BREAST IRRADIATION POSTLUMPECTOMY - DEVELOPMENT AND EVALUATION OF A DECISION INSTRUMENT

Purpose: To develop an instrument to help clinicians inform patients a bout the benefits and risks of breast irradiation following lumpectomy and to help an informed patient decide whether she prefers this treat ment. Methods: A Decision Board consisting of written material and vis ual aids was developed. It provides the patient with derailed informat ion about her choices (breast irradiation or nat), outcomes (breast re currence and survival), probability of those outcomes, and quality of life associated with treatment and outcome. We studied the decision-ma king process in 82 consecutive node-negative lumpectomy patients who w ere seen in consultation by a radiation oncologist and oncology nurse. The Decision Board was used in the last 30 patients in the cohort. Re sults: Patient comprehension following the consultation without the De cision Board was greater than 65% for all questions addressed, except for poor understanding of the lack of survival benefit associated with breast irradiation (12% of patients answered correctly) and that it c ould not be repeated (15% of patients answered correctly). Comprehensi on following the consultation with the Decision Board was similar, but understanding regarding the repetition of radiation (83%) was improve d. Only 70% of patients in the no-Decision Board group felt they were offered a choice. This was increased to 97% in the Decision-Board grou p. Overall, 95% of patients chose breast irradiation, and this did not differ between groups. Patients reported several reasons for choosing breast irradiation, all of equal importance. Conclusion: The Decision Board facilitated shared decision making in node-negative lumpectomy patients who chose breast irradiation, but it did not affect a patient 's choice to select breast irradiation. J Clin Oncol 13:847-853, (C) l 995 by American Society of Clinical Oncology.