Development of Patients’ Decision Aid for Older Women With Stage I Breast Cancer Considering Radiotherapy After Lumpectomy

Wong, Jennifer; D’Alimonte, Laura; Angus, Jan; Paszat, L; Metcalfe, Kelly; Whelan, Timothy J.; Llewellyn‐Thomas, Hilary A.; Warner, Eiran; Franssen, Edmée; Szumacher, Ewa

doi:10.1016/j.ijrobp.2011.11.028

Cited by 32 publications

(27 citation statements)

References 17 publications

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“…These findings are consistent with other studies, which concluded that the routine identification of frailty should trigger important discussions between the interprofessional team, caregivers, and the frail seniors to identify their goals of care and preferences, and choose the care plan that best meet these goals [21]. Despite being less used to an active role in decision-making compared to younger patients there are several examples that, with encouragement, older adults can participate in shared decision-making [22, 23]. Older patients’ active engagement in their healthcare is associated with high-quality and cost-effective healthcare [24, 25].…”

Section: Discussionsupporting

confidence: 76%

Key stakeholders’ views on the quality of care and services available to frail seniors in Canada

et al. 2018

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BackgroundFrail seniors often receive ineffective care, which does not meet their needs. It is still unclear how healthcare systems should be redesigned to be more sensitive to the needs and values of frail seniors and their caregivers. We thus aimed to describe key stakeholders’ perspectives on the current healthcare and services available to frail seniors.MethodsIn this qualitative descriptive study, we conducted semi-structured interviews with a convenience sample of 42 frail seniors, caregivers, clinicians, or healthcare administrators/decision makers involved in frail senior care from five Canadian provinces. We explored participants’ perspectives on the quality of care and services for frail seniors. We used an inductive/deductive thematic data analysis approach based on the Square-of-Care model, including emerging themes using the constant comparison method.ResultsWe grouped participants’ perspectives into strengths, weaknesses and opportunities for improvement, and then into nine themes: care processes, continuity of care, social frailty, access to healthcare and services, models of healthcare delivery, cost of care, healthcare staff management and professional development of healthcare providers, material resources and environmental design of healthcare facilities, and coordination of care. Our findings suggest redesigning assessment, communication with frail seniors and their caregivers, targeting care and services to the needs, and integrating care better across settings and in time.ConclusionsA systematic identification of frail older people is the first step to adapt healthcare systems to this population’s needs. Participation of frail older people and their caregivers to decision making would also allow choosing care plans meeting their care goals. The integration of care and services across settings, over time, and with various providers, is also needed to meet frail senior needs.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0969-y) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 76%

Key stakeholders’ views on the quality of care and services available to frail seniors in Canada

et al. 2018

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“…The absolute increase in knowledge scores of more-highly-educated healthy women was comparable to knowledge increase in other patient populations after viewing several kinds of DAs [17,34]. However, relative knowledge increase from baseline to follow-up in populations with patients or persons who are close to patients (relatives, carers) is often smaller than the 18 and 33% we found, ranging from 6 to 9% in studies after decisions other than FP [17,[34][35][36][37], possibly due to higher baseline knowledge in those studies. This might be explained by the fact that patients (or persons who are close to patients) often already know more about their disease or treatment options than healthy volunteers do.…”

Section: Discussionsupporting

confidence: 50%

“…This might be a result of the relative paucity of available information about FP (thus resulting in lower baseline knowledge) compared to availability of information about other more common medical decisions for which DAs have been developed. Additionally, although some studies used knowledge measures that had been used in multiple studies [19,36], due to the specificity of studied decisions, most knowledge scales, including ours, had been developed by the authors, and were not validated [34,35,37]. Therefore, caution should be taken in interpreting scores of these knowledge scales.…”

Section: Discussionmentioning

confidence: 99%

Development of a Decision Aid about fertility preservation for women with breast cancer in the Netherlands

Garvelink

Kuile

Fischer

et al. 2013

Journal of Psychosomatic Obstetrics & Gynecology

101

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“…A patient decision aid for older women with stage I, ER‐positive, PR‐positive breast cancer who are considering adjuvant radiotherapy after lumpectomy was developed . The results of this study indicated that patients had a statistically significant reduction in decisional conflict, increased clarity of the risks and benefits, and improved general treatment knowledge after using the patient decision aid . Studies such as this indicate that educational tools geared toward this subgroup of women may be beneficial to enhancing patient knowledge and allow women to be better informed concerning their treatment options …”

Section: Discussionmentioning

confidence: 98%

“…Other patient‐directed decision tools have been created for this cohort of patients. A patient decision aid for older women with stage I, ER‐positive, PR‐positive breast cancer who are considering adjuvant radiotherapy after lumpectomy was developed . The results of this study indicated that patients had a statistically significant reduction in decisional conflict, increased clarity of the risks and benefits, and improved general treatment knowledge after using the patient decision aid .…”

Section: Discussionmentioning

confidence: 99%

The use of adjuvant radiotherapy in elderly patients with early‐stage breast cancer: Changes in practice patterns after publication of Cancer and Leukemia Group B 9343

Palta

Bhavsar

et al. 2014

Cancer

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BACKGROUND The Cancer and Leukemia Group B (CALGB) 9343 randomized phase 3 trial established lumpectomy and adjuvant therapy with tamoxifen alone, rather than both radiotherapy and tamoxifen, as a reasonable treatment course for women aged >70 years with clinical stage I (AJCC 7th edition), estrogen receptor‐positive breast cancer. An analysis of the Surveillance, Epidemiology, and End Results (SEER) registry was undertaken to assess practice patterns before and after the publication of this landmark study. METHODS The SEER database from 2000 to 2009 was used to identify 40,583 women aged ≥70 years who were treated with breast‐conserving surgery for clinical stage I, estrogen receptor‐positive and/or progesterone receptor‐positive breast cancer. The percentage of patients receiving radiotherapy and the type of radiotherapy delivered was assessed over time. Administration of radiotherapy was further assessed across age groups; SEER cohort; and tumor size, grade, and laterality. RESULTS Approximately 68.6% of patients treated between 2000 and 2004 compared with 61.7% of patients who were treated between 2005 and 2009 received some form of adjuvant radiotherapy (P < .001). Coinciding with a decline in the use of external beam radiotherapy, there was an increase in the use of implant radiotherapy from 1.4% between 2000 and 2004 to 6.2% between 2005 to 2009 (P < .001). There were significant reductions in the frequency of radiotherapy delivery over time across age groups, tumor size, and tumor grade and regardless of laterality (P < .001 for all). CONCLUSIONS Randomized phase 3 data support the omission of adjuvant radiotherapy in elderly women with early‐stage breast cancer. Analysis of practice patterns before and after the publication of these data indicates a significant decline in radiotherapy use; however, nearly two‐thirds of women continue to receive adjuvant radiotherapy. Cancer 2015;121:188–93. © 2014 American Cancer Society.

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Development of Patients’ Decision Aid for Older Women With Stage I Breast Cancer Considering Radiotherapy After Lumpectomy

Cited by 32 publications

References 17 publications

Key stakeholders’ views on the quality of care and services available to frail seniors in Canada

Key stakeholders’ views on the quality of care and services available to frail seniors in Canada

Development of a Decision Aid about fertility preservation for women with breast cancer in the Netherlands

The use of adjuvant radiotherapy in elderly patients with early‐stage breast cancer: Changes in practice patterns after publication of Cancer and Leukemia Group B 9343

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