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Multicenter Study
. 2024 Dec:213:115107.
doi: 10.1016/j.ejca.2024.115107. Epub 2024 Nov 2.

Shared decision-making supported by outcome information regarding surveillance after curative treatment for breast cancer: Results of the SHOUT-BC study

J W Ankersmid  1 , C H C Drossaert  2 , L J A Strobbe  3 , M Q N Hackert  4 , N Engels  5 , J C M Prick  6 , S Teerenstra  7 , Y E A van Riet  8 , R The  9 , C F van Uden-Kraan  4 , S Siesling  10 ; Santeon VBHC Breast Cancer Group
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Free article
Multicenter Study

Shared decision-making supported by outcome information regarding surveillance after curative treatment for breast cancer: Results of the SHOUT-BC study

J W Ankersmid et al. Eur J Cancer. 2024 Dec.
Free article

Abstract

Background: Integrating outcome information into the process of shared decision-making (SDM) about post-treatment surveillance can enhance its effectiveness. The Breast Cancer Surveillance Decision Aid (BCS-PtDA) integrates risk estimations of patients' risks for recurrences as well as outcome information on fear of cancer recurrence (FCR). The SHOUT-BC study aimed to evaluate the effectiveness of the implementation of the BCS-PtDA. Patients' satisfaction with the BCS-PtDA was also evaluated.

Methods: As described in a previously published protocol paper, the study employed a Prospective multiple interrupted time series (ITS) design in which the BCS-PtDA was implemented stepwise into the care pathways of eight Dutch hospitals.

Results: A total of 507 participants completed a questionnaire after their first surveillance consultation which usually takes place approximately one year after surgery. ITS analysis per hospital and subsequent meta-analysis over hospital effects indicated a significant increase in patient-reported SDM from pre- to post-implementation (overall estimated effect: 27.14, 95 % CI: 22.71 to 31.87, p < .0001). Moreover, post-implementation participants (n = 225) reported a more active role in decision-making, decreased decisional conflict, and increased knowledge on the aim and methods of surveillance. Furthermore, a decrease in FCR was seen post-implementation. The self-reported intensity of surveillance schedules decreased slightly and the BCS-PtDA received highly positive evaluations.

Discussion: The implementation of the BCS-PtDA, which integrates outcome information, led to increased patient-reported SDM and an improved quality of decision-making. The BCS-PtDA was evaluated highly positively by participants. Further research should address optimisation of the implementation.

Keywords: Breast cancer; Follow-up; Outcome information; Post-treatment surveillance; PtDA; Shared-decision making.

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Conflict of interest statement

Declaration of Competing Interest R. The is cofounder and CEO of ZorgKeuzeLab, which is the company that has helped to develop and implement the Breast Cancer Surveillance Decision Aid of which effects are examined in this study. The remaining authors declare that there are no conflict of interests.

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