Hamilton researchers find decision aids may help women with breast cancer


Specialists at Hamilton Health Sciences’ Juravinski Cancer Centre have found that a decision board helps women newly diagnosed with breast cancer feel satisfied and knowledgeable about the choices they make about their treatment.

Dr. Tim Whelan, a radiation oncologist and Canada Research Chair in Health Services Research in Cancer, and colleagues evaluated the impact of a decision aid on patient decisionmaking regarding different surgical treatment options.

Hamilton specialists Dr. Mark Levine, Dr. Ken Sanders and Dr. Susan Reid were also involved in the study, published July 27 in the Journal of the American Medical Association.

“Patients in the decision board group had higher knowledge scores about their treatment options (66.9 vs. 58.7), had less decisional conflict (1.40 vs. 1.62), and were more satisfied with decision making (4.50 vs. 4.32) following the consultation,” the authors said.

“Patients who used the decision board were more likely to choose BCT (94 percent vs. 76 percent),” they reported.

“The results of this randomized trial demonstrate that the decision board not only improved patient knowledge about breast cancer and its treatment but also decreased their decisional conflict and increased their satisfaction with decision making following the consultation,” the authors said.”Such instruments should be considered by surgeons when communicating the different surgical options to women with breast cancer,” they conclude. The study noted that long-term results of randomized trials have demonstrated equivalent survival rates for mastectomy and breast-conserving therapy (BCT) for the treatment of early stage breast cancer. Consequently, the choice of treatment should be based on a patient’s preferences.

The decision board is an aid that presents written and visual information to patients regarding their treatment options, the acute and long-term adverse effects associated with treatment, and the effects of treatment on a patient’s breast, long-term survival, and quality of life. The authors conducted a cluster randomized trial in which general surgeons in central, eastern, and western Ontario were randomly assigned to use the decision board, or not, in surgical consultations.

Twenty surgeons took part in the study, and 201 women with newly diagnosed clinical stage I or II breast cancer agreed to be evaluated. Patients received the decision board, or not, based on which surgeon they saw – 94 were assigned to the decision board, and 107 to usual practice. Immediately following counseling, at six months, and at 12 months, patients were questioned about their choices of therapy, conflict about their decision, satisfaction, anxiety, and depression.