Department of Population Health Sciences, School of Medicine, University of Utah, Population Health Sciences, 295 Chipeta Way Rm 1N512, Salt Lake City, UT, 84108, USA.
University of Utah, Salt Lake City, UT, USA.
Breast Cancer Res. 2024 Sep 17;26(1):134. doi: 10.1186/s13058-024-01891-w.
The heterogeneous biology of ductal carcinoma in situ (DCIS), as well as the variable outcomes, in the setting of numerous treatment options have led to prognostic uncertainty. Consequently, making treatment decisions is challenging and necessitates involved communication between patient and provider about the risks and benefits. We developed and investigated an interactive decision support tool (DST) designed to improve communication of treatment options and related long-term risks for individuals diagnosed with DCIS.
The DST was developed for use by individuals aged > 40 years with DCIS and is based on a disease simulation model that integrates empirical data and clinical characteristics to predict patient-specific impacts of six DCIS treatment choices. Personalized risk predictions for each treatment option were communicated using icon arrays and percentages for each outcome. Users of the DST were asked before and after interacting with the DST about: (1) awareness of DCIS treatment options, (2) willingness to consider these options, (3) knowledge of risks associated with DCIS, and (4) helpfulness of the DST. Data were collected from January 2019 to April 2022. Users' median estimated risk of dying from DCIS in 10 years decreased from 9% pre-tool to 3% post-tool (p < 0.0001). 76% (n = 101/132) found the tool helpful.
Information about DCIS treatment options and related risk predictions was effectively communicated, and a large majority participants found the DST to be helpful. Successfully informing patients about their treatment options and how their individual risks affect those options is a critical step in the decision-making process.
gov Identifier NCT02926911.
导管原位癌 (DCIS) 的生物学异质性以及众多治疗选择所导致的不同结局导致了预后的不确定性。因此，治疗决策具有挑战性，需要患者和提供者就风险和益处进行深入沟通。我们开发并研究了一种交互式决策支持工具 (DST)，旨在改善个体 DCIS 患者的治疗方案选择和相关长期风险的沟通。
该 DST 适用于年龄>40 岁的 DCIS 患者，它基于一种疾病模拟模型，该模型集成了经验数据和临床特征，以预测六种 DCIS 治疗选择对每个患者的具体影响。使用图标数组和百分比为每个结果传达了针对每种治疗方案的个性化风险预测。在与 DST 交互之前和之后，DST 用户被问到：(1) 对 DCIS 治疗方案的了解程度，(2) 考虑这些方案的意愿，(3) 对 DCIS 相关风险的了解，以及 (4) DST 的有用性。数据收集于 2019 年 1 月至 2022 年 4 月。患者在 10 年内死于 DCIS 的估计风险中位数从使用工具前的 9%下降到使用工具后的 3%（p<0.0001）。76%（n=101/132）认为该工具有用。
有效地传达了有关 DCIS 治疗方案和相关风险预测的信息，大多数参与者认为该 DST 很有帮助。成功地向患者提供有关其治疗方案以及个人风险如何影响这些方案的信息是决策过程中的关键步骤。
gov 标识符 NCT02926911。
