A novel patient decision aid for aftercare in breast cancer patients: A promising tool to reduce costs by individualizing aftercare |
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| Affiliation: | 1. Division of Urology, University of Ottawa, Ottawa, ON, Canada;2. Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada;3. School of Nursing, University of Ottawa, Ottawa, ON, Canada;4. Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada;1. Department of Radiation Oncology, Virginia Commonwealth University, Massey Cancer Center, Richmond, Virginia;2. Radiation Oncology Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia;3. Department of Radiation Oncology, Indiana University, IU Health Arnett Cancer Center, Lafayette, Indiana;4. Hematology Oncology Section, Medical Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia;5. Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University, Massey Cancer Center, Richmond, Virginia;6. Department of Urology, Virginia Commonwealth University, Richmond, Virginia;7. Department of Urology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia;8. Department of Radiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia |
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| Abstract: | ObjectiveA patient decision aid (PtDA), was developed to support breast cancer patients making choices about their aftercare. The aim of this pilot was to test the effects of the PtDA on Shared Decision Making (SDM), Decision Evaluation (DES) in patients, consultation time, choice of aftercare and hospital costs.MethodsA prospective before-and-after study including a control (no PtDA-usage) and experimental group (PtDA-usage during consultation) was conducted in six hospitals. Patients were offered a choice between intensive (face-to-face consultations) and less intensive (telephonic or on demand consultations) aftercare. All patients filled out three validated questionnaires (baseline (T0), directly after the consultation (T1), three months later (T2)), assessing demographics (T0), SDM(T1) and DES (T1, T2). Hospital costs and choice of aftercare were assessed from the patients' files (T2). Effect sizes ( ɳp2: 0.01 = small; 0.06 = medium; 0.14 = large; φ: 0.1 = small, 0.3 = medium, 0.5 = large) and p-values were calculated using both univariate and multivariate GLMs, a repeated measures GLM and chi-square-tests.ResultsA small improvement in SDM ( ɳp2 = 0.02) and an effect ( ɳp2 = 0.10) on DES was found in the experimental group. Significantly more PtDA-users (51% vs. 29%, φ = 0.22) chose less intensive aftercare, leading to a small reduction of hospital costs (122 vs. 92 Euro, ɳp2 = 0.01), and a large increase in average consultation time (12.5 min; ɳp2 = 0.29).ConclusionThis pilot study showed promising effects of the PtDA on SDM and hospital costs. The PtDA can be developed further to potentially reduce the increased consultation time. |
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| Keywords: | Decision aid Aftercare Shared decision making Cancer survivorship |
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