Decision support for patients with early-stage breast cancer: effects of an interactive breast cancer CDROM on treatment decision, satisfaction, and quality of life.
OBJECTIVE
To investigate the effects of the Interactive Breast Cancer CDROM as a decision aid for breast cancer patients with a choice between breast conserving therapy (BCT) and mastectomy (MT).


METHODS
Consecutive patients with stage I and II breast cancer were enrolled. A quasi-experimental, longitudinal, and pretest/posttest design was used. Follow-up was scheduled 3 and 9 months after discharge from the hospital. Control patients (n = 88) received standard care (oral information and brochures). The CDROM was provided to patients in the experimental condition (n = 92) as a supplement to standard procedures. Outcome variables were treatment decision, satisfaction, and quality of life (QoL).


RESULTS
No effect on treatment decision was found. CDROM patients expressed more general satisfaction with information at 3 and 9 months (95% confidence interval for the difference (d) between the means (d: 4.1 to 12.5 and 5.7 to 14.2 respectively). CDROM patients were also more satisfied with their treatment decision at 3 and at 9 months (d: 0.1 to 0.4; 0.2 to 0.5). Moreover, at 9 months, CDROM patients were more satisfied with breast cancer-specific information (d: 0.9 to 16.5), the decision-making process (d: 0.1 to 0.4), and communication (d: 0.2 to 11.0). At 3 and 9 months, a positive effect was found on general health (d: 0.2 to 14.5 and 0.3 to 15.0). Moreover, at 9 months, CDROM patients reported better physical functioning (d: 5.1 to 19.8), less pain (d: -17.9 to -4.5), and fewer arm symptoms (d: -14.1 to -0.5).


CONCLUSIONS
The Interactive Breast Cancer CDROM improved decision making in patients with early-stage breast cancer with a choice between BCT and MT, as evaluated in terms of patients' satisfaction and QoL.
Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands. J.Molenaar@AMC.UvA.NL
S
S
Molenaar
M A
MA
Sprangers
E J
EJ
Rutgers
E J
EJ
Luiten
J
J
Mulder
P M
PM
Bossuyt
J J
JJ
van Everdingen
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P
Oosterveld
H C
HC
de Haes
D000368:Aged; D001828:Body Image; D001943:Breast Neoplasms / Q000523:psychology / Q000628:therapy*; D016251:CD-ROM; D003657:Decision Making; D003658:Decision Making, Computer-Assisted; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life