© 2003 by Oxford University Press
Journal of the National Cancer Institute, Vol. 95, No. 8, 581-587,
April 16, 2003
© 2003 Oxford University Press
ARTICLE |
Helping Patients Make Informed Choices: A Randomized Trial of a Decision Aid for Adjuvant Chemotherapy in Lymph Node-Negative Breast Cancer
Affiliations of authors: T. Whelan, M. Levine, Cancer Care Ontario (CCO), Hamilton Regional Cancer Centre, and Supportive Cancer Care Research Unit, McMaster University, Hamilton, Ontario, Canada; C. Sawka, K. Pritchard, CCO Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontario; A. Gafni, A. Willan, J. Julian, I. Bodendorfer, Supportive Cancer Care Research Unit, McMaster University; L. Reyno, E. Chouinard, R. Tozer, CCO, Hamilton Regional Cancer Centre; S. Dent, CCO Northwestern Ontario Regional Cancer Centre, Thunder Bay, Ontario; H. Abu-Zahra, CCO Windsor Regional Cancer Centre, Windsor, Ontario.
Correspondence to: Timothy Whelan, B.M., B.Ch., Supportive Cancer Care Research Unit, Hamilton Regional Cancer Center, 699 Concession St., Rm. 3–62, Hamilton, ON L8V 5C2 Canada (e-mail: tim.whelan{at}hrcc.on.ca).
Background: In recent years, patients have indicated a desire for more information about their disease and to be involved in making decisions about their care. We developed an aid called the "Decision Board" to help clinicians inform patients with lymph node-negative breast cancer of the risks and benefits of adjuvant chemotherapy. We determined whether adding the Decision Board to the medical consultation improved patient knowledge and satisfaction compared with the medical consultation alone. Methods: Between October 1995 and March 2000, 176 women with lymph node-negative breast cancer who were candidates for adjuvant chemotherapy were randomly assigned to receive the Decision Board plus the medical consultation (83 patients) or the medical consultation alone (93 patients). One week after the consultation, patients completed a questionnaire assessing their knowledge about breast cancer and chemotherapy. Satisfaction with decision making was assessed 1 week and 3, 6, and 12 months after randomization, and differences between groups were analyzed by a repeated measures analysis of variance. All statistical tests were two-sided. Results: Patients in the Decision Board arm were better informed about breast cancer and adjuvant chemotherapy than patients in the control arm (mean knowledge score = 80.2 [on a scale of 0–100], 95% confidence interval [CI] = 77.1 to 83.3, and 71.7, 95% CI = 69.0 to 74.4, respectively; P<.001). Over the entire study period, satisfaction with decision making was higher for patients in the Decision Board arm than for patients in the control arm (P = .032). There was no statistically significant difference between the two groups in the number of patients who chose adjuvant chemotherapy (77% and 70% for patients in the Decision Board arm and those in the control arm, respectively; P = .303). Conclusion: When making decisions regarding adjuvant chemotherapy, patients with early breast cancer who had been exposed to the Decision Board had better knowledge of the disease and treatment options and greater satisfaction with their decision making than those who received the standard consultation.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. J. Vickers, E. B. Elkin, P. B. Peele, M. Dickler, and L. A. Siminoff Long-Term Health Outcomes of a Decision Aid: Data from a Randomized Trial of Adjuvant! in Women with Localized Breast Cancer Med Decis Making, July 1, 2009; 29(4): 461 - 467. [Abstract] [PDF]
|
|
|
|
 |
|
 M. A. O'Brien, T. J. Whelan, M. Villasis-Keever, A. Gafni, C. Charles, R. Roberts, S. Schiff, and W. Cai Are Cancer-Related Decision Aids Effective? A Systematic Review and Meta-Analysis J. Clin. Oncol., February 20, 2009; 27(6): 974 - 985. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Leatherman and L. Warrick Effectiveness of Decision Aids: A Review of the Evidence Med Care Res Rev, December 1, 2008; 65(6_suppl): 79S - 116S. [Abstract] [PDF]
|
|
|
|
 |
|
 M. A. Gerend and M. Pai Social Determinants of Black-White Disparities in Breast Cancer Mortality: A Review Cancer Epidemiol. Biomarkers Prev., November 1, 2008; 17(11): 2913 - 2923. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Stacey, R. Samant, and C. Bennett Decision Making in Oncology: A Review of Patient Decision Aids to Support Patient Participation CA Cancer J Clin, September 1, 2008; 58(5): 293 - 304. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. O'Connor, D. Stacey, M. J. Barry, N. F. Col, K. B. Eden, V. Entwistle, V. Fiset, M. Holmes-Rovner, S. Khangura, H. Llewellyn-Thomas, et al. Do Patient Decision Aids Meet Effectiveness Criteria of the International Patient Decision Aid Standards Collaboration? A Systematic Review and Meta-analysis Med Decis Making, October 1, 2007; 27(5): 554 - 574. [Abstract] [PDF]
|
|
|
|
|
|
W. J. Temple, M. L. Russell, L. L. Parsons, S. M. Huber, C. A. Jones., J. Bankes, and M. Eliasziw Conservation Surgery for Breast Cancer As the Preferred Choice: A Prospective Analysis J. Clin. Oncol., July 20, 2006; 24(21): 3367 - 3373. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S.J.T. Jansen, W. Otten, M.C.M. Baas-Thijssen, C.J.H. van de Velde, J.W.R. Nortier, and A.M. Stiggelbout Explaining Differences in Attitude Toward Adjuvant Chemotherapy Between Experienced and Inexperienced Breast Cancer Patients J. Clin. Oncol., September 20, 2005; 23(27): 6623 - 6630. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J. Katz, P. M. Lantz, N. K. Janz, A. Fagerlin, K. Schwartz, L. Liu, D. Deapen, B. Salem, I. Lakhani, and M. Morrow Patient Involvement in Surgery Treatment Decisions for Breast Cancer J. Clin. Oncol., August 20, 2005; 23(24): 5526 - 5533. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. A. Olivotto, C. D. Bajdik, P. M. Ravdin, C. H. Speers, A. J. Coldman, B. D. Norris, G. J. Davis, S. K. Chia, and K. A. Gelmon Population-Based Validation of the Prognostic Model ADJUVANT! for Early Breast Cancer J. Clin. Oncol., April 20, 2005; 23(12): 2716 - 2725. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. J. Whelan and C. Loprinzi Physician/Patient Decision Aids for Adjuvant Therapy J. Clin. Oncol., March 10, 2005; 23(8): 1627 - 1630. [Full Text] [PDF]
|
|
|
|
|
|
S. J.T. Jansen, W. Otten, and A. M. Stiggelbout Review of Determinants of Patients' Preferences for Adjuvant Therapy in Cancer J. Clin. Oncol., August 1, 2004; 22(15): 3181 - 3190. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Whelan, M. Levine, A. Willan, A. Gafni, K. Sanders, D. Mirsky, S. Chambers, M. A. O'Brien, S. Reid, and S. Dubois Effect of a Decision Aid on Knowledge and Treatment Decision Making for Breast Cancer Surgery: A Randomized Trial JAMA, July 28, 2004; 292(4): 435 - 441. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Epstein, B. S. Alper, and T. E. Quill Communicating Evidence for Participatory Decision Making JAMA, May 19, 2004; 291(19): 2359 - 2366. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. B. Leighl, P. N. Butow, and M. H.N. Tattersall Treatment Decision Aids in Advanced Cancer: When the Goal Is Not Cure and the Answer Is Not Clear J. Clin. Oncol., May 1, 2004; 22(9): 1759 - 1762. [Full Text] [PDF]
|
|
|
|
 |
|
 G. Guyatt, V. Montori, P J Devereaux, H. Schunemann, and M. Bhandari Patients at the centre: in our practice, and in our use of language Evid. Based Med., January 1, 2004; 9(1): 6 - 7. [Full Text] [PDF]
|
|
|
|
|
|
P. J. Goodwin Reversible Ovarian Ablation or Chemotherapy: Are We Ready for Quality of Life to Guide Adjuvant Treatment Decisions in Breast Cancer? J. Clin. Oncol., December 15, 2003; 21(24): 4474 - 4475. [Full Text] [PDF]
|
|
|
|
|
|
C. Chao, J. L. Studts, T. Abell, T. Hadley, L. Roetzer, S. Dineen, D. Lorenz, A. YoussefAgha, and K. M. McMasters Adjuvant Chemotherapy for Breast Cancer: How Presentation of Recurrence Risk Influences Decision-Making J. Clin. Oncol., December 1, 2003; 21(23): 4299 - 4305. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. O'Connor, A. G. Mulley Jr., and J. E. Wennberg Standard Consultations Are Not Enough to Ensure Decision Quality Regarding Preference-Sensitive Options J Natl Cancer Inst, April 16, 2003; 95(8): 570 - 571. [Full Text] [PDF]
|
|