SAN ANTONIO--A new decision aid, developed by a group of Canadian researchers,
uses an audiotape and a workbook to help women with early-stage breast
cancer decide between mas-tectomy and breast-conserving surgery with radiation
"Since the long-term survival of each option is equivalent, whether
a woman chooses one or the other is very much based on her personal preference,"
Carol A. Sawka, MD, of the Toronto-Sunnybrook Regional Cancer Center, said
at a poster session of the San Antonio Breast Cancer Symposium.
The researchers first developed a set of critical content items for
the information aid, and then consulted several focus groups for feedback
on the usefulness of the information.
"The women all wanted an information aid that would not replace
their time with the surgeon but, rather, augment it. They wanted something
they could use at home later and go over many times," Dr. Sawka said.
The investigators learned from the focus groups that an audiotape would
be helpful so that patients could hear a woman's voice, "a sympathetic
voice," Dr. Sawka emphasized. They then adapted the audiotape workbook
format developed by Annette O'Connor in Ottawa. "The tape runs 26
minutes, and women go through it with the workbook page by page,"
The program differs from a simple educational pamphlet because it provides
explicit probabilities about, for example, possible reactions to radiation
therapy, with pictures showing what these reactions look like. It covers
the differences in surgical approach, need for radiation treatment, short-
and long-term side effects of radiation, risks of recurrence, and follow-up
At the end of the program, the workbook takes the patient through a
values clarification exercise in which the woman considers the personal
importance to her of the possible risks and benefits for each treatment.
"It is basically a scale that allows women to weigh the pros and cons
of each approach, to help them understand where they fit," Dr. Sawka
Results of a pilot study of 18 women showed that, by and large, women
liked the program, found it very useful, and felt that it helped to clarify
information about treatment without raising extra questions. They also
said that the decision aid did not increase their anxiety about their breast
Based on the pilot study, the researchers have created a new version
of the decision aid and are now conducting a randomized trial of 200 women,
in which surgeons provide patients with either the audiotape/workbook or
a standard pamphlet that has the same information but without explicit
probabilities, photographs, or the values clarification exercise. Outcomes
will be comprehension, decisional conflict, anxiety, and post- decisional