Canadian Association of General Surgeons and American College of Surgeons Evidence Based Reviews in Surgery. 19. The effect of a decision aid on knowledge and treatment decision making for breast cancer

Question: What is the impact of a decision aid outlining the different surgical options for stage I or stage II breast cancer on patient decision making? Design: Cluster randomized controlled trial. Setting: Twenty surgeons from communities in centralwest and eastern Ontario. Patients: A total of 201 of 208 patients (97%) with newly diagnosed clinical stage I or stage II breast cancer agreed to participate in the trial. Of these women, 94 were randomized to the decision aid group and 107 to usual standard of care. Intervention: Patients assigned to the decision aid group were shown a decision board that presented information, including acute and long-term adverse effects associated with treatment and the effects of treatment on a patient’s breast, long-term survival and quality of life, for the different treatment options. As well, patients were able to express a preference for treatment. Main outcome measures: (1) Patient knowledge about surgical treatment of breast cancer, (2) decisional conflict, (3) satisfaction with decision making and (4) treatment decision after the consultation. Results: Patients in the decision aid group had higher knowledge scores about their treatment options (66.9 v. 58.7; p < 0.001), had less decisional conflict (1.40 v. 1.62; p = 0.02) and were more satisfied with decision making (4.50 v. 4.32; p = 0.05). Patients who used the decision board were more likely to choose breast conservation therapy (BCT) (94% v. 76%, p = 0.03). Conclusions: The decision aid was helpful in improving communication and patient knowledge. The use of the decision aid resulted in less decisional conflict and better patient satisfaction with their treatment decision.