Randomized trial of a patient decision aid for choice of surgical treatment for breast cancer.
A decision aid for the surgical treatment of early breast cancer was evaluated in a randomized controlled trial. The decision aid, a tape and workbook, includes explicit presentation of probabilities, photographs and graphics, and a values clarification exercise. Community surgeons were randomized to use the decision aid or a control pamphlet. Patients completed a questionnaire prior to using the decision aid, after reviewing it but prior to surgery, and 6 months after enrollment. There was no difference in anxiety, knowledge, or decisional regret across the 2 groups. There was a nonsignificant trend toward lower decisional conflict in the decision aid group. A subgroup of women who were initially leaning toward mastectomy or were unsure had lower decisional conflict. Although the decision aid had minimal impact on the main study outcomes, a subgroup may have benefited. Such subgroups should be identified, and appropriate decision support interventions should be developed and evaluated.
Goel
V
V
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. vivek.goel@utoronto.ca
Sawka
C A
CA
Thiel
E C
EC
Gort
E H
EH
O'Connor
A M
AM
D001943:Breast Neoplasms / Q000601:surgery*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D010353:Patient Education as Topic; D010358:Patient Participation