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 therapy.
"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," she said.
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 schedule.
Values Clarification
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 said.
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 cancer diagnosis.
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 regret.
