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Results from a randomized trial of a web-based,tailored decision aid for women at high risk for breast cancer
Authors:Matthew P. Banegas  Jennifer B. McClure  William E. Barlow  Peter A. Ubel  Dylan M. Smith  Brian J. Zikmund-Fisher  Sarah M. Greene  Angela Fagerlin
Affiliation:1. University of Washington, Department of Health Services, Seattle, USA;2. Fred Hutchinson Cancer Research Center, Seattle, USA;3. Group Health Research Institute, Seattle, USA;4. Cancer Research and Biostatistics, Seattle, USA;5. Fuqua School of Business, Duke University, Durham, USA;6. Sanford School of Public Policy, Duke University, Durham, USA;g Department of Preventive Medicine, Stony Brook University, Stony Brook, USA;h Center for Bioethics and Social Sciences in Medicine, Ann Arbor, USA;i Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, USA;j Department of Internal Medicine, University of Michigan, Ann Arbor, USA;k Risk Science Center, University of Michigan, Ann Arbor, USA;l VA Ann Arbor Center for Clinical Management Research, Ann Arbor, USA;m Department of Psychology, University of Michigan, Ann Arbor, USA
Abstract:

Objective

To assess the impact of Guide to Decide (GtD), a web-based, personally-tailored decision aid designed to inform women's decisions about prophylactic tamoxifen and raloxifene use.

Methods

Postmenopausal women, age 46–74, with BCRAT 5-year risk ≥1.66% and no prior history of breast cancer were randomized to one of three study arms:intervention (n = 690), Time 1 control (n = 160), or 3-month control (n = 162). Intervention participants viewed GtD prior to completing a post-test and 3 month follow-up assessment. Controls did not. We assessed the impact of GtD on women's decisional conflict levels and treatment decision behavior at post-test and at 3 months, respectively.

Results

Intervention participants had significantly lower decisional conflict levels at post-test (p < 0.001) and significantly higher odds of making a decision about whether or not to take prophylactic tamoxifen or raloxifene at 3-month follow-up (p < 0.001) compared to control participants.

Conclusion

GtD lowered decisional conflict and helped women at high risk of breast cancer decide whether to take prophylactic tamoxifen or raloxifene to reduce their cancer risk.

Practice implications

Web-based, tailored decision aids should be used more routinely to facilitate informed medical decisions, reduce patients’ decisional conflict, and empower patients to choose the treatment strategy that best reflects their own values.
Keywords:Decision aids   Tamoxifen   Raloxifene   Breast cancer prevention   Tailoring
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