title: Supporting treatment decision making in advanced cancer: a randomized trial of a decision aid for patients with advanced colorectal cancer considering chemotherapy.
abstract: OBJECTIVE
  Decision making in advanced cancer is increasingly complex. We developed a decision aid (DA) for patients with advanced colorectal cancer who are considering first-line chemotherapy and reviewing treatment options, prognostic information, and toxicities. We examined its impact on patient understanding, treatment decisions, decisional conflict, decision making, consultation satisfaction, anxiety, and quality of life by using a randomized trial design.
  
  
  METHODS
  In all, 207 patients with colorectal cancer who were considering first-line chemotherapy for metastatic disease were randomly assigned to receive a standard medical oncology consultation or a consultation in which the DA (take-home booklet with audio recording, reviewed by an oncologist) was used. Participants completed questionnaires postconsultation, postdecision, and 1 month later.
  
  
  RESULTS
  In this study, 100 patients were randomly assigned to the control arm, and 107 received the DA. Median age of the sample was 62 years, 58% were male, 89% had a performance status of 0 or 1, and 36% had received prior adjuvant chemotherapy. Patients receiving the DA demonstrated a greater increase in understanding of prognosis, options, and benefits, with higher overall understanding (P < .001). Decisional conflict, treatment decisions, and achievement of involvement preferences were similar between the groups. Anxiety was similar across groups and decreased over time. Most patients were confident in a decision during the first consultation; 74% chose chemotherapy, 7% supportive care alone, and 10% observation.
  
  
  CONCLUSIONS
  This randomized trial of a decision aid in advanced cancer showed that its use in advanced colorectal cancer improved patient understanding of prognosis, treatment options, risks, and benefits without increasing anxiety. DAs can improve informed consent and can be tested through randomized trials even in the advanced cancer setting.
authors.affiliation: Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada. Natasha.Leighl@uhn.on.ca
authors.forename: Natasha B
authors.initials: NB
authors.lastname: Leighl
authors.forename: Heather L
authors.initials: HL
authors.lastname: Shepherd
authors.forename: Phyllis N
authors.initials: PN
authors.lastname: Butow
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Clarke
authors.forename: Margaret
authors.initials: M
authors.lastname: McJannett
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Beale
authors.forename: Nicholas R C
authors.initials: NR
authors.lastname: Wilcken
authors.forename: Malcolm J
authors.initials: MJ
authors.lastname: Moore
authors.forename: Eric X
authors.initials: EX
authors.lastname: Chen
authors.forename: David
authors.initials: D
authors.lastname: Goldstein
authors.forename: Lisa
authors.initials: L
authors.lastname: Horvath
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Knox
authors.forename: Monika
authors.initials: M
authors.lastname: Krzyzanowska
authors.forename: Amit M
authors.initials: AM
authors.lastname: Oza
authors.forename: Ronald
authors.initials: R
authors.lastname: Feld
authors.forename: David
authors.initials: D
authors.lastname: Hedley
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
authors.forename: Martin H N
authors.initials: MH
authors.lastname: Tattersall
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001007:Anxiety; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010174:Pamphlets; D010346:Patient Care Management; D010353:Patient Education as Topic; D010358:Patient Participation; D017060:Patient Satisfaction; D011788:Quality of Life; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D014743:Videotape Recording
chemical_list: D000970:Antineoplastic Agents