Advertisement

Annals of Surgical Oncology

, Volume 26, Issue 10, pp 3275–3281 | Cite as

A Randomized Controlled Trial Evaluating the Impact of Pre-Consultation Information on Patients’ Perception of Information Conveyed and Satisfaction with the Decision-Making Process

  • Trista J. Stankowski-Drengler
  • Jennifer L. Tucholka
  • Jordan G. Bruce
  • Nicole M. Steffens
  • Jessica R. Schumacher
  • Caprice C. Greenberg
  • Lee G. Wilke
  • Bret Hanlon
  • Jennifer Steiman
  • Heather B. NeumanEmail author
Breast Oncology

Abstract

Background

Patient participation in treatment decision-making is a health care priority. This study hypothesized that providing a decision aid before surgical consultation would better prepare patients for decision-making. The objective was to examine the impact of a decision aid versus high-quality websites on patients’ perceptions of information conveyed during surgical consultation and satisfaction with the decision process.

Methods

Patients with stages 0 to 3 breast cancer were randomized. Surveys assessed perceptions of information conveyed, being asked surgical preference, and satisfaction with the decision process. Multivariable logistic regression assessed associations between outcomes and randomization arm, patient factors, and surgeon. Change in Pseudo-R2 assessed the comparative effect of these factors on perceptions of the information conveyed.

Results

The median patient age was 59 years. Most of the patients (98%) were white, and 62% were college educated (n = 201). The findings showed no association between randomization arm and perceptions of information conveyed, being asked surgical preference, or satisfaction with the decision process. Most of the patients reported discussing both breast-conserving therapy and mastectomy (69%) and being asked their surgical preference (65%). The surgeon seen was more important than the randomization arm or the patient factors in predicting patients’ perceptions of information conveyed (explained 64-69% of the variation), and 63% of the patients were satisfied with the decision process.

Conclusion

Use of a decision aid compared with high-quality websites did not increase patients’ perceptions of information conveyed or satisfaction with the decision process. Although the surgeon seen influenced aspects of the patient experience, the surgeon was not associated with satisfaction. Understanding the factors driving low satisfaction is critical because this is increasingly used as a marker of health care quality.

Notes

Acknowledgment

The project was supported in part by NIH T32 Grant, NCI P30 CA014520, the BIRCWH Scholars Program (K12 HD055894), and the MT-DIRC Fellowship (R25CA171994).

Disclosures

There are no conflicts of interest.

References

  1. 1.
    Lantz PM, Janz NK, Fagerlin A, et al. Satisfaction with surgery outcomes and the decision process in a population-based sample of women with breast cancer. Health Serv Res. 2005;40:745–767.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Presson AP, Zhang C, Abtahi AM, Kean J, Hung M, Tyser AR. Psychometric properties of the Press Ganey(R) Outpatient Medical Practice Survey. Health Qual Life Outcomes. 2017;15:32.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Services CfMaM. Hospital Value-Based Purchasing. Medicare Learning Network Booklet 2017. Retrieved 16 Mar 2018 at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf.
  4. 4.
    Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.CrossRefGoogle Scholar
  5. 5.
    Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.CrossRefGoogle Scholar
  6. 6.
    Poggi MM, Danforth DN, Sciuto LC, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute Randomized Trial. Cancer. 2003;98:697–702.CrossRefPubMedGoogle Scholar
  7. 7.
    Lee CN, Chang Y, Adimorah N, et al. Decision-making about surgery for early-stage breast cancer. J Am Coll Surg. 2012;214:1–10.CrossRefPubMedGoogle Scholar
  8. 8.
    Waljee JF, Rogers MA, Alderman AK. Decision aids and breast cancer: do they influence choice for surgery and knowledge of treatment options? J Clin Oncol. 2007;25:1067–73.CrossRefPubMedGoogle Scholar
  9. 9.
    Tucholka JL, Yang DY, Bruce JG, et al. A randomized controlled trial evaluating the impact of web-based information on breast cancer patients’ knowledge of surgical treatment options. J Am Coll Surg. 2018;226:126–33.CrossRefPubMedGoogle Scholar
  10. 10.
    Bruce JG, Tucholka JL, Steffens NM, Neuman HB. Quality of online information to support patient decision-making in breast cancer surgery. J Surg Oncol. 2015;112:575–80.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Kind AJ, Jencks S, Brock J, et al. Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study. Ann Intern Med. 2014;161:765–74.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Singh GK. Area deprivation and widening inequalities in US mortality, 1969–1998. Am J Pub Health. 2003;93:1137–43.CrossRefGoogle Scholar
  13. 13.
    Sepucha KR, Belkora JK, Chang Y, et al. Measuring decision quality: psychometric evaluation of a new instrument for breast cancer surgery. BMC Med Informat Decision-Making. 2012;12:51.CrossRefGoogle Scholar
  14. 14.
    Degner LF, Sloan JA, Venkatesh P. The Control Preferences Scale. Can J Nurs Res. 1997;29:21–43.PubMedGoogle Scholar
  15. 15.
    Greenberg CC, Lipsitz SR, Hughes ME, et al. Institutional variation in the surgical treatment of breast cancer: a study of the NCCN. Ann Surg. 2011;254:339–45.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Obeidat R, Finnell DS, Lally RM. Decision aids for surgical treatment of early-stage breast cancer: a narrative review of the literature. Patient Educ Couns. 2011;85:e311–21.CrossRefPubMedGoogle Scholar
  17. 17.
    Stacey D, Legare F, Lewis K, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2017;4:Cd001431.Google Scholar
  18. 18.
    Whelan T, Levine M, Willan A, et al. Effect of a decision aid on knowledge and treatment decision-making for breast cancer surgery: a randomized trial. JAMA. 2004;292:435–41.CrossRefPubMedGoogle Scholar
  19. 19.
    Molenaar S, Oort F, Sprangers M, et al. Predictors of patients’ choices for breast-conserving therapy or mastectomy: a prospective study. Br J Cancer. 2004;90:2123–30.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Bruce JG, Tucholka JL, Steffens NM, Mahoney JE, Neuman HB. Feasibility of providing web-based information to breast cancer patients prior to a surgical consult. J Cancer Educ. 2018;33:1069–74.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Trista J. Stankowski-Drengler
    • 1
  • Jennifer L. Tucholka
    • 1
  • Jordan G. Bruce
    • 2
  • Nicole M. Steffens
    • 3
  • Jessica R. Schumacher
    • 1
  • Caprice C. Greenberg
    • 1
    • 4
  • Lee G. Wilke
    • 1
    • 4
  • Bret Hanlon
    • 1
  • Jennifer Steiman
    • 5
  • Heather B. Neuman
    • 1
    • 4
    Email author
  1. 1.Department of Surgery, Wisconsin Surgical Outcomes Research ProgramUniversity of WisconsinMadisonUSA
  2. 2.Department of SurgeryWashington UniversitySt. LouisUSA
  3. 3.Denver Public Health, Denver Health and Hospital AuthorityDenverUSA
  4. 4.Carbone Cancer Center, University of WisconsinMadisonUSA
  5. 5.Department of SurgeryUniversity of PittsburghPittsburghUSA

Personalised recommendations