Abstract P3-11-02: Women's experiences with a decision aid for neoadjuvant systemic therapy for operable breast cancer
Authors: N Zdenkowski, A Herrmann, A Hall, FM Boyle, P Butow
Journal: Cancer Research (2017)

Abstract Background: Neoadjuvant systemic therapy (NAST) is a treatment option for selected patients with highly proliferative and/or large operable breast cancer. Whilst survival outcomes are equivalent between up-front surgery and NAST, the decision about treatment sequence can be difficult due to complexity and perceived urgency of the decision. Patients may value the outcomes of these options, such as down staging and prognostication, differently. Involving patients in decisions about their healthcare reduces anxiety, increases quality of life and satisfaction with care. Decision aids can improve patient involvement in health care decisions, but one is not available for the decision about NAST. Aims/Methods: We conducted a prospective, single-arm pre-post study to evaluate a custom-designed decision aid developed for women who have been offered NAST. Eligible patients were: female; aged ≥18 years; diagnosed with an operable invasive breast cancer; considered for NAST with curative intent. Here, we report on the grounded theory qualitative analysis of a convenience sample of 16 semi-structured phone interviews to explore patient experience with this decision aid. Results: Participants' median age was 52 (IQR=41-63), median time since breast cancer diagnosis was 5 months (IQR=2-8). Most were married or living with a partner (81.3%) and had a University level degree (68.8%). Patients perceived the decision aid to be useful for becoming more informed and involved in deciding on NAST. Specifically, the decision aid enhanced patients' understanding of their type of breast cancer and the treatment options available to them by summarising and extending the information they received during the consultation with their doctor. Some women perceived the included graphs and statistics to be particularly helpful to understand potential risks and benefits of their treatment options. All patients described the provided information as reliable, relevant and tailored to their needs. They found the decision aid easy to understand and balanced (not in favour of NAST or surgery). The amount of the information provided was seen to be just right. Most women received the decision aid after the initial consultation with their surgeon and perceived this as the right delivery timing. Reading and rereading the decision aid at home in between two consultations allowed women to easily integrate the decision aid into their care. They appreciated the opportunity to reconsider their options after consulting their doctor. A number of women reported that their family members used the decision aid as well and thus became more informed and involved in the decision making process. Some women took the decision aid to the next consultation with their doctor to discuss their preferences and concerns further. All patients followed their doctors' treatment recommendation. The decision aid seemed to confirm but not change women's decisions on NAST. Discussion: These initial results suggest that this decision aid is a useful tool to assist breast cancer patients' involvement in the decision about NAST. A quantitative analysis of the decision aid's acceptability, feasibility and efficacy will be reported subsequently.Background: Neoadjuvant systemic therapy (NAST) is a treatment option for selected patients with highly proliferative and/or large operable breast cancer. Whilst survival outcomes are equivalent between up-front surgery and NAST, the decision about treatment sequence can be difficult due to complexity and perceived urgency of the decision. Patients may value the outcomes of these options, such as down staging and prognostication, differently. Involving patients in decisions about their healthcare reduces anxiety, increases quality of life and satisfaction with care. Decision aids can improve patient involvement in health care decisions, but one is not available for the decision about NAST. Aims/Methods: We conducted a prospective, single-arm pre-post study to evaluate a custom-designed decision aid developed for women who have been offered NAST. Eligible patients were: female; aged ≥18 years; diagnosed with an operable invasive breast cancer; considered for NAST with curative intent. Here, we report on the grounded theory qualitative analysis of a convenience sample of 16 semi-structured phone interviews to explore patient experience with this decision aid. Results: Participants' median age was 52 (IQR=41-63), median time since breast cancer diagnosis was 5 months (IQR=2-8). Most were married or living with a partner (81.3%) and had a University level degree (68.8%). Patients perceived the decision aid to be useful for becoming more informed and involved in deciding on NAST. Specifically, the decision aid enhanced patients' understanding of their type of breast cancer and the treatment options available to them by summarising and extending the information they received during the consultation with their doctor. Some women perceived the included graphs and statistics to be particularly helpful to understand potential risks and benefits of their treatment options. All patients described the provided information as reliable, relevant and tailored to their needs. They found the decision aid easy to understand and balanced (not in favour of NAST or surgery). The amount of the information provided was seen to be just right. Most women received the decision aid after the initial consultation with their surgeon and perceived this as the right delivery timing. Reading and rereading the decision aid at home in between two consultations allowed women to easily integrate the decision aid into their care. They appreciated the opportunity to reconsider their options after consulting their doctor. A number of women reported that their family members used the decision aid as well and thus became more informed and involved in the decision making process. Some women took the decision aid to the next consultation with their doctor to discuss their preferences and concerns further. All patients followed their doctors' treatment recommendation. The decision aid seemed to confirm but not change women's decisions on NAST. Discussion: These initial results suggest that this decision aid is a useful tool to assist breast cancer patients' involvement in the decision about NAST. A quantitative analysis of the decision aid's acceptability, feasibility and efficacy will be reported subsequently. Citation Format: Zdenkowski N, Herrmann A, Hall A, Boyle FM, Butow P. Women's experiences with a decision aid for neoadjuvant systemic therapy for operable breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-11-02.