Adjuvant Chemotherapy for Breast Cancer: How Presentation of Recurrence Risk Influences Decision-Making

Chao, Celia; Studts, Jamie L.; Abell, Troy D.; Hadley, Terence J.; Roetzer, Lynne M.; Dineen, Seán; Lorenz, Doug; YoussefAgha, Ahmed; McMasters, Kelly M.

doi:10.1200/jco.2003.06.025

Cited by 77 publications

(60 citation statements)

References 22 publications

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“…However, recent data from a study by Chao et al 31 suggest that quantitative information about risk and benefit can be confusing, even for relatively sophisticated recipients, such as medical students. Our data address a special type of numeracy among patients who face the decision of participating in Phase I oncology trials.…”

Section: Discussionmentioning

confidence: 99%

Understanding of an aggregate probability statement by patients who are offered participation in Phase I clinical trials

Weinfurt

DePuy

Castel

et al. 2004

Cancer

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BACKGROUNDThere is concern that patients with poor numeracy may have difficulty understanding the information necessary to make informed treatment decisions. The authors sought to characterize a special form of numeracy among patients with advanced cancer who were offered participation in Phase I oncology clinical trials.METHODSSurveys were administered to 328 cancer patients who were considering Phase I trials. Their frequency‐type numeracy was assessed using a multiple‐choice question involving a hypothetical scenario in which a physician stated that an experimental treatment would control cancer in “40% of cases like yours.” In univariate and multivariable analyses, patient characteristics that were associated with better numeracy were identified.RESULTSThe correct frequency‐type interpretation was selected by 72% of respondents. Fourteen percent of respondents incorrectly selected a belief‐type answer, “The doctor is 40% confident that the treatment will control my cancer.” In a multivariable model, patients who answered incorrectly tended to have less formal education and less experience with experimental therapies.CONCLUSIONSBecause the misunderstandings some patients demonstrated may influence their treatment decision making adversely, it is critical to identify such patients and to give them special consideration when communicating information about potential risks and benefits of treatment. Cancer 2004. © 2004 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Understanding of an aggregate probability statement by patients who are offered participation in Phase I clinical trials

Weinfurt

DePuy

Castel

et al. 2004

Cancer

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“…93 The online format of our decision tool facilitates access and personalization; results are customized for a patient's age, allowing women to revisit their decisions over time should their health status, life circumstances, or priorities change. Additionally, the online tool can be readily adapted to accommodate new data from emerging studies.…”

Section: Discussionmentioning

confidence: 99%

Online Tool to Guide Decisions forBRCA1/2Mutation Carriers

Kurian

Muñoz

Rust

et al. 2012

JCO

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A B S T R A C T PurposeWomen with BRCA1 or BRCA2 (BRCA1/2) mutations must choose between prophylactic surgeries and screening to manage their high risks of breast and ovarian cancer, comparing options in terms of cancer incidence, survival, and quality of life. A clinical decision tool could guide these complex choices. MethodsWe built a Monte Carlo model for BRCA1/2 mutation carriers, simulating breast screening with annual mammography plus magnetic resonance imaging (MRI) from ages 25 to 69 years and prophylactic mastectomy (PM) and/or prophylactic oophorectomy (PO) at various ages. Modeled outcomes were cancer incidence, tumor features that shape treatment recommendations, overall survival, and cause-specific mortality. We adapted the model into an online tool to support shared decision making. ResultsWe compared strategies on cancer incidence and survival to age 70 years; for example, PO plus PM at age 25 years optimizes both outcomes (incidence, 4% to 11%; survival, 80% to 83%), whereas PO at age 40 years plus MRI screening offers less effective prevention, yet similar survival (incidence, 36% to 57%; survival, 74% to 80%). To characterize patients' treatment and survivorship experiences, we reported the tumor features and treatments associated with risk-reducing interventions; for example, in most BRCA2 mutation carriers (81%), MRI screening diagnoses stage I, hormone receptor-positive breast cancers, which may not require chemotherapy. ConclusionCancer risk-reducing options for BRCA1/2 mutation carriers vary in their impact on cancer incidence, recommended treatments, quality of life, and survival. To guide decisions informed by multiple health outcomes, we provide an online tool for joint use by patients with their physicians (http://brcatool.stanford.edu).

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“…Of course, the potential for confusion with the presentation of multiple formats without guidance should not be underestimated. 144 It also is essential to emphasize the importance of the denominator, given the numerator bias, and the importance of considering all 4 cells of the design when assessing covariation or cause (eg, "think not only of the times you took this medication and it made you irritable, but also of the times neither or only one of these events happened"). Finally, it is essential to highlight the role of the base rate in making risk judgments-people need to know that a test with 99% accuracy will still yield a lot of false positives if the population prevalence is low.…”

Section: Implications For Risk Elicitation and Communicationmentioning

confidence: 99%

Cancer Risk Elicitation and Communication: Lessons from the Psychology of Risk Perception

Klein

Stefanek

2007

CA: A Cancer Journal for Clinicians

146

129

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Cancer risk perceptions are a key predictor of risk-reduction practices, health behaviors, and processing of cancer information. Nevertheless, patients and the general public (as well as health care providers) exhibit a number of errors and biases in the way they think about risk, such that their risk perceptions and decisions deviate greatly from those prescribed by normative decision models and by experts in risk assessment. For example, people are more likely to engage in screening behaviors such as mammography when faced with loss-based messages than gain-framed messages, and they often ignore the base rate of a given disease when assessing their own risk of obtaining this disease. In this article, we review many of the psychological processes that underlie risk perception and discuss how these processes lead to such deviations. Among these processes are difficulties with use of numerical information (innumeracy), cognitive processes (eg, use of time-saving heuristics), motivational factors (eg, loss and regret aversion), and emotion. We conclude with suggestions for future research in the area, as well as implications for improving the elicitation and communication of personal cancer risk.

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Adjuvant Chemotherapy for Breast Cancer: How Presentation of Recurrence Risk Influences Decision-Making

Abstract: These results support the hypothesis that the method used to present information about chemotherapy influences treatment decisions. Absolute survival benefit is the most easily understood method of conveying the information regarding benefit of treatment.

Cited by 77 publications

References 22 publications

Understanding of an aggregate probability statement by patients who are offered participation in Phase I clinical trials

Understanding of an aggregate probability statement by patients who are offered participation in Phase I clinical trials

Online Tool to Guide Decisions forBRCA1/2Mutation Carriers

Cancer Risk Elicitation and Communication: Lessons from the Psychology of Risk Perception

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