Marie?Anne Durand|Renata W. Yen|A. James O’Malley|Danielle Schubbe|Mary C. Politi|Catherine Saunders|Shubhada Dhage|Kari M. Rosenkranz|Julie A. Margenthaler|Anna N.A. Tosteson|Eloise Crayton|Sherrill Jackson|Amy Bradley|Linda Lucas Walling|Christine Marx|Robert J. Volk|Karen Sepucha|Elissa M. Ozanne|Sanja Percac?Lima|Emily Bergin|Courtney Goodwin|Caity Miller|Camille Harris|Richard J. Barth|Rebecca Aft|Sheldon Feldman|Amy Cyr|Christina V. Angeles|Shuai Jiang|Glyn Elwyn
What matters most: Randomized controlled trial of breast cancer surgery conversation aids across socioeconomic strata
Dartmouth College|Dartmouth College|Dartmouth College|Dartmouth College|Washington University in St. Louis|Dartmouth College|Dartmouth–Hitchcock Medical Center|New York University|University School|Dartmouth–Hitchcock Medical Center|Washington University in St. Louis|Dartmouth College|USC Norris Comprehensive Cancer Center|Cotton (United States)|Washington University in St. Louis|Washington University in St. Louis|Dartmouth College|Dartmouth College|Washington University in St. Louis|The University of Texas MD Anderson Cancer Center|Massachusetts General Hospital|University of Utah|Chelsea Hospital|Massachusetts General Hospital|Montefiore Medical Center|Washington University in St. Louis|Montefiore Medical Center|Dartmouth College|Dartmouth–Hitchcock Medical Center|Washington University in St. Louis|Montefiore Medical Center|Washington University in St. Louis|Dartmouth–Hitchcock Medical Center|Dartmouth College|Dartmouth College
background women lower socioeconomic status ses earlystage breast cancer likely report poorer physicianpatient communication lower satisfaction surgery lower involvement decision making higher decision regret compared women higher ses objective study understand support women across socioeconomic strata making breast cancer surgery choices methods conducted 3arm option grid picture option grid usual care multisite randomized controlled superiority trial surgeonlevel randomization option grid text picture option grid pictures plus text conversation aids evidencebased summaries available breast cancer surgery options paper decision quality primary outcome treatment choice treatment intention shared decision making sdm anxiety quality life decision regret coordination care measured t0 preconsultation t5 1year surgery results sixteen surgeons saw 571 622 consented patients patients picture option grid arm n 248 higher knowledge immediately visit t2 1 week surgery within 2 weeks first postoperative visit t3 improved decision process t2 t3 lower decision regret t3 sdm observed selfreported compared usual care n 257 patients option grid arm n 66 higher decision process scores t2 t3 better coordination care 12 weeks surgery within 2 weeks second postoperative visit t4 observed sdm surgical visit t1 compared usual care arm subgroup analyses suggested picture option grid impact among women lower ses health literacy neither intervention affected concordance treatment choice anxiety conclusions paperbased conversation aids improved key outcomes usual care picture option grid impact among disadvantaged patients lay summary objective study understand help women lower incomes less formal education make breast cancer surgery choices compared usual care conversation aid pictures text led higher knowledge improved decision process shared decision making sdm lowered decision regret textonly conversation aid led improved decision process coordinated care higher sdm compared usual care conversation aid pictures helpful women lower income less formal education conversation aids pictures text helped women make better breast cancer surgery choices