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; N S Russell; B Winkens; J M Immink; P G Westhoff; M C Stenfert Kroese; M R Stam; N Bijker; C M J van Gestel; T van der Weijden; L J Boersma

doi:10.1016/j.tipsro.2021.08.002

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

Tech Innov Patient Support Radiat Oncol. 2021 Aug 29:20:1-9. doi: 10.1016/j.tipsro.2021.08.002. eCollection 2021 Dec.

Authors

D B Raphael^{1

2

3}, N S Russell³, B Winkens⁴, J M Immink^{5

6}, P G Westhoff⁷, M C Stenfert Kroese⁸, M R Stam⁹, N Bijker¹⁰, C M J van Gestel¹¹, T van der Weijden², L J Boersma¹

Affiliations

¹ Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands.
² Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
³ Department of Radiotherapy, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
⁴ Department of Methodology and Statistics, CAPHRI Care and Public Health Research Institute,Maastricht University, Maastricht, the Netherlands.
⁵ Department of Radiation Oncology, Reinier de Graaf Hospital, Delft, the Netherlands.
⁶ Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands.
⁷ Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands.
⁸ Radiotherapy Group, Deventer, the Netherlands.
⁹ Radiotherapy Group, Arnhem, the Netherlands.
¹⁰ Department of Radiation Oncology, Amsterdam University Medical Centers, the Netherlands.
¹¹ Zuidwest Radiotherapeutisch Instituut (ZRTI), the Netherlands.

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.