Impact of Timing on Measurement of Decision Quality and Shared Decision Making: Longitudinal Cohort Study of Breast Cancer Patients

Abstract

Purpose.The objective of this study was to examine whether scores of shared decision-making measures differ when collected shortly after (1 month) or long after (1 year) breast cancer surgical treatment decisions. Methods. Longitudinal, multisite survey of breast cancer (BC) patients, with measurements at 1 month and 1 year after surgery at 4 cancer centers. Patients completed the BC Surgery Decision Quality Instrument (used to generate a knowledge score, ratings of goals, and concordance with treatment preferences) and Shared Decision Making (SDM) Process survey at both time points. We tested several hypotheses related to the scores over time, including whether the scores discriminated between sites that did and did not offer formal decision support services. Exploratory analyses examined factors associated with large increases and decreases in scores over time. Results. Across the 4 sites, 229 patients completed both assessments. The mean total knowledge scores (69.2% [SD 16.6%] at 1 month and 69.4% [SD 17.7%] at 1 year, P = 0.86), SDM Process scores (2.7 [SD 1.1] 1 month v. 2.7 [SD 1.2] 1 year, P = 0.68), and the percentage of patients receiving their preferred treatment (92% at 1 month and 92% at 1 year, P = 1.0) were not significantly different over time. The site using formal decision support had significantly higher knowledge and SDM Process scores at 1 month, and only the SDM Process scores remained significantly higher at 1 year. A significant percentage of patients had large changes in their individual knowledge and SDM Process scores, with increases balancing out decreases. Conclusion. For population-level assessments, it is reasonable to survey BC patients up to a year after the decision, greatly increasing feasibility of measurement. For those evaluating decision support interventions, shorter follow-up is more likely to detect an impact on knowledge scores.

National Survey of Decision-Making for Antidepressants and Educational Level

“…The content of the conversations between patients and physicians was not recorded, so these data are based on patient reports about their knowledge and interactions that occurred, on average, a year before the interview. It is possible that the 2-year recall period could have impacted respondents' answers; however, a recent analysis by Sepucha and colleagues 38 found that timing of measurement on decision quality and SDM did not show a difference in mean knowledge scores between 1 month and 1 year. We also acknowledge the possibility of nonresponse bias from the original sample, which would impact the generalizability of our findings.…”

Long-Term Patient Satisfaction and Quality of Life After Breast-Conserving Therapy: A Prospective Study Using the BREAST-Q

“… 28 , 30 The timing of administration could be important for these scales. 51 If the scales are administered too late, the results may be confounded by the overall satisfaction with the therapy result. If administration is too early, patients might not yet be able to review the different parts of care separately because they would still be suffering from side effects of the surgery.…”

Development and Evaluation of the Shared Decision Making Process Scale: A Short Patient-Reported Measure

“…Time since the visit or since the decision may play an important role in the scores; unfortunately, the data sets did not include sufficient details to examine these relationships. Although there are some data that suggest the mean scores do not change over time, 7 more evidence would be needed to examine the impact of timing on scores. Fourth, we analyzed only data for those individuals who completed all items in the SDM Process scale to be able to identify how short and long versions compare, thus removing people with any missing data.…”