Abstract
BackgroundThe purpose of this paper is to examine the acceptability, feasibility, reliability and validity of a new decision quality instrument that assesses the extent to which patients are informed and receive treatments that match their goals.MethodsCross-sectional mail survey of recent breast cancer survivors, providers and healthy controls and a retest survey of survivors. The decision quality instrument includes knowledge questions and a set of goals, and results in two scores: a breast cancer surgery knowledge score and a concordance score, which reflects the percentage of patients who received treatments that match their goals. Hypotheses related to acceptability, feasibility, discriminant validity, content validity, predictive validity and retest reliability of the survey instrument were examined.ResultsWe had responses from 440 eligible patients, 88 providers and 35 healthy controls. The decision quality instrument was feasible to implement in this study, with low missing data. The knowledge score had good retest reliability (intraclass correlation coefficient = 0.70) and discriminated between providers and patients (mean difference 35%, p < 0.001). The majority of providers felt that the knowledge items covered content that was essential for the decision. Five of the 6 treatment goals met targets for content validity. The five goals had moderate to strong retest reliability (0.64 to 0.87). The concordance score was 89%, indicating that a majority had treatments concordant with that predicted by their goals. Patients who had concordant treatment had similar levels of confidence and regret as those who did not.ConclusionsThe decision quality instrument met the criteria of feasibility, reliability, discriminant and content validity in this sample. Additional research to examine performance of the instrument in prospective studies and more diverse populations is needed.
Highlights
The purpose of this paper is to examine the acceptability, feasibility, reliability and validity of a new decision quality instrument that assesses the extent to which patients are informed and receive treatments that match their goals
The majority of patients diagnosed with early stage breast cancer are eligible to decide between having a mastectomy or lumpectomy with radiation, yet this decision can be very challenging
We examined performance of the Breast Cancer Surgery Decision Quality Instrument (BCS-DQI) along these criteria using three study samples: (1) breast cancer patients who had made a surgical treatment decision two or three years prior to the survey (2) breast cancer health care providers and (3) a group of healthy controls who had never had breast cancer
Summary
The purpose of this paper is to examine the acceptability, feasibility, reliability and validity of a new decision quality instrument that assesses the extent to which patients are informed and receive treatments that match their goals. Guidelines and consensus statements for breast cancer treatment emphasize the equivalence of mastectomy and breast conserving therapy for survival [1,2,3]. These options differ on other dimensions that. Rates of breast conserving surgery or rates of mastectomy have been proposed as quality measures for breast surgery; both of these measures have been found to be lacking [6,7] In this situation, where survival is equivalent, the “best” treatment is dependent upon how each individual patient weighs the other factors, including cosmetic results, likelihood of recurrence and concerns about radiation. A measure that reports on high or low utilization does not provide any evidence that the right procedure is being used on the right patient
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