Supporting decision-making about neoadjuvant therapy for women with breast cancer

Abstract

Patients who have been diagnosed with breast cancer have a range of treatment options available to them. Patient involvement in decision-making is considered best practice, however due to the complexity of the options, health professionals not involving patients, and the distress of the diagnosis of cancer, patients may not be as involved as they wish to be. The decision about whether to receive neoadjuvant systemic therapy is one decision where the preferences of the patient influences treatment choice. Interviews with patients with a history of breast cancer indicated a desire for more information and involvement in the decision about neoadjuvant systemic therapy. In preference-sensitive situations such as this, patient decision aids have been shown to improve decision-related outcomes. The aim of this research was to identify and support the decisional needs of patients and clinicians who are considering neoadjuvant systemic therapy for operable breast cancer. A systematic review found that no decision aid was available for patients considering neoadjuvant systemic therapy for breast cancer. A survey of clinicians found high levels of interest in neoadjuvant systemic therapy, and a need for patient decision support. The studies described above laid the foundation for the development of a patient decision aid, using the International Patient Decision Aid Standards collaboration criteria, for women considering neoadjuvant systemic therapy for operable breast cancer. The evaluation study demonstrated that the decision aid was acceptable to patients and clinicians, and was feasible to use in clinical practice. After using the decision aid, patients had decreased decisional conflict, increased participation, and high satisfaction. Knowledge scores were acceptable, and anxiety and distress decreased over time. This decision aid is a new, effective resource developed in response to an identified need for information and decision support for women with early stage breast cancer who are considering neoadjuvant systemic therapy. Future work will focus on methods to optimise the implementation of the decision aid in routine practice on a global scale.