Helping women with breast cancer choose between surgical treatment options
Semistructured interviews with a purposive sample of women in intervention arms, surgeons, and various stakeholders to learn about aid implementation. RESULTS: 1. Study 1. From 39 interviews, we made the following changes: (1) added a glossary, (2) added 2 questions and an open text question in the...
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| Format: | eBook |
| Language: | English |
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Washington (DC)
Patient-Centered Outcomes Research Institute (PCORI)
2021, 2021
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| Series: | Final research report
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | Semistructured interviews with a purposive sample of women in intervention arms, surgeons, and various stakeholders to learn about aid implementation. RESULTS: 1. Study 1. From 39 interviews, we made the following changes: (1) added a glossary, (2) added 2 questions and an open text question in the concordance subscale, (3) reworded the treatment intention question, and (4) revised the knowledge instructions.2. Study 2. Sixteen surgeons saw 571/622 consented patients (51 became ineligible after baseline). The average patient age was 59 years, 67.1% were of higher SES, and 44.8% had inadequate health literacy. Compared with patients receiving usual care (n = 257), participants in the Picture Option Grid arm (n = 248) had higher knowledge (0.27; 95% CI, 0.01-0.53), higher decision process (1.18; 95% CI, 0.23-2.13), lower decision regret (−22.32; 95% CI, −44.65 to −0.528), and more observed (24.71; 95% CI, 5.93-43.49) and patient-reported (0.17; 95% CI, 0.03-0.31) shared decision-making (SDM). Compared with patients receiving usual care, participants in the Option Grid arm (n = 66) had higher decision process (0.82; 95% CI, 0.01-1.62), better care coordination (0.65; 95% CI, 0.03-1.27), and more observed SDM (28.9; 95% CI, 8.0-49.9). Subgroup analyses suggested that, compared with usual care, the Picture Option Grid had more impact among women of lower SES and lower health literacy. There were no differences between the 2 aids. There was high between-surgeon variation across outcomes.3. Study 3. All 73 interviewees agreed that the aids should be used routinely. The interviews on conversation aid implementation were not conducted in the context of an implementation study Patients believed the aids were a part of usual care and were interested in receiving the aids electronically before their consultation. Surgeons indicated they would choose which aid to use depending on patient literacy. CONCLUSIONS: Paper-based conversation aids improved knowledge, decision process, observed and patient-reported SDM, and coordination of care. Compared with usual care, the Picture Option Grid had a larger impact among patients of lower SES and health literacy than did the Option Grid. Between-surgeon variation suggests the need for standardized physician-level training with the conversation aids in future implementation studies. LIMITATIONS: 1. Study 1. Some participants reported attributes of higher SES.2. Study 2. Surgeon-level randomization led to arm imbalance. Recruitment was 50% lower than planned and disproportionately low for women of low SES. Loss to follow-up was higher than expected.3. Study 3. BACKGROUND: Women of lower socioeconomic status (SES) with early-stage breast cancer are more likely to report lower doctor-patient communication, lower involvement in decision-making, and higher decision regret than are women of higher SES. OBJECTIVE: To compare patient-reported outcomes for 2 paper-based conversation aids among women with early-stage breast cancer, particularly those of lower SES. METHODS: 1. Study 1. Semistructured interviews with early-stage breast cancer patients of lower SES to ensure the acceptability of the Decision Quality Instrument (DQI), our primary outcome measure.2. Study 2. Three-arm cluster-randomized controlled superiority trial of 2 conversation aids (Picture Option Grid and Option Grid) vs usual care among women with early-stage breast cancer with clinician-level randomization. Decision quality (primary outcome) was measured as 3 subscales: breast cancer knowledge, decision process, and treatment concordance.3. Study 3. |
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| Physical Description: | 1 PDF file (164 pages) illustrations |