The majority of women who had surgery for breast cancer said they did not feel fully informed about their treatment options, but a web-based decision aid tool may help better their understanding. The findings stem from a pair of studies recently published online in the Journal of the American College of Surgeons (doi: 10.1016/j.jamcollsurg.2017.10.022, doi: 10.1016/j.jamcollsurg.2017.10.024).
In the first study, researchers focused on how 487 women nationwide who underwent lumpectomy, mastectomy, or both procedures learned about their breast cancer surgery options and how informed they felt before surgery.
Among the women, only 47% who underwent lumpectomy, 67% who underwent mastectomy only, and 28% who underwent both procedures said they had felt “completely informed” of their options before surgery.
Sunny Mitchell, MD, breast surgeon and lead author of the study said in a press release she was "definitely surprised by the large percentage of women who reported not feeling completely informed” (December 15, 2017).
“Making a quick decision” on treatment trumped “thoroughly researching all options” for 35% of women who underwent lumpectomy, 31% who underwent mastectomy, and 22% who underwent both procedures, according to the study. Asked whether they wished they had more time to consider different options, the majority of women in the study agreed somewhat or strongly they had.
In the second study, a web-based decision aid proved more effective than standard cancer information websites in informing patients about breast cancer surgery options.
The trial randomized women with stage 0-III breast cancer to receive an emailed link either to an informational website, such as the National Cancer Institute’s or the American Cancer Society’s, or to a web-based decision aid.
“In addition to providing information, the decision aid allows patients to compare choices by presenting the information in a parallel way,” said Heather Neuman, MD, FACS, associate professor in the department of surgery, University of Wisconsin-Madison, in the press release. “It includes extra pieces of information that prompt patients to think about their values and preferences.”
Women randomized to the decision aid demonstrated higher overall knowledge compared with those randomized to websites. Additionally, 72% of women who received the decision aid recognized that waiting a few weeks to decide about breast cancer surgery would not hurt their survival, compared with 54% who received links to informational websites.
“Patients come in with this urgency, and this finding tells them they can slow down,” said Dr Neuman. “They don't need to have that anxiety.”—Jolynn Tumolo