attitude towards PSA testing (rho = -0.52, P < .01), and between increased usage and reduced intention to undergo PSA testing (rho = -0.44, P < .01). A bimodal distribution identified two types of user: low access and high access users.

CONCLUSIONS

Increased usage of Prosdex leads to more informed decision making, the key aim of the UK Prostate Cancer Risk Management Programme. However, developers realistically have roughly 20 minutes to provide useful information that will support informed decision making when the patient uses a web-based interface. Future decision aids need to be developed with this limitation in mind. We recommend that web-log analysis should be an integral part of online decision aid development and analysis.

TRIAL REGISTRATION

ISRCTN48473735; http://www.controlled-trials.com/ISRCTN48473735 (Archived by WebCite at http://www.webcitation.org/5pqeF89tS).

Underuse of breast cancer adjuvant treatment: patient knowledge, beliefs, and medical mistrust

PURPOSE

Little is known about why women with breast cancer who have surgery do not receive proven effective postsurgical adjuvant treatments.

METHODS

We surveyed 258 women who recently underwent surgical treatment at six New York City hospitals for early-stage breast cancer about their care, knowledge, and beliefs about breast cancer and its treatment. As per national guidelines, all women should have received adjuvant treatment. Adjuvant treatment data were obtained from inpatient and outpatient charts. Factor analysis was used to create scales scored to 100 of treatment beliefs and knowledge, medical mistrust, and physician communication about treatment. Bivariate and multivariate analyses assessed differences between treated and untreated women.

RESULTS

Compared with treated women, untreated women were less likely to know that adjuvant therapies increase survival (on a 100-point scale; 66 v 75; P < .0001), had greater mistrust (64 v 53; P = .001), and had less self-efficacy (92 v 97; P < .05); physician communication about treatment did not affect patient knowledge of treatment benefits (r = 0.8; P = .21). Multivariate analysis found that untreated women were more likely to be 70 years or older (adjusted relative risk [aRR], 1.11; 95% CI, 1.00 to 1.13), to have comorbidities (aRR, 1.10; 95% CI, 1.04 to 1.12), and to express mistrust in the medical delivery system (aRR, 1.003; 95% CI, 1.00 to 1.007), even though they were more likely to believe adjuvant treatments were beneficial (aRR, 0.99; 95% CI, 0.98 to 0.99; model c, 0.84; P < or = .0001).

CONCLUSION

Patient knowledge and beliefs about treatment and medical mistrust are mutable factors associated with underuse of effective adjuvant therapies. Physicians may improve cancer care by ensuring that discussions about adjuvant therapy include a clear presentation of the benefits, not just the risks of treatment, and by addressing patient trust in and concerns about the medical system.

A generic tool for development of decision aids based on clinical practice guidelines

OBJECTIVE

Patient involvement in medical decision making has been suggested to contribute to patients' satisfaction and better patient outcomes. Decision aids are particularly useful for preference-sensitive decisions. Ideally, these should be based on up-to-date evidence-based guidelines. The objective of this project was to develop a generic format for development and maintenance of decision aids based on evidence-based guidelines.

METHODS

Decision aids, evidence-based guidelines and IPDAS standards were used for development of a generic format for decision aids. Patient focus groups were used to assess patients' information needs, expectations, personal values and preferences for presentation of information.

RESULTS

We developed a generic format for decision aids and six specific decision aids derived from evidence-based guidelines. The decision aids were published on the Dutch national health care portal. Furthermore, we reached formal agreement on ownership and maintenance of the decision aids with all stakeholders. We achieved these results within 12 months.

CONCLUSION

Our generic format facilitated the efficient production of specific decision aids based on evidence-based guidelines.

PRACTICE IMPLICATIONS

If guidelines and decision aids are developed in parallel, high-quality patient information can be produced within a short time frame. The process of development should include adequate patient involvement and a strategy for maintenance.

Randomized study of different anti-stigma media

OBJECTIVE

We designed our study to assess if computer-assisted anti-stigma interventions can be effective in reducing the level of psychiatric stigma in a sample of special education university students.

METHODS

We enrolled 193 graduate students. They had two study visits with an interval of 6 months. The participants were randomly distributed into three study groups: 76 students read anti-stigma printed materials (reading group, RG), and 69 studied an anti-stigma computer program (program group, PG), and 48 students were in a control group (CG) and received no intervention. We used the Bogardus scale of social distance (BSSD), the community attitudes toward the mentally ill (CAMI) questionnaire, and the psychiatric knowledge survey (PKS) as the main outcome measures.

RESULTS

After the intervention BSSD, CAMI and PKS scores significantly improved both in RG and PG. After 6 months in RG two out of three CAMI subscales and PKS scores were not different from the baseline. In PG all stigma and knowledge changes remained significant.

CONCLUSIONS

This study demonstrated that computers can be an effective mean in changing attitudes of students toward psychiatric patients.

PRACTICE IMPLICATIONS

A computer-mediated intervention has the potential for educating graduate students about mental disease and for reducing psychiatric stigma.

Shared decision-making in the Netherlands--current state and future perspectives

Dutch government policy is aimed at introducing regulated competition among health care providers and among health care insurers and at empowering patients for being involved in decision-making in health care. Along with this, many Dutch organisations have been created to foster patient orientation within health care and increase patients' power for medical decision-making. The challenge is to deliver reliable and well-balanced information for patients and the public, eg. in patient-tailored web-based formats. The approach of patient participation in medical decision-making has been formally defined in a specific law (WGBO), and the principle of recognising the patient's view is increasingly reflected in the national guidelines for health care professionals. The theme of patient participation in medical decision making is a fairly widespread research topic theme in the Netherlands, including mutual exchange among the researchers in a vivid network. The real bottleneck is perhaps the implementation of patient participation into professional practice. Some recommendations for facilitating a change are made.