Development and evaluation of a decision aid for patients considering first-line chemotherapy for metastatic breast cancer

Abstract

Objective: Treatment decisions in advanced breast cancer are complex, with enhanced quality of life and survival among important treatment goals. Patients with metastatic breast cancer face the decision of whether or not to have chemotherapy, and many wish to be involved in this decision. We report the development and evaluation of a decision aid (DA) designed to assist patients facing this treatment decision.

Design and sample: Women with metastatic breast cancer (n = 17)and medical oncologists in Australia and Canada (n = 7) were invited to evaluate the DA.

Intervention: A DA was developed for patients with hormone resistant metastatic breast cancer considering chemotherapy. The DA presented options of supportive care, with or without chemotherapy. Potential benefits and side effects of different chemotherapy regimens, and evidence-based prognostic estimates were described,and a values clarification exercise included.

Main outcome measures: Patient questionnaires evaluating information and decision involvement preferences, attitudes toward the DA and oncologist feedback regarding attitudes toward the DA.

Results: Seventeen patients participated; fifteen desired as much information about their illness as possible; sixteen wished to be actively involved in the decision-making process. The majority rated the DA as highly acceptable, clear and informative, and would recommend it to others facing this treatment decision.

Conclusion: This is the first DA for patients with advanced metastatic breast cancer considering chemotherapy. A randomized trial is underway to evaluate its role in clinical decision-making.

Figure 1

Flowchart of different treatment pathways for patients considering first‐line chemotherapy for metastatic breast cancer.

Figure 2

Estimates of patient survival with and without chemotherapy treatment in metastatic breast cancer. This page was made optional, allowing patients to skip viewing the survival estimates if desired. ¹⁸ , ¹⁹ , ²⁰ , ²¹

Figure 3

Listing of the seven steps towards a treatment decision and introduction to the values clarification exercise.

Figure 4

‘Weigh scale’ values clarification exercise to quantify pros and cons of different treatment options. ¹⁷

Figure 5

Completed values clarification exercise by an example patient, ‘Susan’, who has completed the exercise with her own personal pros and cons of chemotherapy treatment.