Raphael D B, Russell N S, Winkens B, Immink J M, Westhoff P G, Stenfert Kroese M C, Stam M R, Bijker N, van Gestel C M J, van der Weijden T, Boersma L J
Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands.
Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
Tech Innov Patient Support Radiat Oncol. 2021 Aug 29;20:1-9. doi: 10.1016/j.tipsro.2021.08.002. eCollection 2021 Dec.
In selected breast cancer patients, radiation treatment (RT) lowers the recurrence risk, with minor or no improvement of survival. In these patients, the choice to undergo RT is considered a preference-sensitive decision. To facilitate shared decision-making (SDM) for this choice, a patient decision aid was made. We aimed to evaluate the effect of the PtDA on decisional conflict.
We performed a multi-center pre- and post-intervention study (BRASA-trial). The first 214 patients made a choice without support of the PtDA; the subsequent 189 patients received a link to the PtDA. The primary endpoint was decisional conflict; secondary endpoints were perceived SDM and knowledge on treatment options. Patients filled out questionnaires immediately after, and three months after their decision. Data were analyzed with multi-level regression analysis.
After correcting for the difference in age and educational level, the mean (±SD) decisional conflict for the intervention group (27.3 ± 11.4) was similar to the control group (26.8 ± 11.4; difference = 0.86, 95 %CI 1.67,3.36) three months after their decision. This also applied to perceived SDM. Patients exposed to the PtDA pursued additional treatment less often (45% vs 56%, odds ratio 0.59, 95 %CI 0.37,0.95) and scored significantly higher on the knowledge test (7.4 ± 2.5 vs 6.1 ± 2.7, corrected difference = 1.0, 95 %CI 0.50,1.49). There was no significant increase in consultation time.
Handing out the PtDA was not associated with improved scores in decisional conflict or perceived SDM, but it was associated with a choice for less additional treatment and better knowledge about the treatment options.
在部分乳腺癌患者中，放射治疗（RT）可降低复发风险，但对生存率的改善较小或无改善。在这些患者中，接受RT的选择被认为是一个偏好敏感型决策。为促进对此选择的共同决策（SDM），制作了一份患者决策辅助工具。我们旨在评估患者决策辅助工具（PtDA）对决策冲突的影响。
我们进行了一项多中心干预前后研究（BRASA试验）。前214名患者在没有PtDA支持的情况下做出选择；随后的189名患者收到了PtDA的链接。主要终点是决策冲突；次要终点是感知到的SDM和对治疗选择的了解。患者在做出决定后立即以及决定后三个月填写问卷。数据采用多级回归分析进行分析。
在校正年龄和教育水平差异后，干预组在做出决定三个月后的平均（±标准差）决策冲突（27.3±11.4）与对照组（26.8±11.4；差异=0.86，95%CI 1.67，3.36）相似。这也适用于感知到的SDM。接触PtDA的患者较少寻求额外治疗（45%对56%，优势比0.59，95%CI 0.37，0.95），并且在知识测试中的得分显著更高（7.4±2.5对6.1±2.7，校正差异=1.0，95%CI 0.50，1.49）。咨询时间没有显著增加。
发放PtDA与决策冲突得分或感知到的SDM改善无关，但与选择较少的额外治疗以及对治疗选择有更好的了解有关。
