Helping Patients Make Informed Choices: A Randomized Trial of a Decision Aid for Adjuvant Chemotherapy in Lymph Node-Negative Breast Cancer
Timothy J. Whelan,Carol Sawka,Mark Levine,Amiram Gafni,Leonard M. Reyno,Andrew R. Willan,Jim A. Julian,Susan Dent,H. Abu-Zahra,Edmond Chouinard,Richard Tozer,Kathleen I. Pritchard,Ilona Bodendorfer +12 more
TLDR
When making decisions regarding adjuvant chemotherapy, patients with early breast cancer who had been exposed to the Decision Board had better knowledge of the disease and treatment options and greater satisfaction with their decision making than those who received the standard consultation.Abstract:
Background: In recent years, patients have indicated a desire for more information about their disease and to be involved in making decisions about their care. We developed an aid called the “Decision Board” to help clinicians inform patients with lymph node-negative breast cancer of the risks and benefits of adjuvant chemotherapy. We determined whether adding the Decision Board to the medical consultation improved patient knowledge and satisfaction compared with the medical consultation alone. Methods: Between October 1995 and March 2000, 176 women with lymph nodenegative breast cancer who were candidates for adjuvant chemotherapy were randomly assigned to receive the Decision Board plus the medical consultation (83 patients) or the medical consultation alone (93 patients). One week after the consultation, patients completed a questionnaire assessing their knowledge about breast cancer and chemotherapy. Satisfaction with decision making was assessed 1 week and 3, 6, and 12 months after randomization, and differences between groups were analyzed by a repeated measures analysis of variance. All statistical tests were two-sided. Results: Patients in the Decision Board arm were better informed about breast cancer and adjuvant chemotherapy than patients in the control arm (mean knowledge score = 80.2 [on a scale of 0–100], 95% confidence interval [CI] = 77.1 to 83.3, and 71.7, 95% CI = 69.0 to 74.4, respectively; P<.001). Over the entire study period, satisfaction with decision making was higher for patients in the Decision Board arm than for patients in the control arm (P = .032). There was no statistically significant difference between the two groups in the number of patients who chose adjuvant chemotherapy (77% and 70% for patients in the Decision Board arm and those in the control arm, respectively; P = .303). Conclusion: When making decisions regarding adjuvant chemotherapy, patients with early breast cancer who had been exposed to the Decision Board had better knowledge of the disease and treatment options and greater satisfaction with their decision making than those who received the standard consultation. [J Natl Cancer Inst 2003;95:581–7]read more
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Decision aids for people facing health treatment or screening decisions
Dawn Stacey,Dawn Stacey,Krystina B. Lewis,Michael J. Barry,Carol Bennett,Karen Eden,Margaret Holmes-Rovner,Hilary A. Llewellyn-Thomas,Anne Lyddiatt,Richard Thomson,Lyndal Trevena +10 more
TL;DR: Decision aids reduced the proportion of undecided participants and appeared to have a positive effect on patient-clinician communication, and those exposed to a decision aid were either equally or more satisfied with their decision, the decision-making process, and the preparation for decision making compared to usual care.
Journal ArticleDOI
Barriers and facilitators to implementing shared decision-making in clinical practice: Update of a systematic review of health professionals’ perceptions
TL;DR: This systematic review update confirms the results of the original review on the barriers and facilitators to implementing shared decision-making in clinical practice as perceived by health professionals.
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GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations
Jeffrey C Andrews,Gordon H. Guyatt,Andrew D Oxman,Phil Alderson,Philipp Dahm,Yngve Falck-Ytter,Mona Nasser,Joerg J Meerpohl,Piet N. Post,Regina Kunz,Jan Brozek,Gunn Elisabeth Vist,David Rind,Elie A. Akl,Holger J. Schünemann +14 more
TL;DR: The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to classifying the direction and strength of recommendations is described, separated into strong and weak.
Journal ArticleDOI
Interventions for improving the adoption of shared decision making by healthcare professionals
Dawn Stacey,Stéphane Turcotte,Marie-Joëlle Cossi,Jennifer Kryworuchko,Ian D. Graham,Anne Lyddiatt,Mary C. Politi,Richard Thomson,Glyn Elwyn,Norbert Donner-Banzhoff +9 more
TL;DR: It is uncertain whether interventions to improve adoption of SDM are effective given the low quality of the evidence, but any intervention that actively targets patients, healthcare professionals, or both, is better than none.
Journal ArticleDOI
Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals' perceptions
Karine Gravel,Ian D. Graham +1 more
TL;DR: It is revealed that interventions to foster implementation of shared decision-making in clinical practice will need to address a broad range of factors, and that on this subject there is very little known about any health professionals others than physicians.
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TL;DR: The age-specific benefits of polychemotherapy appeared to be largely irrespective of menopausal status at presentation, oestrogen receptor status of the primary tumour, and of whether adjuvant tamoxifen had been given.
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