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The American Society of Breast Surgeons.
Annals of Surgical Oncology

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A Randomized Controlled Trial Evaluating the Impact of Pre-Consultation Information on Patients’ Perception of Information Conveyed and Satisfaction with the Decision-Making Process

Trista J. Stankowski-Drengler MD, Jennifer L. Tucholka BS, Jordan G. Bruce MD, Nicole M. Steffens MPH, Jessica R. Schumacher PhD, Caprice C. Greenberg MD, MPH, Lee G. Wilke MD, Bret Hanlon PhD, Jennifer Steiman MD, Heather B. Neuman MD, MS
Breast Oncology
Volume 26, Issue 10 / October , 2019

Abstract

Background

Patient participation in treatment decision-making is a health care priority. This study hypothesized that providing a decision aid before surgical consultation would better prepare patients for decision-making. The objective was to examine the impact of a decision aid versus high-quality websites on patients’ perceptions of information conveyed during surgical consultation and satisfaction with the decision process.

Methods

Patients with stages 0 to 3 breast cancer were randomized. Surveys assessed perceptions of information conveyed, being asked surgical preference, and satisfaction with the decision process. Multivariable logistic regression assessed associations between outcomes and randomization arm, patient factors, and surgeon. Change in Pseudo-R2 assessed the comparative effect of these factors on perceptions of the information conveyed.

Results

The median patient age was 59 years. Most of the patients (98%) were white, and 62% were college educated (n = 201). The findings showed no association between randomization arm and perceptions of information conveyed, being asked surgical preference, or satisfaction with the decision process. Most of the patients reported discussing both breast-conserving therapy and mastectomy (69%) and being asked their surgical preference (65%). The surgeon seen was more important than the randomization arm or the patient factors in predicting patients’ perceptions of information conveyed (explained 64-69% of the variation), and 63% of the patients were satisfied with the decision process.

Conclusion

Use of a decision aid compared with high-quality websites did not increase patients’ perceptions of information conveyed or satisfaction with the decision process. Although the surgeon seen influenced aspects of the patient experience, the surgeon was not associated with satisfaction. Understanding the factors driving low satisfaction is critical because this is increasingly used as a marker of health care quality.

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