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Decision Aids and Breast Cancer: Do They Influence Choice for Surgery and Knowledge of Treatment Options?

Jennifer F. Waljee, Mary A.M. Rogers, Amy K. Alderman

From the Section of General Surgery and Section of Plastic Surgery, Department of Surgery; and the Robert Wood Johnson Clinical Scholars Program and Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI

Address reprint requests to Jennifer F. Waljee, MD, MPH, 6312 Medical Sciences Building I, 1150 West Medical Center Dr, Ann Arbor, MI 48109; e-mail: filip{at}med.umich.edu

Purpose: To describe the effect of decision aids on the choice for surgery and knowledge of surgical therapy among women with early-stage breast cancer.

Methods: A systematic review was conducted between years 1966 to 2006 of all studies designed to assess the effect of decision aids on surgical therapy. MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health (CINAHL), the Cochrane Network, HAPI databases, and bibliographies were searched. Of the 123 studies screened, 11 studies met criteria. Meta-analyses were performed to assess the pooled relative risk for surgical choice and the pooled mean difference in patient knowledge.

Results: Results from randomized controlled trials indicated that women who used a decision aid were 25% more likely to choose breast-conserving surgery over mastectomy (risk ratio, 1.25; 95% CI, 1.11 to 1.40). Decision aids significantly increased patient knowledge by 24% (P = .024). The data also suggested that decision aids decreased decisional conflict and increased satisfaction with the decision-making process. Decision aids were well received by surgeons and patients, facilitated patients’ desire for shared decision making, and were feasible to implement into practice.

Conclusion: Decision aids are important adjuncts for counseling women with early-stage breast cancer. Their use increases the likelihood that women will choose breast-conserving surgery, and enhances patient knowledge of treatment options.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.