Neve Matt, Henry-Noel Nayanee, Mehta Rajin, Trudeau Maureen, Menjak Ines, Szumacher Ewa
Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, CAN.
Neuroscience and Health Studies, Population Health (Science), University of Toronto, Toronto, CAN.
Cureus. 2020 Apr 16;12(4):e7690. doi: 10.7759/cureus.7690.
Background Whole breast irradiation therapy (WBRT), accelerated partial breast irradiation (APBI), and omission of radiotherapy (ORT) are options for women aged 65 years and older with low-risk breast cancer post lumpectomy. Aim The aim of the study was to develop and pilot a decision aid pamphlet (DA), among women aged 65 years and older with low-risk breast cancer and who were undergoing or had undergone WBRT, to ensure they were fully informed about the different options for radiation treatment following lumpectomy. Methods We piloted the decision aid with 40 participants, women aged 65-86 years with low-risk breast cancer and who had undergone or were undergoing WBRT. The women completed a pre-DA Decisional Conflict Scale (DCS) and post-DA DCS, Knowledge, Preparation for Decision-Making and Acceptability questionnaires. We then used descriptive statistics to compare the DCS scores before and after distributing the decision aid. Results The median age of the 40 participants was 72 years (range, 65-86 years), 38% less than 70, 48% between 70 and 80 and 15% over 80. Ethnicity included 53% Caucasians and the remaining 48% African-Americans, Asians, Europeans, and others. Thirty-three percent completed high school, 25% college/university, and 7.5% elementary education. Seventy-eight percent had T1 and 23% T2 breast cancer. Thirty-three percent completed RT less than one year prior to the study, 30% between one to two years, and 38% greater than two years. The median pre-DA DCS score was 31.2 (31.2-90.6), and the median post-DA DCS score was 23.4 (0-75.0). Six (6/40) patients scored 0 on the DCS post intervention, while 13 (13/40) scored less than 15.6. The median knowledge score was 70%. Preparation for decision-making median score was 90%. Ninety-nine percent stated that the DA was useful for future patients. Conclusion We piloted a DA that aimed to provide the necessary information for women aged 65 years and older with low-risk breast cancer, to understand radiation treatment options post lumpectomy. The results obtained from the study highlighted the utility of the DA in increasing patient comprehension about the different treatment options, reducing decisional conflict in terms of perceptions of uncertainty and preparing patients to engage with their radiation oncologist during the treatment decision-making process. Ultimately, this study promoted the importance of patient-centered care in geriatric oncology by piloting this DA to see its effectiveness while also being responsive to patient's thoughts regarding the tool, so as to have their values guide its further development.
背景 全乳照射疗法（WBRT）、加速部分乳腺照射（APBI）以及省略放射治疗（ORT）是65岁及以上低风险乳腺癌患者保乳术后的治疗选择。目的 本研究的目的是为65岁及以上低风险乳腺癌且正在接受或已经接受过WBRT的女性开发并试行一份决策辅助手册（DA），以确保她们充分了解保乳术后不同的放射治疗选择。方法 我们对40名参与者试行该决策辅助工具，这些女性年龄在65 - 86岁之间，患有低风险乳腺癌，且已经接受或正在接受WBRT。这些女性完成了DA前的决策冲突量表（DCS）以及DA后的DCS、知识、决策准备和可接受性问卷。然后我们使用描述性统计来比较发放决策辅助工具前后的DCS分数。结果 40名参与者的中位年龄为72岁（范围65 - 86岁），38%小于70岁，48%在70至80岁之间，15%超过80岁。种族包括53%的白种人，其余48%为非裔美国人、亚洲人、欧洲人和其他人。33%完成了高中学业，25%完成了大专/大学学业，7.5%完成了小学教育。78%患有T1期乳腺癌，23%患有T2期乳腺癌。33%在研究前不到一年完成放疗，30%在一至两年之间，38%超过两年。DA前DCS分数的中位数为31.2（31.2 - 90.6），DA后DCS分数的中位数为23.4（0 - 75.0）。6名（6/40）患者在干预后DCS得分为0，而13名（13/40）患者得分低于15.6。知识分数的中位数为70%。决策准备分数的中位数为90%。99%的人表示该DA对未来患者有用。结论 我们试行的一份DA旨在为65岁及以上低风险乳腺癌女性提供必要信息，使其了解保乳术后的放射治疗选择。该研究获得的结果突出了DA在提高患者对不同治疗选择的理解、减少决策不确定性方面的冲突以及使患者在治疗决策过程中做好与放疗肿瘤学家沟通准备方面的作用。最终，本研究通过试行该DA以观察其有效性，同时回应患者对该工具的想法，从而以患者的价值观指导其进一步发展，凸显了老年肿瘤学中以患者为中心的护理的重要性。
