Implementation of a visual aid to improve disease comprehension in patients with new breast cancer diagnoses.
Authors: Patel Rima , Blanter Julia , Kier Melanie Wain , Waksal Julian Alexander , Wu Meng , Berwick Shana , Sheng Tianxiang , Kessler Alaina J. , Bhardwaj Aarti Sonia 
Published: October 2023

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Background: Studies have shown that patients with new cancer diagnoses are overwhelmed due to the large amount of information presented at their initial oncology visit. Inability to meet these high informational demands has been associated with poorer outcomes. Most patient education is done verbally despite data showing that patients only retain 14% of verbal communication compared to 85% of information with visual aids. The aim of this study was to determine if implementation of a visual educational tool on breast cancer diagnosis and treatment would improve comprehension in patients with new diagnoses. Methods: We designed an educational tool to visually depict breast cancer subtype, stage, and treatment plan. We recruited English-speaking patients with new diagnoses of breast cancer who were seen for an initial oncology visit at the Mount Sinai Dubin Breast Center. Patients were randomized to receive the visual aid (intervention) or continue with standard-of-care (control). For patients randomized to the intervention arm, the oncologist used the visual aid to provide education on their diagnosis and treatment plan during the visit. All patients completed a survey at their initial visit and approximately 1 month after diagnosis. The survey included demographic information, patient preferences, and assessment of their understanding of diagnosis and treatment. The worksheet and surveys were piloted with 5 patients with breast cancer and modified based on their feedback. A knowledge score was calculated based on their survey responses with scores ranging from 2 (low knowledge) to 6 (all questions answered correctly). We utilized paired t-test to compare the means of knowledge scores at initial visit and 1 month follow up. Results: Twenty female patients were enrolled from 2022-2023 with a median age of 61 years. Ten patients were randomized to the intervention arm and 10 to the control arm. The initial mean knowledge score of the control group was 4.9 and the follow up mean score was 5.6 (P = 0.11). The initial mean score of the intervention group was 5.3 whereas the follow up mean score was 5.6 (P = 0.84). There was no significant difference between the intervention group and the control group (P = 0.944). An increase in overall scores was noted from initial to follow up survey in all groups. There was a complete elimination of all low scores (< 3) across both groups in the follow up survey. Conclusions: Education at the initial visit improves understanding of breast cancer diagnosis and treatment. Our study demonstrated a standardized informational tool did not improve understanding when compared to individualized teaching with their oncologist. However, our study was limited to a single breast cancer center with a small sample size and English-speaking patients. Next steps include translation of the educational tool into additional languages, as well as expansion of this study to a larger patient population.