Physician/Patient Decision Aids for Adjuvant Therapy
Authors: Timothy J. Whelan, Charles Loprinzi
Journal: Journal of Clinical Oncology (2005)

Many women with breast cancer are requesting more information about their disease, and studies suggest that they have an increasing desire to be involved in decisions about their care. To participate in decision making regarding adjuvant therapy, a woman needs accurate information about her options, associated adverse effects, and her risk of recurrence with and without treatment. A basic prerequisite of informed decision making is that a woman needs to understand this information as best as possible. Clinical studies have identified problems with both determining the risk of recurrence for individual patients and communicating this information in the clinical consultation. Pursuant to this, a number of physician/patient decision aids have been developed to address these problems. Decision aids are tools designed to help people make specific and deliberative choices among different options by providing information on the options and outcomes relative to a person’s health; these aids can take many forms. They may include combinations of written and visual information such as decision boards or flip charts, audio or video tapes, and interactive computer driven multimedia programs. Decision aids, generally, are meant to supplement, not replace, the traditional process of patient counseling by the physician. A decision aid should include a clear description of treatment options, including associated benefits and risks. The information provided should be evidence based and tailored to individual patients. The effectiveness of the instrument, in terms of improving patient knowledge and facilitating decision making should be demonstrated in clinical trials and the instrument should be easy to use and accessible. Currently, there are a number of instruments that have been developed as decision aids for adjuvant therapy in breast cancer. The Decision Board (Supportive Cancer Care Research Unit, Hamilton, Ontario, Canada) is a visual aid that a doctor or nurse can use to present information to the patient on her adjuvant therapy options, associated risks of recurrence, adverse effects, and potential impact on the patient’s quality of life. The instrument is 24 inches wide 18 inches high and contains written and graphic information (Fig 1). The information is presented to the patient in successive panels in a sequential fashion. At the end of the presentation, thepatient is facedwith anoverall visual representation of her options and the possible outcomes associated with each option. The patient is given a take-home version to review and discuss with others, if she desires. The Decision Board provides information on risk of recurrence with and without adjuvant therapy. Risks of recurrence without adjuvant therapy are determined from randomized clinical trials based on wellknown prognostic factors such as the number of involved nodes and tumor size and grade. The risks of recurrence with adjuvant therapy are provided based on proportional risk reductions determined from the Early Breast Cancer Trialist Collaborative Group (EBCTCG) overview. The instrument is easy to use and can be modified as new information becomes available. VOLUME 23 d NUMBER 8 d MARCH 1