University of Michigan Medical School, Ann Arbor, MI, USA; Vanderbilt University Medical Center, Department of Surgery, Nashville, TN, USA.
University of Michigan Medical School, Ann Arbor, MI, USA.
Am J Surg. 2024 Sep;235:115774. doi: 10.1016/j.amjsurg.2024.115774. Epub 2024 May 25.
BACKGROUND: Despite national guidelines recommending omission of sentinel lymph node biopsy (SLNB) and post-lumpectomy radiotherapy (RT) in older women with early-stage, hormone receptor-positive (HR+) breast cancer, these practices persist. This pilot study assesses whether a decision aid can target patient-level determinants of low-value treatments. METHODS: We adapted and pilot-tested a decision aid in women ≥70 years old with early-stage HR + breast cancer. Primary outcomes included acceptability and appropriateness of the decision aid. Secondary outcomes included treatment choice and satisfaction with decision. RESULTS: Twenty-three patients enrolled in the trial. 19 completed survey one; 16 completed survey two. Primary outcomes demonstrated that 84% of patients agreed or strongly agreed the aid was acceptable and appropriate. Secondary outcomes demonstrated that 19% of patients underwent SLNB (below pre-intervention baseline), and 85% received adjuvant RT (change not statistically significant). CONCLUSIONS: We demonstrate that a decision aid may effectively target patient-level factors contributing to overuse of low-value therapies.
背景：尽管国家指南建议在早期激素受体阳性（HR+）乳腺癌的老年女性中省略前哨淋巴结活检（SLNB）和保乳术后放疗（RT），但这些做法仍然存在。本试点研究评估了决策辅助工具是否可以针对低价值治疗的患者层面决定因素。 方法：我们对年龄≥70 岁的早期 HR+乳腺癌女性进行了决策辅助工具的改编和试点测试。主要结局包括决策辅助工具的可接受性和适当性。次要结局包括治疗选择和决策满意度。 结果：共有 23 名患者参加了试验。19 名患者完成了调查一，16 名患者完成了调查二。主要结局表明，84%的患者同意或强烈同意该辅助工具是可接受和适当的。次要结局表明，19%的患者接受了 SLNB（低于干预前的基线），85%的患者接受了辅助 RT（变化无统计学意义）。 结论：我们证明决策辅助工具可能有效地针对导致过度使用低价值治疗的患者层面因素。
Ann Surg Oncol. 2021-2
Int J Radiat Oncol Biol Phys. 2012-2-11
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