Decreased use of adjuvant breast cancer therapy in a randomized controlled trial of a decision aid with individualized risk information.
OBJECTIVE
Oncology patients often seek involvement in their medical consultations. Such involvement is endorsed by most health care providers and mirrored in practice guidelines. However, oncologists exhibit great variation in how they provide patients with disease-relevant information, and many remain reluctant to do so at all. The authors examined the impact of a patient-specific decision aid on women's decisions about adjuvant therapy for breast cancer.


METHODS
386 women with breast cancer were randomized to receive either an informational pamphlet about adjuvant therapy (usual care) or a patient-specific, evidence-based decision aid about adjuvant therapy. The authors compared rates of adjuvant therapy between the groups controlling for age, education, marital status, race, tumor severity, and practice type of their physician (university-based or community-based).


RESULTS
Among women with low tumor severity, only 58% (35/60) of women in the decision aid group chose adjuvant therapy, compared to 87% (33/38) of their counterparts in usual care (P<0.01).


CONCLUSIONS
This study illustrates the important impact of medical decision aids on treatment choices, particularly for patients for whom treatment has little benefit. In the case of adjuvant therapy for breast cancer, providing individualized, evidence-based risk information for shared decision making resulted in fewer women with low tumor severity choosing adjuvant treatment.
Peele
Pamela B
PB
Department of Health Policy & Management, Graduate School of Public Health, University of Pittsburgh, PA 15261, USA. peele@pitt.edu
Siminoff
Laura A
LA
Xu
Ying
Y
Ravdin
Peter M
PM
D000368:Aged; D000465:Algorithms; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000145:classification / Q000188:drug therapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D009820:Ohio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D010820:Physicians / Q000145:classification / Q000706:statistics & numerical data; D018570:Risk Assessment; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013781:Texas
D000970:Antineoplastic Agents