title: Breast cancer specialists' views on and use of risk prediction models in clinical practice: a mixed methods approach.
abstract: OBJECTIVE
  Risk prediction models (RPM) in breast cancer quantify survival benefit from adjuvant systemic treatment. These models [e.g. Adjuvant! Online (AO)] are increasingly used during consultations, despite their not being designed for such use. As still little is known about oncologists' views on and use of RPM to communicate prognosis to patients, we investigated if, why, and how they use RPM.
  
  
  METHODS
  We disseminated an online questionnaire that was based on the literature and individual and group interviews with oncologists.
  
  
  RESULTS
  Fifty-one oncologists (partially) completed the questionnaire. AO is the best known (95%) and most frequently used RPM (96%). It is used to help oncologists decide whether or not to recommend chemotherapy (>85%), to inform (86%) and help patients decide about treatment (>80%), or to persuade them to follow the proposed course of treatment (74%). Most oncologists (74%) believe that using AO helps patients understand their prognosis.
  
  
  CONCLUSIONS
  RPM have found a place in daily practice, especially AO. Oncologists think that using AO helps patients understand their prognosis, yet studies suggest that this is not always the case. Our findings highlight the importance of exploring whether patients understand the information that RPM provide.
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Ellen G
authors.initials: EG
authors.lastname: Engelhardt
authors.forename: Arwen H
authors.initials: AH
authors.lastname: Pieterse
authors.forename: Nanny
authors.initials: N
authors.lastname: van Duijn-Bakker
authors.forename: Judith R
authors.initials: JR
authors.lastname: Kroep
authors.forename: Hanneke C J M
authors.initials: HC
authors.lastname: de Haes
authors.forename: Ellen M A
authors.initials: EM
authors.lastname: Smets
authors.forename: Anne M
authors.initials: AM
authors.lastname: Stiggelbout
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality* / Q000523:psychology; D032882:Comprehension; D016001:Confidence Intervals; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D013502:General Surgery / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000706:statistics & numerical data; D008875:Middle Aged; D015233:Models, Statistical; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D035501:Uncertainty