Impact of an In-visit Decision Aid on Patient Knowledge about Contralateral Prophylactic Mastectomy: A Pilot Study

• Published in: Annals of surgical oncology Vol. 24; no. 1; pp. 91 - 99
• Main Authors: Yao, Katharine, Belkora, Jeff, Bedrosian, Isabelle, Rosenberg, Shoshana, Sisco, Mark, Barrera, Ermilo, Kyrillios, Alexandra, Tilburt, Jon, Wang, Chihsiung, Rabbitt, Sarah, Pesce, Catherine, Simovic, Sandra, Winchester, David J., Sepucha, Karen
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 2017; Springer Nature B.V
• Subjects: Aged; Breast Neoplasms - psychology; Breast Neoplasms - surgery; Breast Oncology; Decision Support Techniques; Female; Humans; Medicine; Medicine & Public Health; Middle Aged; Oncology; Patient Education as Topic; Pilot Projects; Prophylactic Mastectomy - psychology; Surgery; Surgical Oncology; Contralateral Breast Cancer; Knowledge Score; Usual Care; Usual Care Group; Contralateral Prophylactic Mastectomy
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-016-5556-x

Background Studies have reported that breast cancer patients have limited understanding about the oncologic outcomes following contralateral prophylactic mastectomy (CPM). We hypothesized that an in-visit decision aid (DA) would be associated with higher patient knowledge about the anticipated short and long term outcomes of CPM. Methods We piloted a DA which used the SCOPED: (Situation, Choices, Objectives, People, Evaluation and Decision) framework. Knowledge, dichotomized as “low” (≤3 correct) versus “high” (≥4 correct), was assessed immediately after the visit by a 5 item survey. There were 97 DA patients (response rate 62.2 %) and 114 usual care (UC) patients (response rate 71.3 %). Results Patient demographic factors were similar between the two groups. Twenty-one (21.7 %) patients in the DA group underwent CPM compared with 18 (15.8 %) in the UC group ( p  = 0.22). Mean and median knowledge levels were significantly higher in the DA group compared with the UC group for patients of all ages, tumor stage, race, family history, anxiety levels, worry about CBC, and surgery type. Eighty-six (78.9 %) of UC versus 35 (37.9 %) DA patients had low knowledge. Of patients who underwent CPM, 15 (83.3 %) in the UC cohort versus 5 (25.0 %) of DA patients had “low” knowledge. Conclusions Knowledge was higher in the DA group. The UC group had approximately three times the number of patients of the DA group who were at risk for making a poorly informed decision to have CPM. Future studies should assess the impact of increased knowledge on overall CPM rates.