title: Impact of an In-visit Decision Aid on Patient Knowledge about Contralateral Prophylactic Mastectomy: A Pilot Study.
abstract: BACKGROUND
  Studies have reported that breast cancer patients have limited understanding about the oncologic outcomes following contralateral prophylactic mastectomy (CPM). We hypothesized that an in-visit decision aid (DA) would be associated with higher patient knowledge about the anticipated short and long term outcomes of CPM.
  
  
  METHODS
  We piloted a DA which used the SCOPED: (Situation, Choices, Objectives, People, Evaluation and Decision) framework. Knowledge, dichotomized as "low" (≤3 correct) versus "high" (≥4 correct), was assessed immediately after the visit by a 5 item survey. There were 97 DA patients (response rate 62.2 %) and 114 usual care (UC) patients (response rate 71.3 %).
  
  
  RESULTS
  Patient demographic factors were similar between the two groups. Twenty-one (21.7 %) patients in the DA group underwent CPM compared with 18 (15.8 %) in the UC group (p = 0.22). Mean and median knowledge levels were significantly higher in the DA group compared with the UC group for patients of all ages, tumor stage, race, family history, anxiety levels, worry about CBC, and surgery type. Eighty-six (78.9 %) of UC versus 35 (37.9 %) DA patients had low knowledge. Of patients who underwent CPM, 15 (83.3 %) in the UC cohort versus 5 (25.0 %) of DA patients had "low" knowledge.
  
  
  CONCLUSIONS
  Knowledge was higher in the DA group. The UC group had approximately three times the number of patients of the DA group who were at risk for making a poorly informed decision to have CPM. Future studies should assess the impact of increased knowledge on overall CPM rates.
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. kyao@northshore.org.
authors.forename: Katharine
authors.initials: K
authors.lastname: Yao
authors.affiliation: University of California San Francisco School of Medicine, San Francisco, CA, USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Belkora
authors.affiliation: Department of Surgery, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bedrosian
authors.affiliation: Dana Farber Cancer Institute, Boston, MA, USA.
authors.forename: Shoshana
authors.initials: S
authors.lastname: Rosenberg
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Sisco
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Ermilo
authors.initials: E
authors.lastname: Barrera
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kyrillios
authors.affiliation: Mayo Clinic, Rochester, MN, USA.
authors.forename: Jon
authors.initials: J
authors.lastname: Tilburt
authors.affiliation: Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Chihsiung
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Rabbitt
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Pesce
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Simovic
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Winchester
authors.affiliation: Massachusetts General Hospital, Health Decision Sciences Center, Boston, MA, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Sepucha
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology* / Q000601:surgery*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008875:Middle Aged; D010353:Patient Education as Topic; D010865:Pilot Projects; D000072036:Prophylactic Mastectomy / Q000523:psychology*