title: Development of patients' decision aid for older women with stage I breast cancer considering radiotherapy after lumpectomy.
abstract: OBJECTIVE
  To develop a patient decision aid (PtDA) for older women with Stage I, pathologically node negative, estrogen receptor-positive progesterone receptor-positive breast cancer who are considering adjuvant radiotherapy after lumpectomy and to examine its impact on patients' decision making.
  
  
  METHODS
  A PtDA was developed and evaluated in three steps according to the Ottawa Decision Support Framework: (1) needs assessment (n = 16); (2) Pilot I to examine PtDA acceptability (n = 12); and (3) Pilot II, a pretest posttest (n = 38) with older women with estrogen receptor-positive progesterone receptor-positive breast cancer after lumpectomy who were receiving adjuvant radiation therapy. Measures included patients' satisfaction with the PtDA, self-reported decisional conflict, level of distress, treatment-related knowledge, and choice predisposition.
  
  
  RESULTS
  The PtDA is a booklet that details each adjuvant treatment option's benefits, risks, and side effects tailored to the patient's clinical profile; includes a values clarification exercise; and includes steps to guide patients towards their decision. On the basis of qualitative comments and satisfaction ratings, all women thought that the PtDA was helpful and informative. In comparison with their baseline scores, patients had a statistically significant (p < 0.05) reduction in decisional conflict (adjusted mean difference [AMD], -7.18; 95% confidence interval [CI], -13.50 to 12.59); increased clarity of the benefits and risks (AMD, -10.86; CI, -20.33 to 21.49); and improved general treatment knowledge (AMD, 8.99; CI, 2.88-10.28) after using the PtDA. General trends were also reported in the patients' choice predisposition scores that suggested potential differences in treatment decision after PtDA use.
  
  
  CONCLUSIONS
  This study provides evidence that this PtDA may be a helpful educational tool for this group of women. The quality of care for older breast cancer patients may be enhanced by the use of a tailored PtDA to help patients be better informed about their treatment options.
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wong
authors.forename: Laura
authors.initials: L
authors.lastname: D'Alimonte
authors.forename: Jan
authors.initials: J
authors.lastname: Angus
authors.forename: Larry
authors.initials: L
authors.lastname: Paszat
authors.forename: Kelly
authors.initials: K
authors.lastname: Metcalfe
authors.forename: Tim
authors.initials: T
authors.lastname: Whelan
authors.forename: Hilary
authors.initials: H
authors.lastname: Llewellyn-Thomas
authors.forename: Eiran
authors.initials: E
authors.lastname: Warner
authors.forename: Edmee
authors.initials: E
authors.lastname: Franssen
authors.forename: Ewa
authors.initials: E
authors.lastname: Szumacher
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000737:chemistry / Q000473:pathology / Q000523:psychology / Q000532:radiotherapy* / Q000601:surgery; D002755:Choice Behavior; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D010174:Pamphlets; D010358:Patient Participation; D010865:Pilot Projects; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods / Q000523:psychology; D011960:Receptors, Estrogen / Q000032:analysis; D011795:Surveys and Questionnaires
chemical_list: D011960:Receptors, Estrogen