A systematic review of decision aids for patients making a decision about treatment for early breast cancer

Abstract

Several complex treatment decisions may be offered to women with early stage breast cancer, about a range of treatments from different modalities including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids can facilitate shared decision-making and improve decision-related outcomes. We aimed to systematically identify, describe and appraise the literature on treatment decision aids for women with early breast cancer, synthesise the data and identify breast cancer decisions that lack a decision aid. A prospectively developed search strategy was applied to MEDLINE, the Cochrane databases, EMBASE, PsycINFO, Web of Science and abstract databases from major conferences. Data were extracted into a pre-piloted form. Quality and risk of bias were measured using Qualsyst criteria. Results were synthesised into narrative format. Thirty-three eligible articles were identified, evaluating 23 individual treatment decision aids, comprising 13 randomised controlled trial reports, seven non-randomised comparative studies, eight single-arm pre-post studies and five cross-sectional studies. The decisions addressed by these decision aids were: breast conserving surgery versus mastectomy (+/- reconstruction); use of chemotherapy and/or endocrine therapy; radiotherapy; and fertility preservation. Outcome measures were heterogeneous, precluding meta-analysis. Decisional conflict decreased, and knowledge and satisfaction increased, without any change in anxiety or depression, in most studies. No studies were identified that evaluated decision aids for neoadjuvant systemic therapy, or contralateral prophylactic mastectomy. Decision aids are available and improved decision-related outcomes for many breast cancer treatment decisions including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids for neoadjuvant systemic therapy and contralateral prophylactic mastectomy could not be found, and may be warranted.

SB-T-121205, a next-generation taxane, enhances apoptosis and inhibits migration/invasion in MCF-7/PTX cells

“…Currently, standard therapies for breast cancer patients include surgery, radiotherapy and chemotherapy, which plays an irreplaceable role (2). Paclitaxel (PTX; Fig.…”

Use of Integrative Oncology, Involvement in Decision-Making, and Breast Cancer Survivor Health-Related Quality of Life in the First 5 Years Postdiagnosis

“… 4 - 8 Patient involvement in decisions about medical treatment has been found to predict a variety of short-term positive outcomes including reduced levels of decision-regret and better patient satisfaction with care. 9 , 10 Involvement in decision-making about breast cancer treatment specifically and about breast cancer surgery has been found to be associated with lower levels of anxiety 11 and increased short-term well-being. 10 , 12 Some studies have even found self-reported involvement in decision-making predicts long-term outcomes including cancer survivor HRQOL 10 , 13 even years after diagnosis.…”

Does physician communication style impact patient report of decision quality for breast cancer treatment?

“…There has been some research demonstrating the positive impact of decision interventions, like decision aids, on the quality of women’s treatment decisions. [52] Yet ours is the first study to examine the association between patient perceptions of provider communication style and patient-reported decision quality in breast cancer. Our findings suggest that interventions to enhance autonomy-supportive communication practices among surgeons and medical oncologists will likely have a positive impact on patient perceptions of the quality of their cancer treatment decisions for most individuals.…”