TY - JOUR
T1 - A patient decision aid for breast cancer patients deciding on their radiation treatment, no change in decisional conflict but better informed choices
AU - Raphael, D. B.
AU - Russell, N. S.
AU - Winkens, B.
AU - Immink, J. M.
AU - Westhoff, P. G.
AU - Stenfert Kroese, M. C.
AU - Stam, M. R.
AU - Bijker, N.
AU - van Gestel, C. M. J.
AU - van der Weijden, T.
AU - Boersma, L. J.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Background and Purpose: In selected breast cancer patients, radiation treatment (RT) lowers the recurrence risk, with minor or no improvement of survival. In these patients, the choice to undergo RT is considered a preference-sensitive decision. To facilitate shared decision-making (SDM) for this choice, a patient decision aid was made. We aimed to evaluate the effect of the PtDA on decisional conflict. Material and methods: We performed a multi-center pre- and post-intervention study (BRASA-trial). The first 214 patients made a choice without support of the PtDA; the subsequent 189 patients received a link to the PtDA. The primary endpoint was decisional conflict; secondary endpoints were perceived SDM and knowledge on treatment options. Patients filled out questionnaires immediately after, and three months after their decision. Data were analyzed with multi-level regression analysis. Results: After correcting for the difference in age and educational level, the mean (±SD) decisional conflict for the intervention group (27.3 ± 11.4) was similar to the control group (26.8 ± 11.4; difference = 0.86, 95 %CI 1.67,3.36) three months after their decision. This also applied to perceived SDM. Patients exposed to the PtDA pursued additional treatment less often (45% vs 56%, odds ratio 0.59, 95 %CI 0.37,0.95) and scored significantly higher on the knowledge test (7.4 ± 2.5 vs 6.1 ± 2.7, corrected difference = 1.0, 95 %CI 0.50,1.49). There was no significant increase in consultation time. Conclusions: Handing out the PtDA was not associated with improved scores in decisional conflict or perceived SDM, but it was associated with a choice for less additional treatment and better knowledge about the treatment options.
AB - Background and Purpose: In selected breast cancer patients, radiation treatment (RT) lowers the recurrence risk, with minor or no improvement of survival. In these patients, the choice to undergo RT is considered a preference-sensitive decision. To facilitate shared decision-making (SDM) for this choice, a patient decision aid was made. We aimed to evaluate the effect of the PtDA on decisional conflict. Material and methods: We performed a multi-center pre- and post-intervention study (BRASA-trial). The first 214 patients made a choice without support of the PtDA; the subsequent 189 patients received a link to the PtDA. The primary endpoint was decisional conflict; secondary endpoints were perceived SDM and knowledge on treatment options. Patients filled out questionnaires immediately after, and three months after their decision. Data were analyzed with multi-level regression analysis. Results: After correcting for the difference in age and educational level, the mean (±SD) decisional conflict for the intervention group (27.3 ± 11.4) was similar to the control group (26.8 ± 11.4; difference = 0.86, 95 %CI 1.67,3.36) three months after their decision. This also applied to perceived SDM. Patients exposed to the PtDA pursued additional treatment less often (45% vs 56%, odds ratio 0.59, 95 %CI 0.37,0.95) and scored significantly higher on the knowledge test (7.4 ± 2.5 vs 6.1 ± 2.7, corrected difference = 1.0, 95 %CI 0.50,1.49). There was no significant increase in consultation time. Conclusions: Handing out the PtDA was not associated with improved scores in decisional conflict or perceived SDM, but it was associated with a choice for less additional treatment and better knowledge about the treatment options.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85122822355&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/34589620
U2 - https://doi.org/10.1016/j.tipsro.2021.08.002
DO - https://doi.org/10.1016/j.tipsro.2021.08.002
M3 - Article
C2 - 34589620
SN - 2405-6324
VL - 20
SP - 1
EP - 9
JO - Technical Innovations and Patient Support in Radiation Oncology
JF - Technical Innovations and Patient Support in Radiation Oncology
ER -