Offering a choice between two adjuvant chemotherapy regimens: a pilot study to develop a decision aid for women with breast cancer

Background: The primary objective of this study was to develop a decision a id which would encourage and assist patients to become involved in treatmen t decision making, and help clinicians to objectively educate patients abou t the benefits and risks of adjuvant chemotherapy for breast cancer. A seco ndary objective was to investigate the factors influencing this treatment d ecision-making process for women when choosing between adriamycin and cyclo phosphamide (AC) versus cyclophosphamide, methotrexate and fi-fluorouracil (CMF) chemotherapy. Methods: An educational visual instrument called a Deci sion Board was developed consisting of written and graphical material. The Decision Board displays general information about chemotherapy and detailed information about each chemotherapy regimen, including the schedule and si de effects, and was presented to patients with a scripted standardized oral explanation. The instrument was evaluated in 46 premenopausal women newly diagnosed with node-positive breast cancer. Following presentation of the b oard, the patients were given a take-home version to review and asked to re turn 1-2 weeks later with a decision. During the second visit each patient was asked to complete a questionnaire regarding demographics, learning and comprehension, treatment preference, and factors influencing their decision . Results: Recall of information was acceptable (greater than or equal to 8 0%), The Decision Board was found helpful by all, but the level of difficul ty with decision making was variable. Out of 46 women, 23 women chose AC, 2 1 chose CMF, and two chose no treatment. The major factors affecting treatm ent preference were related to the impact on quality of life, the length of therapy, and the side effects, in particular, vomiting and alopecia, Concl usions: The Decision Board appears to be a valuable educational tool that e nables patients to become well-informed and directly involved in their trea tment decisions. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved .