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. 2021 Aug 29:20:1-9.
doi: 10.1016/j.tipsro.2021.08.002. eCollection 2021 Dec.

A patient decision aid for breast cancer patients deciding on their radiation treatment, no change in decisional conflict but better informed choices

D B Raphael  1   2   3 , N S Russell  3 , B Winkens  4 , J M Immink  5   6 , P G Westhoff  7 , M C Stenfert Kroese  8 , M R Stam  9 , N Bijker  10 , C M J van Gestel  11 , T van der Weijden  2 , L J Boersma  1
Affiliations

A patient decision aid for breast cancer patients deciding on their radiation treatment, no change in decisional conflict but better informed choices

D B Raphael et al. Tech Innov Patient Support Radiat Oncol. .

Abstract

Background and purpose: In selected breast cancer patients, radiation treatment (RT) lowers the recurrence risk, with minor or no improvement of survival. In these patients, the choice to undergo RT is considered a preference-sensitive decision. To facilitate shared decision-making (SDM) for this choice, a patient decision aid was made. We aimed to evaluate the effect of the PtDA on decisional conflict.

Material and methods: We performed a multi-center pre- and post-intervention study (BRASA-trial). The first 214 patients made a choice without support of the PtDA; the subsequent 189 patients received a link to the PtDA. The primary endpoint was decisional conflict; secondary endpoints were perceived SDM and knowledge on treatment options. Patients filled out questionnaires immediately after, and three months after their decision. Data were analyzed with multi-level regression analysis.

Results: After correcting for the difference in age and educational level, the mean (±SD) decisional conflict for the intervention group (27.3 ± 11.4) was similar to the control group (26.8 ± 11.4; difference = 0.86, 95 %CI 1.67,3.36) three months after their decision. This also applied to perceived SDM. Patients exposed to the PtDA pursued additional treatment less often (45% vs 56%, odds ratio 0.59, 95 %CI 0.37,0.95) and scored significantly higher on the knowledge test (7.4 ± 2.5 vs 6.1 ± 2.7, corrected difference = 1.0, 95 %CI 0.50,1.49). There was no significant increase in consultation time.

Conclusions: Handing out the PtDA was not associated with improved scores in decisional conflict or perceived SDM, but it was associated with a choice for less additional treatment and better knowledge about the treatment options.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flow diagram with an overview of included patients per arm.
See this image and copyright information in PMC

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