Treatment-related Knowledge Research Articles

Impact of the Use of Street Play Mode of Education on the Self-care Capacity of Village Women for Lifestyle Modification for Prevention of Hypertension

Objectives: The objectives of this study were as follows: (1) To ascertain the prevalence of hypertension (HTN) among village women. (2) To determine the impact of an intervention strategy of Behavior Change Communication utilizing a camp approach supplemented with nukkad natak on the self-care capacity of village women for lifestyle modification for prevention of HTN. Materials and Methods: The study was conducted during June–July 2023 in the field practice area of Community Medicine of a medical college. Sample size was arbitrary (n = 200) out of all willing women attending outpatient departments during the study period. First, a baseline assessment of the study population was done. Street plays were held for the study population on HTN-related healthy lifestyle. Changes in their knowledge were documented. Appropriate statistical analysis was done using Excel sheets. Results: Most (79%) of the women in the village had normal blood pressure, with 19% of them having mild and 2% had moderate HTN. Most hypertensive women (72%) were not taking medications. Out of 12 hypertensive women who were taking antihypertensive medications, half of them were regular. There was a significant improvement in the score of self-care capacity, treatment HTN diet-related knowledge of the women after the intervention. Respondents liked the idea of organizing drama to propagate health-related messages. Conclusion: One in every five persons in the study population of rural health training centre (RHTC) had HTN. Most hypertensive women (72%) were not taking medications. Those who were taking antihypertensive medications, only half were regular in it. After Nukkad Natak based intervention, there was a significant improvement in the scores of HTN diet and treatment-related knowledge and self-care capacity of the respondents for prevention of HTN. Our respondents liked the idea of organizing drama to propagate health-related messages.

Experiences and perspectives related to shared decision-making among outpatients with degenerative joint disease in Taiwan: a qualitative study

ObjectivesVarious treatment options are available for degenerative joint disease (DJD). During clinical visits, patients and clinicians collaboratively make decisions regarding the optimal treatment for DJD; this is the essence of...

Symptoms and Treatment-Related Knowledge of Cancer Patients Receiving Chemotherapy)

This study aims to investigate the existing level of knowledge regarding the symptoms, side effects, and treatment plans of cancer patients undergoing chemotherapy. Addressing gaps in literature and enhancing patient education can significantly improve outcomes and reduce cancer-related mortality and morbidity worldwide. Several search engines, including PubMed, CINHAAL, Science Direct, Research Gate, and Google Scholar, were used to conduct a comprehensive and broad literature evaluation. Each database was searched using keywords for "Knowledge OR Health Literacy OR Health Education OR Patient Knowledge AND Chemotherapy OR Symptoms OR Treatment Plan", resulting in the inclusion of 20 relevant articles for the study. The results highlighted the major challenges faced by patients undergoing chemotherapy and the severity of their symptoms, emphasizing the need for improved management strategies. Moreover, there are notable gaps in patient knowledge about chemotherapy and its side effects, underscoring the importance of targeted education programs and strengthened communication between healthcare providers and patients for better outcomes. Knowledge about the symptoms and treatment of cancer patients undergoing chemotherapy is an essential component for better survival and for reducing suffering. It is important to identify patients' knowledge about chemotherapy so that they can receive health education tailored to the needs, capabilities, and preferences of each individual patient.

Assessment of Knowledge Regarding Risks and Benefits of the Use of Non-Vitamin K Antagonist Oral Anticoagulants.

Background:Non-vitamin K antagonist oral anticoagulants (NOAC) have replaced vitamin K antagonist (VKA) oral anticoagulants as the first-line treatment option for stroke prevention in high-risk patients with atrial fibrillation. With VKA therapy, disease and treatment-related knowledge is associated with improved adherence and outcomes. There is concern that due to the lack of need for ongoing visits for laboratory monitoring in patients on NOACs, there is less opportunity for education, leading to poor disease- and treatment-related knowledge in this patient group.Methods:One hundred ninety-nine (199) patients presenting to 2 primary care clinics on NOAC therapy were surveyed regarding atrial fibrillation and their knowledge regarding NOACs. Chart review was completed to determine patient characteristics and data obtained was compared with survey results to determine the accuracy of the survey responses.Results:Patients with a lower degree of NOAC knowledge tended to be older (P < .001), have higher Charlson Comorbidity Index scores (P = .001), use apixaban more often (P = .008), and have been on NOACs for a shorter time period (P = .007).Conclusions:There is an opportunity to improve NOAC-related knowledge in patients with atrial fibrillation. When developing educational interventions, patient characteristics associated with poor knowledge should be considered. Based on our results, these are patients who are older, more medically complex, are on apixaban, and have been on NOAC therapy for a shorter duration.

An equivalence analysis of provider education in youth mental health care.

To test for equivalence between providers with and without advanced degrees in multiple domains related to delivery of evidence-based treatment. Provider and client data from an effectiveness trial of Alternatives for Families: A Cognitive Behavioral Therapy (AF-CBT) in a major metropolitan area in the United States. We tested for equivalence between providers (N=182) with and without advanced degrees in treatment-related knowledge, practices, and attitudes; job demands and stress; and training engagement and trainer-rated competence in AF-CBT. We also conducted exploratory analyses to test for equivalence in family clinical outcomes. Providers completed measures prior to randomization and at 6-month follow-up, after completion of training and consultation in AF-CBT. Children and caregivers completed assessments at 0, 6, 12, and 18months. Providers without advanced degrees were largely non-inferior to those with advanced degrees in treatment-related knowledge, practices, and attitudes, while findings for job demands and stress were mixed. Providers without advanced degrees were non-inferior to providers with advanced degrees in consultation attendance (B=-1.42; confidence interval (CI)=-3.01-0.16; margin of equivalence (Δ)=2), number of case presentations (B=0.64; CI=-0.49-1.76; Δ=2), total training hours (B=-4.57; CI=-10.52-1.37; Δ=3), and trainer-rated competence in AF-CBT (B=-0.04; CI=-3.04-2.96; Δ=4), and they were significantly more likely to complete training (odds ratio=0.66; CI=0.10-0.96; Δ=30%). Results for clinical outcomes were largely inconclusive. Provider-level outcomes for those with and without advanced degrees were generally comparable. Additional research is needed to examine equivalence in clinical outcomes. Expanding evidence-based treatment training to individuals without advanced degrees may help to reduce workforce shortages and improve reach of evidence-based treatments.

Two parallel short forms to measure disease- and treatment-associated knowledge in rheumatoid arthritis: application of item response theory.

ObjectiveThe aim was to develop two disease- and treatment-related knowledge about RA (DataK-RA) short forms using item response theory-based linear optimal test design.MethodsWe used the open source Excel add-in solver to program a linear optimization algorithm to develop two short forms from the DataK-RA item bank. The algorithm was instructed to optimize precision (i.e. reliability) of the scores for both short forms, subject to a number of constraints that served to ensure that each short form would include unique items and that the short forms would have similar psychometric properties. Agreement among item response theory scores obtained from the different short forms was assessed using the Bland–Altman method and Student’s paired t-test. Construct validity and relative efficiency of the short forms was evaluated by relating the score to age, sex and educational attainment.ResultsTwo short forms were derived from the DataK-RA item bank that satisfied all content constraints. Both short forms included 15 unique items and yielded reliable scores (r > 0.70), with low ceiling and floor effects. The short forms yielded statistically indistinguishable mean scores according to Student’s paired t-test and Bland–Altman analysis. Scores on short forms 1 and 2 were associated with age, sex and educational attainment to a similar extent.ConclusionIn this study, we developed two DataK-RA short forms with unique items, yet similar psychometric properties, that can be used to assess patients pre‐ and post‐test interventions aimed at improving disease-related knowledge in RA patients.

Evaluation of a basic educational program for patients with rheumatoid arthritis

HintergrundEin neues Rahmenkonzept hat die flexible Ableitung und Nutzung von rheumatologischen Schulungsprogrammen für unterschiedliche Versorgungsbereiche ermöglicht. Auf dieser Grundlage wurde eine 5‑stündige Basisschulung für Patienten mit rheumatoider Arthritis (RA) entwickelt, es wurden rheumatologische Fachärzte und Psychologen trainiert, und dann wurde die Wirksamkeit nach dem Wirkmodell der Patientenschulung evaluiert.MethodenMit dem Studiendesign einer extern randomisierten Wartekontrollgruppenstudie mit 3 Messzeitpunkten wurde geprüft, wie sich die 5‑stündige Basisschulung auf das Erkrankungs- und Behandlungswissen sowie auf die Gesundheitskompetenz von RA-Patienten (n = 249) auswirkt. Weitere Fragen betrafen Einstellungsparameter, Kommunikationskompetenz, Erkrankungsauswirkungen und die Zufriedenheit mit der Schulung. Die Auswertungen erfolgten auf Intention-to-treat-Basis mit Kovarianzanalysen für die Hauptzielgrößen unter Berücksichtigung des Ausgangswertes.ErgebnisseDie Analysen zeigen, dass die Basisschulung RA wirksam ist. Noch 3 Monate nach der Schulung verfügten die Schulungsteilnehmer über mehr Wissen und Gesundheitskompetenz als die Wartekontrollgruppe mit kleinem bis mittelgroßem Effekt (d = 0,37 bzw. 0,38). In den Nebenzielgrößen zeigten sich mit Ausnahme der Krankheitskommunikation keine weiteren Schulungseffekte.DiskussionDie Basisschulung bietet eine gute Grundlage, auf der weitere Interventionen zur Verbesserung von Einstellungs- und Erkrankungsparametern aufbauen können. Sie eignet sich damit als zentraler Baustein für die rheumatologische Versorgung auf verschiedenen Ebenen.Zusatzmaterial onlineDie Online-Version dieses Beitrags (10.1007/s00393-020-00769-4) enthält weitere Tabellen. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“.

Reducing complexity: explaining inborn errors of metabolism and their treatment to children and adolescents

BackgroundInborn errors of metabolism (IEM) are a group of rare, heterogeneous and complex genetic conditions. Clinically, IEM often affect the central nervous system and other organs. Some carry the risk of progression and / or potentially life-threatening crises. Many patients have to adhere to lifelong dietary or drug treatment.The complexity of IEM makes it difficult for patients and caregivers to understand their pathophysiology, inheritance and therapy rationale. Especially patients reaching adolescence may have only limited knowledge of their condition since medical care has often entirely been handled by their parents. Knowledge about disease and treatment, however, constitute pillars of self-responsible disease management. Not many standardized patient education materials on IEM are available and their comprehensibility has not been systematically investigated.MethodsWe developed and tested patient education materials for school-aged children and adolescents with IEM. Informative texts and illustrations in paper form and as videos were developed by an international network of metabolic care professionals together with a graphic artist and experts for easy-to-read language. The materials were presented in standardized single or group training sessions to 111 individuals; first, to 74 healthy children and adolescents (recruited via public schools) and consecutively to 37 paediatric patients with IEM (phenylketonuria, galactosemia, urea cycle defects, lysosomal storage disorders) from six metabolic centres. Knowledge-gain was assessed by pre- and post-testing.ResultsKnowledge-gain was significant in healthy children and adolescents as well as in patients (p < .001, r =. -77 /. -70). Effect sizes were large in both groups (r = -.77 / -.70). This result was independent from family language and teacher-rated concentration or cognitive capacity in healthy children.ConclusionThe newly developed patient education materials are a powerful tool to improve disease- and treatment-related knowledge. They facilitate communication between the medical team and children and adolescents with IEM and their caregivers.

Response pattern analysis of IBD-KID: A knowledge assessment tool for children with inflammatory bowel disease.

Paediatric inflammatory bowel disease (IBD) is a chronic relapsing condition requiring adherence to complex treatment regimens to achieve best outcomes. Adherence is frequently low in this population but can be improved by increasing disease- and treatment-related knowledge. The IBD-knowledge inventory device (IBD-KID) is a knowledge assessment tool specifically developed and validated for children with IBD. To analyse IBD-KID participant response patterns in order to review the strength of the tool. A cohort of children with IBD completed IBD-KID, and their responses were used to assess the tool's validity and feasibility. Item response analysis assessed the item difficulty and the ability of items to discriminate between high/low scorers. The analysis considered item structure, readability and the effectiveness of multiple choice items. A total of 105 completed IBD-KID assessments showed that 12 items (52%) had an acceptable difficulty level, and 17 (74%) were effective at discriminating between high/low scorers. Nine (61%) had good readability, but comprehension levels ranged from 5 to 18 years. Seven (30%) had elevated 'don't know' responses, highlighting the need for content and construction review. Of the 10 multiple choice items, 9 were complex and not functioning efficiently. Internal consistency was acceptable but could be improved by removing two items. The response analysis metrics were reviewed by an expert panel and provided a framework for IBD-KID improvements with the aim of increasing discrimination and reducing difficulty without adversely affecting reliability. The proposed revisions will address components that may have caused children to answer incorrectly due to confusion rather than lack of knowledge.

Exploring the Relationship Between Patient Activation, Treatment Satisfaction, and Decisional Conflict in Patients Approaching End-Stage Renal Disease.

Patients approaching end-stage renal disease (ESRD) experience a high level of decisional conflict because they are often not provided with sufficient support and information regarding different treatment options prior to renal failure. Decisional conflict is an important correlate of treatment satisfaction, as it is associated with disease- and treatment-related knowledge that can inform decision-making. Patient activation, the willingness and ability to independently manage one's own health and healthcare, is an individual difference factor that may have important mitigating effects on decisional conflict. To identify modifiable factors that may enhance the decision-making process in patients approaching ESRD by exploring potential mediational effects between decisional conflict, treatment satisfaction, and patient activation. Sixty-four patients approaching ESRD completed self-report measures (32% response rate). Measures included the Decisional Conflict Scale, the Kidney Disease Treatment Questionnaire, and the Patient Activation Measure Short Form. There was a high level of self-reported decisional conflict in this sample. Linear regressions revealed main effects among treatment satisfaction, patient activation, and decisional conflict. These variables were entered into PROCESS to assess a mediational pattern. Results showed that higher chronic kidney disease-related treatment satisfaction predicted lower decisional conflict through higher patient activation in a statistical mediational relationship. While the link between treatment satisfaction and decision-making is well established, these results suggest this relationship might be partially explained by patient activation, a potentially modifiable process in patients approaching ESRD. Therefore, interventions that encourage patients to become actively involved in their care could also reduce decisional conflict among patients approaching ESRD.

Application effect of Internet+ service platform for reproductive health and infertility patients

Objective To explore the effects of Internet plus patients with infertility and reproductive health service platform. Methods A total of 240 cases of the in vitro fertilization and embryo transfer (IVF-ET) technology assisted pregnancy were selected by convenience sampling method. The patients from July to October 2017 were assigned into control group (n=117) , and patients from November 2017 to January 2018 were assigned into observation group (n=123) in the reproductive center of the Second Hospital of Jilin University and completed the first test tube baby (IVF-ET) . The control group was treated with conventional education service mode. While based on the conventional education services, the education service in the observation group was carried out under the establishment of Internet plus reproductive health and infertility patients. Patient knowledge about infertility treatment, the occurrence of patients' non-compliance, the allowance of follow-up visits and pregnancy outcome were compared between the two groups. Results The score of related knowledge of infertility treatment of the observation group was (72.67±3.41) , and that of the control group was (64.72±4.38) . The difference in knowledge was statistically significant (t=15.640, P<0.01) . The incidence of non-compliance of the observation group was 15.45%, which was lower than that of the control group (51.28%) with statistical difference (χ2=34.87, P<0.01) . The active follow-up rate of the observation group (71.54%) was higher than that of the control group (57.26%) , and the difference was statistically significant (χ2=5.340, P<0.05) . The pregnancy rate of the observation group (53.65%) was higher than that of the control group (40.17%) , and the difference was statistically significant (χ2=4.370, P<0.05) . Conclusions Internet plus infertility services platform can improve the infertility patients' mastery of treatment-related knowledge, reduce the frequency of occurrence of non-compliance during the treatment, improve the compliance of doctors and treatment and improve the rate of active follow-up of patients, so as to improve the pregnancy outcome. Key words: Reproductive techniques, assisted; Internet +; Infertility; Service platform

Effectiveness of an interventional package on treatment related knowledge and practices among cervical cancer patients

Effectiveness of an interventional package on treatment related knowledge and practices among cervical cancer patients

Patient knowledge and pulmonary medication adherence in adult patients with cystic fibrosis.

Background and objectivesPatient knowledge of lung function (ie, forced expiratory volume in 1 s [FEV1]% predicted) and the intended benefits of their prescribed pulmonary medications might play an important role in medication adherence, but this relationship has not been examined previously in patients with cystic fibrosis (CF).MethodsAll patients diagnosed with CF and without prior lung transplantation were invited to complete knowledge and self-reported medication adherence questionnaires during routine outpatient visits to the Adult CF Clinic, St Paul’s Hospital, Vancouver, Canada from June 2013 to August 2014.ResultsA total of 142 out of 167 (85%) consecutive adults attending CF clinic completed patient knowledge and medication adherence survey questionnaires. Sixty-four percent of the patients recalled their last FEV1% predicted value within 5%, and 70% knew the intended benefits of all their prescribed medications. Self-reported adherence rates were highest for inhaled antibiotics (81%), azithromycin (87%), and dornase alpha (76%) and lowest for hypertonic saline (47%). Individuals who knew their FEV1% predicted value within 5% were more likely to self-report adherence to dornase alpha (84% vs 62%, P=0.06) and inhaled antibiotics (88% vs 64%, P=0.06) compared to those who did not, but these associations were not statistically significant. There were no significant associations observed between patient knowledge of intended medication benefits and self-reported medication adherence.ConclusionContrary to our hypothesis, disease- and treatment-related knowledge was not associated with self-reported medication adherence. This suggests other barriers to medication adherence should be targeted in future studies aiming to improve medication adherence in adults with CF.

First contact: the intersection of demographics, knowledge, and appraisal of treatment at the initial infertility visit

To determine the impact of the initial infertility visit on treatment-related knowledge, patient anxiety, and appraisals of treatment. Prospective survey. Academic medical center. Two hundred thirty-four English-speaking women aged 18-50years attending their first infertility visit. Participants completed a survey assessing health literacy, knowledge, anxiety, and appraisals of the treatment process before and after their infertility visit. Knowledge of infertility and treatment and anxiety and appraisal scores. Most participants were white and earned >$100,000/year and had at least a college education. Baseline knowledge of reproductive anatomy, assisted reproductive technology (ART), and fertility factors was modest but improved after the initial visit. Factors associated with higher knowledge included higher education and income, white or Asian ethnicity, and English as a primary language. Patient appraisals of treatment represented by the positive (Challenge) and negative (Threat and Loss) subscale scores on the Appraisal of Life Events (ALE) scale changed over time Negative appraisals of treatment and anxiety scores decreased and positive appraisals of treatment increased after the initial visit. Lower knowledge was associated with higher positive appraisal scores; lower health literacy was associated with higher anxiety and appraisal scores (positive and negative) after the visit. Black women had higher Challenge scores compared with white and Asian women. Hispanic women had higher anxiety scores than non-Hispanic women. Infertility patients have modest baseline knowledge of fertility and infertility treatment. The initial infertility visit can improve this knowledge and decrease both negative appraisals of treatment and anxiety levels. Differences in knowledge and appraisal were seen across ethnic groups and other demographic variables. Physicians should individualize patient counseling to improve patients' knowledge and provide realistic treatment expectations while also reducing patient anxiety.

Prospective Evaluation of Patient Satisfaction Following the Use of Education Materials for Cervical Cancer Brachytherapy

There is growing emphasis on incorporating patient education tools in oncology. Preparatory patient education results in greater treatment-related knowledge and less emotional stress at the completion of cancer treatment, possibly as it relates to the development of effective patient coping mechanisms. To improve patient quality of life and promote understanding of intracavitary and interstitial gynecologic brachytherapy, we developed and investigated the role of an illustrated, educational flipbook as a part of the standard consent process. We also assessed the utility of take-home patient education materials on patient satisfaction. Female patients greater than 18 years old, with a diagnosis of cervical cancer undergoing definitive chemoradiation were prospectively randomized to undergo informed consent without (Arm A) or with (Arm B) supplemental education materials. These materials consisted of a descriptive, take-home illustrated flipbook outlining the brachytherapy rationale, workflow process, applicators, and perioperative care. Patients in both arms were given a 12 question, 5-point Likert scale-based survey adapted from a previously validated version to measure patient satisfaction with cancer treatment information. A second survey was given to Arm B patients to assess the educational impact of the take-home materials. The mean score from the patient satisfaction surveys were compared between treatment groups using a two-sample t-test. From October 2012 to January 2013, 14 patients were randomized equally between 2 treatment arms. The mean age was 51 years (range 26-75). Twelve patients completed all 14 patient satisfaction survey questions. Using 5-point Likert items the highest possible total score was 60. The mean total patient satisfaction scores ± standard deviations in Arm A and Arm B were 53.4 ± 6.4 and 58.3 ± 1.6, respectively (P = 0.12). As the study progressed, the mean total scores in Arm A increased. Overall, patients were satisfied with their ability to make informed decisions regarding their cancer treatment. Analysis of satisfaction subscales showed Arm B patients were more satisfied with educational resources, and the opportunity to ask questions about managing side effects. Patients in both groups were least satisfied with information regarding interactions between prescribed cancer treatment and alternative treatments that patients may pursue independently. Arm B patients responded positively to all metrics of adequacy of the take-home educational materials. Brachytherapy educational take-home materials improve patient satisfaction with information regarding gynecologic brachytherapy. The use of the materials also establishes a rubric which facilitates the informed consent process to ensure adequate cancer treatment information is provided.

Impact of a novel decision counseling program on treatment knowledge, decisional conflict, and choice in men with early-stage, low-risk prostate cancer.

9 Background: Active surveillance (AS - serial follow-up PSA, exam, and biopsy) is an option for men with early stage, low risk prostate cancer (LRPca). While data show comparable survival for AS vs active treatment (AT - surgery or radiation), currently most men with LRPca undergo AT. A pilot Decision Counseling Program (DCP) to assist men in making an informed, shared LRPca treatment decision was implemented. Methods: Men with LRPca seen at the Jefferson Genitourinary Multidisciplinary Cancer Center (JGUMDCC) were consented. A nurse educator (NE) reviewed risks/benefits of AS and AT; had the participant identify factors influencing treatment decision making and specify decision factor weights; entered data into an online DCP; and generated a report of participant treatment preference and decision factors. The report was used by the participant and clinicians in shared treatment decision making. A follow-up survey was administered 30 days after the visit, with treatment status assessed. Change in treatment-related knowledge and decisional conflict were measured using baseline and 30-day survey data. Results: Baseline decision counseling preference of 16 participants: 4 - AS, 8 equal for AS and AT, 4 - AT. At 30 days, 12 participants initiated AS, 4 chose AT; participant mean treatment knowledge scores (8-point scale) increased (+1.13 points); decisional conflict subscale scores (strongly disagree = 1, strongly agree = 5) decreased (uncertain: -1.15, uninformed: -1.36, unclear: -1.12; and unsupported: -1.15). Conclusions: Decision counseling and shared decision making helped participants become better informed about treatment choices and reduced uncertainty in treatment decision making. The combined intervention resulted in most participants choosing AS. Ongoing study recruitment, data collection, and analyses are planned.

Development of Patients’ Decision Aid for Older Women With Stage I Breast Cancer Considering Radiotherapy After Lumpectomy

To develop a patient decision aid (PtDA) for older women with Stage I, pathologically node negative, estrogen receptor-positive progesterone receptor-positive breast cancer who are considering adjuvant radiotherapy after lumpectomy and to examine its impact on patients' decision making. A PtDA was developed and evaluated in three steps according to the Ottawa Decision Support Framework: (1) needs assessment (n = 16); (2) Pilot I to examine PtDA acceptability (n = 12); and (3) Pilot II, a pretest posttest (n = 38) with older women with estrogen receptor-positive progesterone receptor-positive breast cancer after lumpectomy who were receiving adjuvant radiation therapy. Measures included patients' satisfaction with the PtDA, self-reported decisional conflict, level of distress, treatment-related knowledge, and choice predisposition. The PtDA is a booklet that details each adjuvant treatment option's benefits, risks, and side effects tailored to the patient's clinical profile; includes a values clarification exercise; and includes steps to guide patients towards their decision. On the basis of qualitative comments and satisfaction ratings, all women thought that the PtDA was helpful and informative. In comparison with their baseline scores, patients had a statistically significant (p < 0.05) reduction in decisional conflict (adjusted mean difference [AMD], -7.18; 95% confidence interval [CI], -13.50 to 12.59); increased clarity of the benefits and risks (AMD, -10.86; CI, -20.33 to 21.49); and improved general treatment knowledge (AMD, 8.99; CI, 2.88-10.28) after using the PtDA. General trends were also reported in the patients' choice predisposition scores that suggested potential differences in treatment decision after PtDA use. This study provides evidence that this PtDA may be a helpful educational tool for this group of women. The quality of care for older breast cancer patients may be enhanced by the use of a tailored PtDA to help patients be better informed about their treatment options.

P5-15-03: Development of a Patient Decision Aid for Women 70 Years and Older with Stage I, Hormonally Sensitive, Breast Cancer Considering Adjuvant Treatment Post-Lumpectomy.

Abstract Background: Decision Aids (DA) are developed with the intent to support people in making specific and deliberate choices by improving information transfer about different outcomes. Previous research has shown that DAs can increase patient knowledge regarding treatment options, reduce decisional conflict, and increase patient satisfaction with the decision-making process. However, no DAs have been developed to help older breast cancer patients decide whether or not to undergo adjuvant RT. We developed and tested a DA for older women with stage I,ER/PR positive breast cancer considering adjuvant treatment post-lumpectomy and we examined its impact on treatment decision-making process. Methods and Materials: A DA was developed and evaluated in three steps following the Ottawa Decision Aid Framework: 1) Needs assessment (N=16); 2) Pilot I, to examine the DA's acceptability (N=12); and 3) Pilot II, a pre-test post-test (N=38) with older women with ER/PR responsive breast cancer post-lumpectomy who were receiving adjuvant RT. Measures included questionnaires to assess patient's satisfaction with the DA, patients’ self-reported decisional conflict (DC), level of distress, treatment-related knowledge, and choice predisposition Results: The DA is a booklet that details each adjuvant treatment option's benefits, risks and side-effects tailored to their clinical profile; includes a value clarification exercise; and steps to guide them towards their own treatment decision. All women felt the DA was helpful and informative. Compared with baseline scores, patients had a statistically significant (p &amp;lt; .05) reduction in DC (adjusted mean difference [AMD], −7.18; 95% confidence interval [CI], −13.50 to 12.59); increased clarity of the treatment benefits and risks (AMD, −10.86, CI, −20.33 to 21.49; and improved general treatment knowledge (AMD, 8.99, CI, 2.88 to 10.28) after using the DA. General trends were also reported in patient's choice predisposition scores suggesting potential differences in treatment decision after DA use. Discussion: This study provides evidence that this DA may be a helpful educational tool for this group of women. The quality of care for older breast cancer patients may be enhanced by using a tailored DA to help the patient be informed of their treatment options and to prepare for decision-making. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-15-03.

62 Breast cancer patients' treatment related knowledge after clinical pathway in the field of empowerment

62 Breast cancer patients' treatment related knowledge after clinical pathway in the field of empowerment

Safer sexual behaviours after 1 year of antiretroviral treatment in KwaZulu-Natal, South Africa: a prospective cohort study

As antiretroviral treatment (ART) becomes more widely available in low and middle income countries, the relationship between treatment and sexual risk behaviour in these countries has also become more important. This is a prospective study of all treatment-na?ve patients (n = 735) recruited from all three public hospitals in Uthukela health district in KwaZulu-Natal and followed up at 6 and 12 months of being on ART. No evidence of increased risky sexual behaviours over time was found, from before commencing on ART, to 6 and 12 months on ART. Specifically, a significant reduction in risk taking was reported regarding sex without a condom in the past 3 months (P = 0.001) and unprotected sex with HIV-negative or unknown HIV status persons (P = 0.003). The number of sexual partners did, however, not significantly reduce over time. Some socio-demographic factors were associated with unprotected sex (being a man: odds ratio 1.7 (1.1-2.7), lower education: 0.4 (0.2-0.8)), one health factor (higher CD4 cell counts: 2.6 (1.1-6.1)) and social-behavioural factors (higher stigma: 1.2 (1.1-1.3), alcohol use at last sex: 6.9 (1.8-26.1)) and lower ART adherence: 0.5 (0.2-0.08)), while HIV knowledge (ART optimism, duration since known HIV-positive, HIV disease and treatment related knowledge), HIV symptoms and depression were not associated with unprotected sex. This prospective study with a large sample of persons on ART showed evidence of inhibition of risky sexual behaviours over time. Although unsafe sexual behaviours had decreased, some proportion did not practice safe sex.