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Randomized Trial of a Patient Decision Aid for Choice of Surgical Treatment for Breast Cancer

Institute for Clinical Evaluative Sciences, Toronto-Sunnybrook Regional Cancer Centre, Toronto, Departments of Health Administration

Carol A. Sawka, MD

Institute for Clinical Evaluative Sciences, Toronto-Sunnybrook Regional Cancer Centre, Toronto, Departments of Medicine

Elaine C. Thiel, RN, BScN

Institute for Clinical Evaluative Sciences, Toronto

Elaine H. Gort, MSc

Institute for Clinical Evaluative Sciences, Toronto

Annette M. O’Connor, RN, PhD

University of Toronto, Toronto; and University of Ottawa, Ottawa

A decision aid for the surgical treatment of early breast cancer was evaluated in a randomized controlled trial. The decision aid, a tape and workbook, includes explicit presentation of probabilities, photographs and graphics, and a values clarification exercise. Community surgeons were randomized to use the decision aid or a control pamphlet. Patients completed a questionnaire prior to using the decision aid, after reviewing it but prior to surgery, and 6 months after enrollment. There was no difference in anxiety, knowledge, or decisional regret across the 2 groups. There was a nonsignificant trend toward lower decisional conflict in the decision aid group. A subgroup of women who were initially leaning toward mastectomy or were unsure had lower decisional conflict. Although the decision aid had minimal impact on the main study outcomes, a subgroup may have benefited. Such subgroups should be identified, and appropriate decision support interventions should be developed and evaluated.

Key Words: decision aid • breast cancer surgery • randomized controlled trial

Medical Decision Making, Vol. 21, No. 1, 1-6 (2001)
DOI: 10.1177/0272989X0102100101


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