Decision Support for Women With Breast Cancer

Breast cancer is a common malignancy among women in the United States. There are a variety of treatment decisions that need to be made. This study has been developed after a review of the literature demonstrated that women with breast cancer are making decisions regarding complex therapy issues in a way that is not congruent with their decision-making control preference.

Some patients want to be empowered with information so that they can actively participate in the decision making about their care; others want to rely on the recommendations made by the oncologist. This is important because patients who were not satisfied with their adjuvant treatment decision noted a negative effect on quality of life and self image. These patients had more difficulties with treatment side effects; including aches, hot flashes, pain, and mood alteration. In additions the Institute of Medicine recommended that patient centeredness be a key aim of health care organizations and that all patients be given the opportunity to exercise the degree of control they choose over health care decisions that affect them.

It is hypothesized that women making decisions regarding adjuvant therapy who are supported to make decisions based on their preferred level of control will have positive psychological outcomes.

Study Overview

• Status: Terminated
• Conditions: Breast Neoplasms
• Intervention / Treatment: Behavioral: Decision control preference scale

Detailed Description

This evidence based study has been developed after a review of the literature demonstrated that 14 - 58% of women with breast cancer are making decisions regarding complex therapy issues in a way that is not congruent with their decision-making control preference. Because of the prevalence of decision-making control preference incongruence and strong evidence that providing support for a woman's decision making control preference is related to quality of life measures, this study will test the implementation of a nursing intervention to support the decision making of women with breast cancer. Using sample randomization with assignment to one of two groups, this study will explore whether using Degner's Control Preference (DCP) Scale supports decision making control preferences in women who are making decisions about breast cancer treatment. Results of the study will guide implementation of sustainable evidence-based behavioral practices that can have significant effects on quality of care outcomes.

This study will assess satisfaction with decision involvement, depression, and decision making distress in women with early stage breast cancer after a decision support intervention to support a woman's preferred decision control preference. It is hypothesized that a decision support intervention that consists of providing information from the Degner Control Preference (DCP) Scale to the provider and patient will have a positive effect on psychological outcomes (decision satisfaction, decision making distress, and depression) in women making decisions about breast cancer treatment. Testing the effect of the decision support intervention on decision satisfaction, decision making distress and depression will be measured using t-Tests.

Patients with early stage breast cancer who are scheduled to have a medical oncology consultation, to decide an adjuvant therapy regimen, will be asked to participate.

128 patients will be randomly assigned to a group in which the patient and their oncologist would know the patient's preferred level of decision making control (intervention group) or a group that would receive information about a balanced diet (attention control group). Two nurses on the research team will consent participants, participate in the intervention, and collect data through interviews. Post intervention interviews will occur within 24 hours of the intervention and 4 weeks later.

• Study Type: Interventional
• Enrollment (Actual): 14
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Maryland
    • Baltimore, Maryland, United States, 21205
      • Johns Hopkins Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

1. Women with early stage (Stage I and Stage II) breast cancer that are considering adjuvant therapy and are being evaluated at the Johns Hopkins Avon Foundation Breast Center.
2. Age 18 years and older.
3. Able to read and speak English.

Exclusion Criteria:

1. Severe visual impairments that would make it difficult to read study instruments or inability to read.
2. Lack of capacity to provide informed consent to participate in the study.
3. Patients being seen for a second opinion.
4. Patients with a history of previous neoadjuvant chemotherapy.
5. Women who are pregnant.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Single Group Assignment
• Masking: Single

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Lifestyle counseling; Decision control preference intervention

Behavioral: Decision control preference scale; At time 1, participants in the intervention group will be asked to complete the Decision Control Preference Scale.The range of decision control is measured by the Decision Control Preference (DCP) Scale. The scale is used to measure the preferred or actual role in decision making using five response statements: two represent an active or patient-controlled role, one a shared or collaborative role, and two represent a passive or provider-controlled role. The preferred level of decision making control will be known by the participant in the intervention group and the information given to the oncologist prior to the consultation regarding adjuvant therapy; Other Names: DCP scale

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Satisfaction with Decision at 24 hours	Satisfaction with Decision (SWD) scale: A 6 item tool with a 5-point Likert scale ranging from 1, "strongly disagree" to 5, "strongly agree", will be used to evaluate the patient's satisfaction with decision involvement by phone within 24 hours following the consultation and repeated 4 weeks later. This instrument is based on the Satisfaction with Decision Instrument of Holmes-Rovner. The SWD scale performed reliability, Cronbach's alpha = 0.86	24 hours after consultation
Satisfaction with Decision at 4 weeks	Satisfaction with Decision (SWD) scale: A 6 item tool with a 5-point Likert scale ranging from 1, "strongly disagree" to 5, "strongly agree", will be used to evaluate the patient's satisfaction with decision involvement by phone within 24 hours following the consultation and repeated 4 weeks later. This instrument is based on the Satisfaction with Decision Instrument of Holmes-Rovner. The SWD scale performed reliability, Cronbach's alpha = 0.86	4 weeks after consultation

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Baseline Depression Score	This scale will be used to measure depressive symptoms. The CSES-D 10 is a 10-item brief version of a self-report questionnaire developed by the Center for Epidemiologic Studies at the National Institute of Mental Health for use in studies of depression in community samples. The CSES-D 10 version has been used across multiple populations. It has been shown to have test-retest reliability of 0.80 in patients with GI cancer.	Baseline before consultation
Baseline Impact of Event Score	A 15-item Likert scale ranging from total scores of 0 to 75 with levels of: 9-25 indicative of moderate adaptation difficulties and > 26 is considered indicative of clinical adaptation difficulties. Intrusion (the extent to which individuals are overwhelmed by thoughts and feelings of breast cancer, 7 items) and avoidance (the tendency to avoid thoughts and feelings about breast cancer, 8 items) are subscales. In this study, it will be used to measure patient distress in participating in health care decision making. The Cronbach's alpha for patients with GI cancer was 0.86.	Baseline, before consultation
Depression Score at 4 weeks	This scale will be used to measure depressive symptoms. The CSES-D 10 is a 10-item brief version of a self-report questionnaire developed by the Center for Epidemiologic Studies at the National Institute of Mental Health for use in studies of depression in community samples. The CSES-D 10 version has been used across multiple populations. It has been shown to have test-retest reliability of 0.80 in patients with GI cancer.	4 weeks after consultation
Impact of Event score at 24 hours	A 15-item Likert scale ranging from total scores of 0 to 75 with levels of: 9-25 indicative of moderate adaptation difficulties and > 26 is considered indicative of clinical adaptation difficulties. Intrusion (the extent to which individuals are overwhelmed by thoughts and feelings of breast cancer, 7 items) and avoidance (the tendency to avoid thoughts and feelings about breast cancer, 8 items) are subscales. In this study, it will be used to measure patient distress in participating in health care decision making. The Cronbach's alpha for patients with GI cancer was 0.86.	24 hours after consultation
Impact of Event Score at 4 weeks	A 15-item Likert scale ranging from total scores of 0 to 75 with levels of: 9-25 indicative of moderate adaptation difficulties and > 26 is considered indicative of clinical adaptation difficulties. Intrusion (the extent to which individuals are overwhelmed by thoughts and feelings of breast cancer, 7 items) and avoidance (the tendency to avoid thoughts and feelings about breast cancer, 8 items) are subscales. In this study, it will be used to measure patient distress in participating in health care decision making. The Cronbach's alpha for patients with GI cancer was 0.86.	4 weeks after consultation
Congruence between preferred and actual decision making control at 24 hours	This is a yes/no answer to determine congruence between actual and preferred level of decision making control. Descriptive analysis of the results will be preformed	24 hours after consultation
Congruence between preferred and actual decision making control at 4 weeks	This is a yes/no answer to determine congruence between actual and preferred level of decision making control. Descriptive analysis of the results will be preformed	4 weeks after consultation
Baseline Impact of Event Score	A 15-item Likert scale ranging from total scores of 0 to 75 with levels of: 9-25 indicative of moderate adaptation difficulties and > 26 is considered indicative of clinical adaptation difficulties. Intrusion (the extent to which individuals are overwhelmed by thoughts and feelings of breast cancer, 7 items) and avoidance (the tendency to avoid thoughts and feelings about breast cancer, 8 items) are subscales. In this study, it will be used to measure patient distress in participating in health care decision making. The Cronbach's alpha for patients with GI cancer was 0.86.	Before consultation

Collaborators and Investigators

• Sponsor: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
• Investigators: Principal Investigator: Sharon Olsen, PhD, Johns Hopkins University School of Nursing

Publications and helpful links

General Publications

• Degner LF, Kristjanson LJ, Bowman D, Sloan JA, Carriere KC, O'Neil J, Bilodeau B, Watson P, Mueller B. Information needs and decisional preferences in women with breast cancer. JAMA. 1997 May 14;277(18):1485-92.
• Degner LF, Sloan JA, Venkatesh P. The Control Preferences Scale. Can J Nurs Res. 1997 Fall;29(3):21-43.
• Holmes-Rovner M, Kroll J, Schmitt N, Rovner DR, Breer ML, Rothert ML, Padonu G, Talarczyk G. Patient satisfaction with health care decisions: the satisfaction with decision scale. Med Decis Making. 1996 Jan-Mar;16(1):58-64. doi: 10.1177/0272989X9601600114.
• Lo SS, Mumby PB, Norton J, Rychlik K, Smerage J, Kash J, Chew HK, Gaynor ER, Hayes DF, Epstein A, Albain KS. Prospective multicenter study of the impact of the 21-gene recurrence score assay on medical oncologist and patient adjuvant breast cancer treatment selection. J Clin Oncol. 2010 Apr 1;28(10):1671-6. doi: 10.1200/JCO.2008.20.2119. Epub 2010 Jan 11.
• Hack TF, Degner LF, Watson P, Sinha L. Do patients benefit from participating in medical decision making? Longitudinal follow-up of women with breast cancer. Psychooncology. 2006 Jan;15(1):9-19. doi: 10.1002/pon.907.
• Shaha M, Cox CL, Talman K, Kelly D. Uncertainty in breast, prostate, and colorectal cancer: implications for supportive care. J Nurs Scholarsh. 2008;40(1):60-7. doi: 10.1111/j.1547-5069.2007.00207.x.

Study record dates

Study Major Dates

• Study Start: September 1, 2011
• Primary Completion (Actual): March 1, 2012
• Study Completion (Actual): March 1, 2012

Study Registration Dates

• First Submitted: September 21, 2011
• First Submitted That Met QC Criteria: October 4, 2011
• First Posted (Estimate): October 6, 2011

Study Record Updates

• Last Update Posted (Estimate): April 9, 2014
• Last Update Submitted That Met QC Criteria: April 8, 2014
• Last Verified: April 1, 2014

More Information

Terms related to this study

• Keywords: Decision making; Decisional aide
• Additional Relevant MeSH Terms: Skin Diseases; Neoplasms; Neoplasms by Site; Breast Diseases; Breast Neoplasms
• Other Study ID Numbers: NA00046799; J1158 (Other Identifier: The Sidney Kimmel Comprehensive Cancer Center)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No