the impact of a web-based patient decision aid for women considering breast reconstruction

Conditions: Breast Cancer

Summary: this study evaluates the impact of an online patient decision aid on the process of decision making regarding breast reconstruction and the decision quality in women with breast cancer undergoing mastectomy and considering immediate breast reconstruction. half of participants will receive care as usual and access to the online decision aid, while the other half will receive care as usual including a standard information leaflet.

rationale: in the netherlands, of the approximately 15,000 women who are diagnosed with breast cancer each year, about 40% undergo mastectomy. a wide variety of breast reconstructive methods are offered to these women. in most cases, there is no clear medical recommendation on which procedure is the best. decisions for breast surgery and reconstruction are frequently made during an emotionally burdensome and restricted timeframe. women may find it hard to make a decision for the type of surgery and reconstruction, some feel that the decision is hurried and uninformed, and many have some degree of regret about their decision at a later date. to support women in making a well-informed decision about breast reconstruction, an online patient decision aid (pda) has been developed. objective: the primary objective of the study is to evaluate the impact of the use of the online pda on the process of decision making regarding breast reconstruction and the decision quality. the secondary objective of the study is to evaluate the impact of the use of the online pda on patient reported health outcomes, to identify possible moderators of the effect, and to investigate the cost-effectiveness. hypotheses: it is hypothesized that the online pda, as compared to usual care, will improve the decision making process about breast reconstruction (i.e. leads to less decisional conflict, higher satisfaction with information, higher levels of preparedness for decision making and higher perceived levels of shared decision making) and that it will improve the decision quality (i.e. leads to higher levels of knowledge about breast reconstruction and lower levels of regret). study design: a multicenter randomized controlled trial (rct) will be performed in eight hospitals. all consenting participants will be randomized into one of the two study arms (intervention group or control group). women in both groups will be invited to complete questionnaires at baseline (i.e. before randomization), 1 week after consultation with a plastic surgeon and 3 and 12 months after breast surgery. study population: 250 women will participate.

Eligibility criteria:
inclusion criteria: * female (≥18 years); * diagnosed with breast cancer or carcinoma in situ; * will be treated with mastectomy and is eligible for immediate breast reconstruction; * is referred to a plastic surgeon (consultation takes place ≥3 working days after study invitation); * has internet access and sufficient computer skills; * is able to read and speak the dutch language. exclusion criteria: none

Keywords: breast reconstruction patient decision aid decisional conflict randomized controlled trial