Trista J Stankowski-Drengler1, Jennifer L Tucholka1, Jordan G Bruce2, Nicole M Steffens3, Jessica R Schumacher1, Caprice C Greenberg1,4, Lee G Wilke1,4, Bret Hanlon1, Jennifer Steiman5, Heather B Neuman6,7. 1. Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin, Madison, WI, USA. 2. Department of Surgery, Washington University, St. Louis, MO, USA. 3. Denver Public Health, Denver Health and Hospital Authority, Denver, CO, USA. 4. Carbone Cancer Center, University of Wisconsin, Madison, WI, USA. 5. Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA. 6. Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin, Madison, WI, USA. neuman@surgery.wisc.edu. 7. Carbone Cancer Center, University of Wisconsin, Madison, WI, USA. neuman@surgery.wisc.edu.
Abstract
BACKGROUND: Patient participation in treatment decision-making is a health care priority. This study hypothesized that providing a decision aid before surgical consultation would better prepare patients for decision-making. The objective was to examine the impact of a decision aid versus high-quality websites on patients' perceptions of information conveyed during surgical consultation and satisfaction with the decision process. METHODS:Patients with stages 0 to 3 breast cancer were randomized. Surveys assessed perceptions of information conveyed, being asked surgical preference, and satisfaction with the decision process. Multivariable logistic regression assessed associations between outcomes and randomization arm, patient factors, and surgeon. Change in Pseudo-R2 assessed the comparative effect of these factors on perceptions of the information conveyed. RESULTS: The median patient age was 59 years. Most of the patients (98%) were white, and 62% were college educated (n = 201). The findings showed no association between randomization arm and perceptions of information conveyed, being asked surgical preference, or satisfaction with the decision process. Most of the patients reported discussing both breast-conserving therapy and mastectomy (69%) and being asked their surgical preference (65%). The surgeon seen was more important than the randomization arm or the patient factors in predicting patients' perceptions of information conveyed (explained 64-69% of the variation), and 63% of the patients were satisfied with the decision process. CONCLUSION: Use of a decision aid compared with high-quality websites did not increase patients' perceptions of information conveyed or satisfaction with the decision process. Although the surgeon seen influenced aspects of the patient experience, the surgeon was not associated with satisfaction. Understanding the factors driving low satisfaction is critical because this is increasingly used as a marker of health care quality.
RCT Entities:
BACKGROUND:Patient participation in treatment decision-making is a health care priority. This study hypothesized that providing a decision aid before surgical consultation would better prepare patients for decision-making. The objective was to examine the impact of a decision aid versus high-quality websites on patients' perceptions of information conveyed during surgical consultation and satisfaction with the decision process. METHODS:Patients with stages 0 to 3 breast cancer were randomized. Surveys assessed perceptions of information conveyed, being asked surgical preference, and satisfaction with the decision process. Multivariable logistic regression assessed associations between outcomes and randomization arm, patient factors, and surgeon. Change in Pseudo-R2 assessed the comparative effect of these factors on perceptions of the information conveyed. RESULTS: The median patient age was 59 years. Most of the patients (98%) were white, and 62% were college educated (n = 201). The findings showed no association between randomization arm and perceptions of information conveyed, being asked surgical preference, or satisfaction with the decision process. Most of the patients reported discussing both breast-conserving therapy and mastectomy (69%) and being asked their surgical preference (65%). The surgeon seen was more important than the randomization arm or the patient factors in predicting patients' perceptions of information conveyed (explained 64-69% of the variation), and 63% of the patients were satisfied with the decision process. CONCLUSION: Use of a decision aid compared with high-quality websites did not increase patients' perceptions of information conveyed or satisfaction with the decision process. Although the surgeon seen influenced aspects of the patient experience, the surgeon was not associated with satisfaction. Understanding the factors driving low satisfaction is critical because this is increasingly used as a marker of health care quality.
Authors: Dawn Stacey; France Légaré; Krystina Lewis; Michael J Barry; Carol L Bennett; Karen B Eden; Margaret Holmes-Rovner; Hilary Llewellyn-Thomas; Anne Lyddiatt; Richard Thomson; Lyndal Trevena Journal: Cochrane Database Syst Rev Date: 2017-04-12
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Authors: Jennifer L Tucholka; Dou-Yan Yang; Jordan G Bruce; Nicole M Steffens; Jessica R Schumacher; Caprice C Greenberg; Lee G Wilke; Jennifer Steiman; Heather B Neuman Journal: J Am Coll Surg Date: 2017-12-12 Impact factor: 6.113
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