A Randomized Controlled Trial of a Decision Aid for Women at Increased Risk of Ovarian Cancer

Tiller, Kerry; Meiser, Bettina; Gaff, Clara; Kirk, Judy; Dudding, Tracy; Phillips, Kelly‐Anne; Friedlander, Michael; Tucker, Katherine

doi:10.1177/0272989x06290486

Cited by 33 publications

(42 citation statements)

References 46 publications

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“…Although this phenomenon has been identified in previous studies in the familial cancer setting, the discrepancy between the general and clinical population appears to be narrowing [39]. For example, earlier Australian data reported post-school qualifications in over 70% of women attending familial cancer clinics [48,49], suggesting that the numbers of women with lower educational levels is increasing in familial cancer clinics.…”

Section: Limitationsmentioning

confidence: 83%

A randomized controlled trial of a decision aid for women considering genetic testing for breast and ovarian cancer risk

Wakefield

Meiser

Homewood

et al. 2007

Breast Cancer Res Treat

103

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Section: Limitationsmentioning

confidence: 83%

A randomized controlled trial of a decision aid for women considering genetic testing for breast and ovarian cancer risk

Wakefield

Meiser

Homewood

et al. 2007

Breast Cancer Res Treat

103

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“…[54] Randomized trials have shown the impact of decision support interventions on reduced DC, most often measured by the total score of the DCS. Despite the wide use of DC as an outcome in such trials, few studies have conducted analyses adjusting for baseline measures and demographics.…”

Section: Discussionmentioning

confidence: 99%

The Personal Patient Profile-Prostate decision support for men with localized prostate cancer: A multi-center randomized trial

Berry

Halpenny

Hong

et al. 2013

Urologic Oncology: Seminars and Original Investigations

169

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OBJECTIVE The purpose of this trial was to compare usual patient education plus the Internet-based, Personal Patient Profile-Prostate, versus usual education alone, on conflict associated with decision making, plus explore time-to-treatment and treatment choice. METHODS A randomized, multi-center clinical trial was conducted with measures at baseline, one and six months. Men with newly diagnosed localized prostate cancer who sought consultation at urology, radiation oncology or multi-disciplinary clinics in four geographically-distinct American cities were recruited. Intervention group participants used the Personal Patient Profile-Prostate, a decision support system comprised of customized text and video coaching regarding potential outcomes, influential factors, and communication with care providers. The primary outcome, patient-reported decisional conflict, was evaluated over time using Generalized Estimating Equations to fit generalized linear models. Additional outcomes, time-to-treatment, treatment choice and program acceptability/usefulness, were explored. RESULTS A total of 494 eligible men were randomized (266 intervention; 228 control). The intervention reduced adjusted decisional conflict over time as compared with the control group, for the uncertainty score (estimate −3.61; (confidence interval, −7.01,−0.22) and values clarity (estimate −3.57; confidence interval (−5.85,−1.30) Borderline effect was seen for the total decisional conflict score (estimate −1.75; confidence interval (−3.61,0.11). Time-to-treatment was comparable between groups, while undecided men in the intervention group chose brachytherapy more often than in the control group. Acceptability and usefulness were highly rated. CONCLUSION The Personal Patient Profile-Prostate is the first intervention to significantly reduce decisional conflict in a multi-center trial of American men with newly diagnosed localized prostate cancer. Our findings support efficacy of P3P for addressing decision uncertainty and facilitating patient selection of a prostate cancer treatment that is consistent with the patient values and preferences.

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“…No significant effects were found after use of decision aids for coronary revascularization, 55 risk reducing mastectomy, 56 prophylactic oophorectomy, 57 or gynecologic procedures for menorrhagia. 58,59 …”

Section: Resultsmentioning

confidence: 90%

Strategies for Reducing Regional Variation in the Use of Surgery

2014

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Objective To review the literature evaluating the effect of practice guidelines and decision aids on use of surgery and regional variation. Background The use of surgical procedures varies widely across geographic regions. Although practice guidelines and decision aids have been promoted for reducing variation, their true effectiveness is uncertain. Methods Studies evaluating the influence of clinical practice guidelines or consensus statements, shared decision making and decision aids, or provider feedback of comparative utilization, on rates of surgical procedures were identified through literature searches of Ovid MEDLINE, EMBASE, and Web of Science. Results A total of 1946 studies were identified and 27 were included in the final review. Of the 12 studies evaluating implementation of guidelines, 6 reported a significant effect. Those examining overall population-based rates had mixed effects, but all studies evaluating procedure choice described at least a small increase in use of recommended therapy. Three of 5 studies examining the effect of guidelines on regional variation reported a significant reduction after dissemination. Of the 15 studies examining decision aids, 5 revealed significant effects. Many studies of decision aids reported decreases in population-based procedure rates. Nearly all studies evaluating the impact of decision aids on procedure choice reported increases in rates of less invasive procedures. Only one study of decision aids assessed changes in regional variation and found mixed results. Conclusions Both practice guidelines and decision aids have been proven effective in many clinical contexts. Expanding the clinical scope of these tools and eliminating barriers to implementation will be essential to further efforts directed toward reducing regional variation in the use of surgery.

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A Randomized Controlled Trial of a Decision Aid for Women at Increased Risk of Ovarian Cancer

Cited by 33 publications

References 46 publications

A randomized controlled trial of a decision aid for women considering genetic testing for breast and ovarian cancer risk

A randomized controlled trial of a decision aid for women considering genetic testing for breast and ovarian cancer risk

The Personal Patient Profile-Prostate decision support for men with localized prostate cancer: A multi-center randomized trial

Strategies for Reducing Regional Variation in the Use of Surgery

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