Decision Tool Benefits Women Considering Adjuvant Chemotherapy for Breast Cancer

 

 

Behind the Cancer Headlines®

April 16, 2003

 

 

Women with breast cancer who are considering treatment with adjuvant chemotherapy may benefit in decision making from the use of a formal decision aid, according to a study published in the Journal of the National Cancer Institute. The study found that the addition of a decision aid to a doctor's consultation improved patients' knowledge about their disease and increased their satisfaction with the decision-making process.

 

Decision aids are designed to help patients make more informed decisions about their treatment. Decision aids help explain different treatment options and provide quantitative estimates of risks and benefits. They also tailor information to individual patients while encouraging them to consider their own values when making decisions about their treatment. For this study, the decision aid consisted of a visual aid and written materials administered by a nurse during the medical consultation.

 

Timothy Whelan, M.D., of the Hamilton Regional Cancer Centre in Ontario, and his colleagues conducted a randomized trial to determine the effectiveness of a decision aid called the Decision Board in helping patients with lymph node-negative breast cancer understand their disease and treatment options. The study involved 176 women randomly assigned to receive either Decision Board plus medical consultation or medical consultation alone. One week after the end of the consultation, patients completed a questionnaire assessing their knowledge about breast cancer and satisfaction with decision making.

 

Patients who received the Decision Board had a better understanding of their disease, risk of cancer recurrence, and treatment options compared with patients who received medical consultation alone. Patients who received the Decision Board also reported being more satisfied with the decision-making process than patients in the usual care group. The Decision Board also increased the number of women who preferred a more active role in decision making. The authors note that the Decision Board did not increase patient anxiety, the length of the consultation, or the decision to take adjuvant chemotherapy.

 

"We recommend that physicians consider such an instrument when presenting treatment options of adjuvant systemic therapy to women with early-stage breast cancer," the authors say.

 

In an accompanying editorial, Annette M. O'Connor, Ph.D., of the University of Ottawa and Ottawa Health Research Institute in Canada, Albert G. Mulley Jr., M.D., of the Massachusetts General Hospital and Harvard Medical School in Boston, and John E. Wennberg, M.D., of Dartmouth Medical School in Hanover, N.H., discuss how decision aids help in understanding the complexities in making decisions about cancer treatment.

 

They point out that physicians need to be aware that decision aids exist and that these decision aids need to be accessible. Decision aids also need to be current, attractive, easy to use, and not require additional cost, time, or equipment, they say, adding that physicians need to feel motivated to use decision aids.

 

"Perhaps the motivation that doctors need most must await development and wide use of valid but simple measures of decision quality," the editorialists say. "Such measures would undoubtedly disclose important gaps in relevant information and important mismatches between what patients value and the treatment they receive."

 

 

SOURCE:

 

Journal of the National Cancer Institute, April 16, 2003