Tape/Workbook Helps Breast Cancer Patients Decide on Therapy

SAN ANTONIO--A new decision aid, developed by a group of Canadian researchers,uses an audiotape and a workbook to help women with early-stage breastcancer decide between mas-tectomy and breast-conserving surgery with radiationtherapy.

"Since the long-term survival of each option is equivalent, whethera woman chooses one or the other is very much based on her personal preference,"Carol A. Sawka, MD, of the Toronto-Sunnybrook Regional Cancer Center, saidat a poster session of the San Antonio Breast Cancer Symposium.

The researchers first developed a set of critical content items forthe information aid, and then consulted several focus groups for feedbackon the usefulness of the information.

"The women all wanted an information aid that would not replacetheir time with the surgeon but, rather, augment it. They wanted somethingthey could use at home later and go over many times," Dr. Sawka said.

The investigators learned from the focus groups that an audiotape wouldbe helpful so that patients could hear a woman's voice, "a sympatheticvoice," Dr. Sawka emphasized. They then adapted the audiotape workbookformat developed by Annette O'Connor in Ottawa. "The tape runs 26minutes, and women go through it with the workbook page by page,"she said.

The program differs from a simple educational pamphlet because it providesexplicit probabilities about, for example, possible reactions to radiationtherapy, with pictures showing what these reactions look like. It coversthe differences in surgical approach, need for radiation treatment, short-and long-term side effects of radiation, risks of recurrence, and follow-upschedule.

Values Clarification

At the end of the program, the workbook takes the patient through avalues clarification exercise in which the woman considers the personalimportance to her of the possible risks and benefits for each treatment."It is basically a scale that allows women to weigh the pros and consof each approach, to help them understand where they fit," Dr. Sawkasaid.

Results of a pilot study of 18 women showed that, by and large, womenliked the program, found it very useful, and felt that it helped to clarifyinformation about treatment without raising extra questions. They alsosaid that the decision aid did not increase their anxiety about their breastcancer diagnosis.

Based on the pilot study, the researchers have created a new versionof the decision aid and are now conducting a randomized trial of 200 women,in which surgeons provide patients with either the audiotape/workbook ora standard pamphlet that has the same information but without explicitprobabilities, photographs, or the values clarification exercise. Outcomeswill be comprehension, decisional conflict, anxiety, and post- decisionalregret.