Development and Evaluation of Different Versions of the Decision Board for Early Breast Cancer

Abstract

Abstract : The main objective of this study is to further enhance information transfer between the doctor and the patient, giving women with early stage breast cancer an opportunity to more fully participate in treatment decision making. To accomplish this, the authors developed a decision aid, called the Decision Board (DB), for women regarding choices in breast cancer with respect to surgical treatment and adjuvant chemotherapy. The study compares three versions of the decision board (DB), all containing the same information but using different forms of media: (1) the standard DB, which is a foam core, poster-sized version with pull-out panels; (2) the computer DB, which uses a Windows-based program that resembles the standard DB and is available on a laptop computer; and (3) the paper DB, which is a small 8.5 x 11-inch paper version of the standard DB that also serves as the take-home brochure for the standard DB. The different versions of the DB were developed to improve the instrument's usefulness and to allow for information to be updated more readily. A total of 310 patients were accrued to the study and were randomly assigned to one of the three versions. The DB presents one of two treatment choices: (1) an adjuvant chemotherapy decision for women with stage I or II moderate risk breast cancer (no chemotherapy vs. CMF [Cyclophosphamide, Methotrexate, and Fluorouracil] vs. AC [Adriamycin and Cyclophosphamide] vs. ACT [Adriamycin, Cyclophosphamide, and Taxol]); and (2) a surgical decision (mastectomy vs. lumpectomy plus radiation). Preliminary analyses show that the three versions of the DB indicate similar levels of patient knowledge, decisional conflict, and satisfaction with decision making among the patients who used them. The three instruments also showed a similar level of usefulness to patients and physicians. The study supports the use of computer-based and paper-based versions of the DB in treatment decision-making.