A Randomized Controlled Trial Evaluating the Impact of Web-Based Information on Breast Cancer Patients' Knowledge of Surgical Treatment Options

Abstract

Background: Prior research suggests that providing women newly diagnosed with breast cancer information during the gap between cancer diagnosis and their first surgeon consultation may support decision making. Our objective was to compare patients’ knowledge after the pre-consultation delivery of standard websites versus a web-based decision aid (DA). Study Design: We randomized women with stage 0-III breast cancer within an academic and community breast clinic to be emailed a link to selected standard websites (National Cancer Institute, American Cancer Society, Breastcancer.org,) versus the Health Dialog DA (Clinicaltrials.gov NCT03116035). Patients seeking second opinions, diagnosed by excisional biopsy, or without an email address were ineligible. Pre-consultation knowledge was assessed using the Breast Cancer Surgery Decision Quality Instrument. We compared differences in knowledge using t-test. Results Median patient age was 59 years, 99% were white, and 65% a college degree or higher, with no differences in demographics between study arms. Knowledge was higher in patients who received the DA (median 80% vs 66% correct, p=0.01). DA patients were more likely to know that waiting a few weeks to make a treatment decision would not affect survival (72% versus 54%, p<0.01). Patients in both arms found the information helpful (median score 8/10). Conclusion Although patients found receipt of any pre-consultation information helpful, the DA resulted in improved knowledge over standard websites and effectively conveyed that there is time to make a breast cancer surgery decision. Decreasing the urgency patients feel may improve the quality of patient-surgeon interactions and lead to more informed decision-making.

Evaluate the effectiveness of breast cancer decision aids: A systematic review and meta‐analysis of randomize clinical trails

“…Further evaluation excluded 80 full texts. Ultimately, 22 articles were included(Garvelink et al., 2017 ; Goel et al., 2001 ; Green et al., 2004 ; Hersch et al., 2015 ; Klaassen et al, 2018 ; Lam et al., 2014 ; Lee et al., 2010 ; Luan et al., 2016 ; Manne et al., 2015 ; Mathieu et al., 2010 ; Metcalfe et al., 2017 ; Molenaar et al., 2001 ; Osaka & Nakayama, 2017 ; Parkinson et al., 2018 ; Perez‐Lacasta et al., 2019 ; Politi et al., 2019 ; Stankowski‐Drengler et al., 2019 ; Street et al., 1995 ; Tucholka et al., 2018 ; Vodermaier et al., 2009 , 2011 ; Whelan et al., 2004 ) (Figure 1 ) which comprised 17 articles that evaluated decision aids for breast cancer treatment, and five on breast cancer screening. Trials were conducted in the United States (8), Canada (3), Australia (3), the Netherlands (3), Germany (2), China (1), Japan (1) and Spain (1) (Table 1 ).…”

Applied techniques for putting pre-visit planning in clinical practice to empower patient-centered care in the pandemic era: a systematic review and framework suggestion

“… 193 patients +++ sexual health clinics UK Sexual problems Pre-assessment tools Demographic data, Medical history, Lifestyle, Family history, Lab data, Reason for referral, Patient awareness, Drug side effects Symptoms, Medication Patient-provider communication, Illness perceptions, Perceived involvement in care, Adherence to visit scheduling, ITT analysis, Self-care, Mental health topics, Identifying referral appropriateness Symptom control 19 18 Sleath, B et al [ 23 ] 2017 Patient Educ Couns Online and offline sources of information and support To improve patient-provider communication during time-limited primary care visits and represent a strategy for improving diabetes care. 259 +++ pediatric asthma clinic USA Asthma Patient education Demographic data, Patient awareness Patient-provider communication, Appointment intake information 15 19 Tucholka, J. L. et al [ 39 ] 2018 J Am Coll Surg Online and offline sources of information and support To assess the acceptability of a new strategy of pre-consultation prevention summaries and reminders in general practice. 377 patients +++ Breast cancer clinic USA Breast cancer Patient education Demographic data, Patient awareness Illness perceptions, Medication and treatment adherence 16 20 Aboumatar, H. J et al [ 66 ] 2013 J Gen Intern Med Online and offline sources of information and support Combining patient-oncologist intervention to improve communication in advanced cancer 41 primary care physicians and 275 of their patients +++ Primary care clinic USA Hypertension Patient education Demographic data, Patient awareness Appointment intake information 18 21 Albada, A. et al [ 29 ] 2015 Patient Educ Couns Electronic pre-office visit checklist ...…”

“…According to findings, the most favorite types of pre-visit model were related to using electronic pre-office visit checklists and supporting patients by providing them with the necessary information in the form of online and offline training. In three articles, this information was provided to patients in the form of educational websites [ 37 , 39 , 40 , 60 ], while in the other six articles, the information was provided to patients in the form of training sessions before the patient’s visit and referring to the clinic [ 23 , 36 , 38 , 41 , 42 , 61 , 62 , 66 ].…”

Breast Cancer Knowledge and Decisions Made for Contralateral Prophylactic Mastectomy: A Survey of Surgeons and Women in the General Population

“…In a comparison of breast cancer patient knowledge among women who received an in-visit decision aid versus usual care treatment discussion, Yao et al determined that the decision aid group had a higher percentage of women with high-level knowledge of breast cancer as determined by a post-visit questionnaire (18). Tucholka et al studied the most effective means of educating women on breast cancer treatment and survival comparing an electronic decision aid with providing url's for select standard cancer websites, and determined that those receiving the electronic decision aid were more knowledgeable about survival, likelihood of death, and specific procedural risks, allowing them to make a more informed decision (21). In addition to content, how best to present treatment decision aids is challenging, particularly among the less educated and those of lower socioeconomic status.…”