title: How and for whom are decision aids effective? Long-term psychological outcome of a randomized controlled trial in women with newly diagnosed breast cancer.
abstract: OBJECTIVE
  The current study evaluates the long-term psychological impact of a decision aid intervention for surgical and systemic treatment in women with newly diagnosed breast cancer from a previous reported randomized, controlled trial (Vodermaier et al., 2009).
  
  
  METHODS
  Patients (n = 111) were randomized into usual care, or a 20-min decision aid intervention plus an information brochure prior to consultation planning with the senior physician. The retention rate at 1 year was 88%.
  
  
  RESULTS
  Linear mixed model analyses demonstrated that the intervention group experienced less decisional conflict (p = .047; d = .19), which was driven by perceptions of a more effective choice (p = .029; d = .20) over time. Subgroup analyses revealed that patients in the intervention group who participated in chemotherapy decision making showed better long-term body image outcomes (p = .009; d = .44), which were mediated by reduced depressive coping (p = .049). No effects emerged for anxiety and depressive symptoms, or for quality of life. Internal health locus of control moderated group effects on 'uncertainty with the decision' (p = .003).
  
  
  CONCLUSIONS
  The study results provide novel evidence on the role of individual differences and the mechanisms behind decision aid effectiveness, and demonstrate the long-term impact of decision aid interventions on some indices of well-being.
authors.affiliation: Department of Obstetrics and Gynaecology-Campus Grosshadern, University of Munich.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vodermaier
authors.affiliation: Department of Obstetrics and Gynaecology-Campus Grosshadern, University of Munich.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Caspari
authors.affiliation: Department of Biostatistics, Princess Margret Hospital.
authors.forename: Lisa
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Obstetrics and Gynaecology-Campus Grosshadern, University of Munich.
authors.forename: Janna
authors.initials: J
authors.lastname: Koehm
authors.affiliation: Department of Obstetrics and Gynaecology-Campus Grosshadern, University of Munich.
authors.forename: Nina
authors.initials: N
authors.lastname: Ditsch
authors.affiliation: Department of Obstetrics and Gynaecology-Campus Grosshadern, University of Munich.
authors.forename: Michael
authors.initials: M
authors.lastname: Untch
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000523:psychology*; D003220:Conflict, Psychological; D003657:Decision Making; D005260:Female; D006801:Humans; D007389:Internal-External Control; D016014:Linear Models; D008875:Middle Aged; D010353:Patient Education as Topic; D011795:Surveys and Questionnaires