Implementing Patient-Oriented Decision Support into Breast Cancer Care
Reporter: Abigail T. Berman, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: September 26, 2013
Presenting Author: Barbara L. Fowble, MD
Presenting Author Affiliation: University of California San Francisco, San Francisco, CA
If you or one of your family members has been diagnosed with breast cancer, you know how much information you can be given at the initial diagnosis—in fact, it can be an overwhelming amount of information. In particular, you are required to interact with a surgeon, and often a radiation oncologist, plastic surgeon, and a medical oncologist. As healthcare providers, we seek to simplify what you need to know, but also simultaneously provide you with ample information to participate in the decision-making process. One advancement in breast cancer care has been the implementation of multidisciplinary clinics, where patients are seen by healthcare teams surgery, radiation, and medical oncology all in one day. There are also patient advocates and navigators who help in the process. To date, there has been little literature on the topic of patient decision-making.
A study by Fowble and colleagues from the University of California San Francisco examined two areas of decision support: decision aids (DAs), which educate patients about treatment options and outcomes and communication aids (CAs), which help patients identify questions for their physicians and provide written summaries and audio-recordings of consultations. The study examined the effect of DAs and CAs, which were introduced in 2005, on communication and treatment decision-making in the authors’ breast cancer clinic. Counselors provided patients with written materials and videos from the Informed Medical Decisions Foundation. The counselors, who would then accompany the patients on their visits, assisted them in creating a list of questions for before their meeting with different physicians. After each office visit, they were given summaries and recordings of the visits. The authors used the O’Connor’s Decisional Conflict Scale (DCS) which measures patient uncertainty regarding the best course of action to assess how conflicted patients felt before and after the visit. They also administered Sepucha’s Decision Quality Instrument (DQI) that assesses whether patients were making an informed choice.
The authors found that DA increased patient knowledge by almost a factor of two and decreased patients’ decision conflict. They found that CA increased the number of patient questions and question self-efficacy. The satisfaction after administration of DAs and CAs was 8.9/10. Interestingly, in 2009-2010, 83% of patients were offered CAs but only 67% accepted the offer. Follow up survey of DAs and CAs found satisfaction 8.9/10. In 2009-2010, 83% of 1,355 new patients were offered CAs: 67% accepted the offer. After office visits, 83% reviewed their consultation summaries and 56% reviewed the audio-recordings.
As a patient, you should ask your hospital and doctors what resources are available in terms of decision aids (DAs) and communication aids (CAs). This study shows that they work to improve satisfaction with visits and also may give you a better understanding of treatment options.