Project Overview +

For the past decade there has been debate around whether mastectomy or breast conserving surgery (BCS) with radiation is the "best" treatment for early stage breast cancer. The goal of this study is to develop and pilot test an interactive computer-based decision tool for improving patient knowledge about breast cancer treatment, and help elicit patients' preferences for treatment characteristics.

Aims +

Aim 1. Conduct group and individual interviews with breast cancer surgeons affiliated with the American College of Surgeons (ACoS) regarding the content and integration of the tool into clinical delivery systems.

Aim 2. Conduct group and individual interviews with diverse breast cancer survivors to obtain feedback on the content and type of information desired in making treatment decisions.

Aim 3. Work with the Center for Health Communication Research (CHCR) at the University of Michigan to develop an interactive, web-based decision tool for use in early stage breast cancer treatment decision-making.

Aim 4. Pilot test the decision tool in three practices in the Chicago, IL area and at the University of Michigan Breast Center to evaluate the content, look and feel of the tool, and the ability of the tool to influence knowledge and preferences.

Participants +

At various stages, this study includes:

  • breast surgeons
  • breast cancer survivors
  • new onset early stage breast cancer patients

Intervention +

Phase 1: Qualitative

  • Engage breast surgeons and breast cancer patients in tool development.
  • Interview 12-18 surgeons in the Chicago area to obtain feedback about content and logistics of tool delivery in clinical practice.
  • Interview 21-27 breast cancer survivors affiliated with the UM breast center to obtain feedback on content and preferences for information.

Phase 2: Tool development

The tool focuses on improving the quality of breast cancer treatment decisions, by ensuring that clear and accurate risk and benefit information is conveyed, and incorporating preference elicitation methodology to provide patients with feedback about the attributes that are most important to them in treatment decision-making:

  • Finalize content, schema and preference clarification exercise. Develop website.
  • Integrate conjoint analysis exercise and final graphics choices.
  • Complete data capture and programming elements. Beta test and refine.

Phase 3: Testing

  • Pilot test the tool in 3 practices in Chicago and the UM breast center.
  • Evaluate the look, feel and content of the tool among 24 newly diagnosed breast cancer patients.
  • Assess the effectiveness of the tool on knowledge and decisional outcomes among 24 newly diagnosed breast cancer patients who view the tool, and 48 who do not.

Findings +

Seventy subjects have been recruited with complete information available for 58. Their mean age was 57 years, 60% had a college degree or more, and 86% were white. Those viewing the website first had higher scores on several decision outcomes than those taking the survey first. Knowledge scores were also higher among those viewing the website before the survey (3.0 vs. 2.61, p=.23). The risk of recurrence was the most important treatment attribute, followed by retaining the natural breast, in both groups. Concordance between treatment choice and conjoint-analysis generated treatment was 65% for website first and 61% for survey first groups.

Conclusion +

A tool designed to improve the quality of surgical breast cancer treatment decisions by focusing on improving knowledge and preference-concordant decisions appears effective in this pilot study. Further work to assess the impact of the tool in larger and more diverse populations is needed.