Abstract P2-10-01: onlineDeCISion.org: An interactive web-based clinical decision aid for DCIS treatment
Authors: Ozanne Elissa M , Stout Natasha K , Schneider Katharine , Soeteman Djøra , Schrag Deborah , Fordis Michael , Punglia Rinaa S 
Published: May 2015

Purpose: Treatment decisions regarding Ductal Carcinoma in Situ (DCIS) are complex, and patients often have inaccurate and incomplete understanding of the risks and benefits they face. Our objective was to create a web-based decision aid (onlineDeCISion.org) that can be used in clinical practice to guide both clinicians and their patients with these decisions.

Methods: We developed a web-based clinical decision aid to provide tailored information about DCIS treatment choices including an individual patient’s risk of recurrence, likelihood of long-term breast preservation and survival outcomes following up to 6 different treatment strategies for DCIS (lumpectomy, lumpectomy with radiation, lumpectomy with tamoxifen, lumpectomy with radiation and tamoxifen, and mastectomy with or without breast reconstruction). The decision aid is populated by our previously developed simulation model of DCIS outcomes. A theoretical framework and best-practices for web-based decision tools guided the development of the decision aid including semi-structured interviews and usability testing with a diverse group of multidisciplinary clinicians and patient advocates.

Results: The decision aid was designed to include these key features: 1) descriptions of treatment options; 2) ability to input patient health-adjusted age; 3) tailored likelihood of time-specific (10-year and lifetime) recurrence and survival outcomes; and 4) projections of downstream effects of each treatment. The decision aid provides default recurrence risks based on clinical trial data but allows clinicians to customize 10-year DCIS and invasive recurrence risks to retain flexibility to display expected outcomes for individual patients. These estimates can be based on the patient’s actual age, or age adjusted for health status, allowing for a more realistic expectation of the benefits each treatment holds.

Conclusion: Our web-based decision aid displays tailored outcomes following different treatment strategies for DCIS, allowing patients to be better informed about the tradeoffs of treatments available to them and select treatments consonant with their personal preferences, improving the quality of decision making for DCIS. The interactive design features allow users of the decision aid the ability to address uncertainty around risks of recurrence and comorbidity risks and facilitate the use of the decision aid across diverse populations. While the decision aid warrants further evaluation, the results of our study promise to improve decision making in patients with DCIS.

Citation Format: Elissa M Ozanne, Natasha K Stout, Katharine Schneider, Djøra Soeteman, Deborah Schrag, Michael Fordis, Rinaa S Punglia. onlineDeCISion.org: An interactive web-based clinical decision aid for DCIS treatment [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-10-01.