乳がん手術の意思決定における患者の関与の増加
共同意思決定介入を通じて、社会経済的に不利な立場にある患者の乳癌手術の意思決定への関与を高める
This trial studies how well a breast cancer surgery decision aid works in increasing patient engagement in decision making for patients with newly diagnosed stage 0-III breast cancer. The trial also examines barriers to patient engagement even with the use of a decision aid, and if barriers are more likely to be experienced by socioeconomically disadvantaged patients.
調査の概要
詳細な説明
The primary and secondary objectives of the study:
PRIMARY OBJECTIVES:
I. Test the effectiveness of a breast cancer surgery decision aid in increasing patient engagement in decision making (measured by knowledge and power) in clinics serving a high proportion of socioeconomically disadvantaged patients.
II. Test the extent to which the effect of a decision aid on patient engagement is mediated through the mitigation of barriers and determine if persistent barriers are disproportionately experienced by socioeconomically disadvantaged patients.
SECONDARY OBJECTIVES:
I. Characterize how persistent barriers influence patient engagement in decision making in order to identify targets for adjunct interventions that could be implemented in clinics serving a high proportion of socioeconomically disadvantaged patients.
Trial Design:
OUTLINE: This is a multi-site cluster randomized trial using a stepped wedge design. Ten clinics will be recruited for participation. All clinics will begin in the usual care arm. Clinics will be randomized to the timing with which they cross-over to the decision aid intervention, with new clinics crossing over every 10 weeks.
ARM I: usual care
ARM II: decision aid intervention
The only difference between patients enrolled before institutional crossover and patients enrolled after institutional crossover is those who are enrolled after institutional crossover will have been offered the decision aid as accepted practice in the clinic.
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
-
-
California
-
Dublin、California、アメリカ、94568
- Epic Care-Dublin
-
Emeryville、California、アメリカ、94608
- Bay Area Breast Surgeons Inc
-
Emeryville、California、アメリカ、94608
- Epic Care Partners in Cancer Care
-
Martinez、California、アメリカ、94553-3156
- Contra Costa Regional Medical Center
-
Oakland、California、アメリカ、94609
- Alta Bates Summit Medical Center - Summit Campus
-
Oakland、California、アメリカ、94609
- Bay Area Tumor Institute
-
Walnut Creek、California、アメリカ、94597
- Epic Care Cyberknife Center
-
-
Georgia
-
Augusta、Georgia、アメリカ、30912
- Augusta University Medical Center
-
-
Hawaii
-
Honolulu、Hawaii、アメリカ、96813
- Queen's Medical Center
-
Honolulu、Hawaii、アメリカ、96817
- The Cancer Center of Hawaii-Liliha
-
Honolulu、Hawaii、アメリカ、96813
- Hawaii Cancer Care Inc - Waterfront Plaza
-
Honolulu、Hawaii、アメリカ、96813
- Queen's Cancer Cenrer - POB I
-
Honolulu、Hawaii、アメリカ、96813
- Straub Clinic and Hospital
-
Honolulu、Hawaii、アメリカ、96813
- University of Hawaii Cancer Center
-
Honolulu、Hawaii、アメリカ、96817
- Hawaii Cancer Care Inc-Liliha
-
Honolulu、Hawaii、アメリカ、96817
- Kuakini Medical Center
-
Honolulu、Hawaii、アメリカ、96817
- Queen's Cancer Center - Kuakini
-
Honolulu、Hawaii、アメリカ、96826
- Kapiolani Medical Center for Women and Children
-
Honolulu、Hawaii、アメリカ、96813
- Island Urology
-
Lihue、Hawaii、アメリカ、96766
- Wilcox Memorial Hospital and Kauai Medical Clinic
-
‘Aiea、Hawaii、アメリカ、96701
- Pali Momi Medical Center
-
‘Aiea、Hawaii、アメリカ、96701
- Queen's Cancer Center - Pearlridge
-
‘Aiea、Hawaii、アメリカ、96701
- The Cancer Center of Hawaii-Pali Momi
-
‘Aiea、Hawaii、アメリカ、96701
- Hawaii Cancer Care - Savio
-
-
Idaho
-
Boise、Idaho、アメリカ、83706
- Saint Alphonsus Cancer Care Center-Boise
-
Caldwell、Idaho、アメリカ、83605
- Saint Alphonsus Cancer Care Center-Caldwell
-
Coeur d'Alene、Idaho、アメリカ、83814
- Kootenai Health - Coeur d'Alene
-
Emmett、Idaho、アメリカ、83617
- Walter Knox Memorial Hospital
-
Meridian、Idaho、アメリカ、83642
- Idaho Urologic Institute-Meridian
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Nampa、Idaho、アメリカ、83686
- Saint Alphonsus Medical Center-Nampa
-
Post Falls、Idaho、アメリカ、83854
- Kootenai Clinic Cancer Services - Post Falls
-
Sandpoint、Idaho、アメリカ、83864
- Kootenai Cancer Clinic
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-
Illinois
-
Chicago、Illinois、アメリカ、60612
- John H Stroger Jr Hospital of Cook County
-
Danville、Illinois、アメリカ、61832
- Carle on Vermilion
-
Effingham、Illinois、アメリカ、62401
- Carle Physician Group-Effingham
-
Mattoon、Illinois、アメリカ、61938
- Carle Physician Group-Mattoon/Charleston
-
Urbana、Illinois、アメリカ、61801
- Carle Cancer Center
-
Urbana、Illinois、アメリカ、61801
- The Carle Foundation Hospital
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Louisiana
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New Orleans、Louisiana、アメリカ、70121
- Ochsner Medical Center Jefferson
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Montana
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Anaconda、Montana、アメリカ、59711
- Community Hospital of Anaconda
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Billings、Montana、アメリカ、59101
- Billings Clinic Cancer Center
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Bozeman、Montana、アメリカ、59715
- Bozeman Deaconess Hospital
-
Great Falls、Montana、アメリカ、59405
- Great Falls Clinic
-
Great Falls、Montana、アメリカ、59405
- Benefis Healthcare- Sletten Cancer Institute
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Helena、Montana、アメリカ、59601
- Saint Peter's Community Hospital
-
Kalispell、Montana、アメリカ、59901
- Kalispell Regional Medical Center
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Missoula、Montana、アメリカ、59804
- Community Medical Hospital
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New Mexico
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Albuquerque、New Mexico、アメリカ、87102
- University of New Mexico Cancer Center
-
-
Oregon
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Baker City、Oregon、アメリカ、97814
- Saint Alphonsus Medical Center-Baker City
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Ontario、Oregon、アメリカ、97914
- Saint Alphonsus Medical Center-Ontario
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South Carolina
-
Charleston、South Carolina、アメリカ、29425
- Medical University of South Carolina
-
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Virginia
-
Richmond、Virginia、アメリカ、23235
- VCU Massey Cancer Center at Stony Point
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Richmond、Virginia、アメリカ、23298
- Virginia Commonwealth University/Massey Cancer Center
-
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Wisconsin
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Marshfield、Wisconsin、アメリカ、54449
- Marshfield Medical Center-Marshfield
-
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Wyoming
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Cody、Wyoming、アメリカ、82414
- Billings Clinic-Cody
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Sheridan、Wyoming、アメリカ、82801
- Welch Cancer Center
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-
-
-
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Tamuning、グアム、96913
- FHP Health Center-Guam
-
-
-
-
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San Juan、プエルトリコ、00902
- Pan American Center for Oncology Trials LLC
-
-
参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- Newly diagnosed with stage 0-III breast cancer
- Eligible patients must be planning breast surgery as a component of their definitive treatment
- Patients with impaired decision-making capacity (such as with a diagnosis of dementia or memory loss) are not eligible for this study
- Patients with hearing impairment requiring the use of an interpreter are not eligible for this study
- Patients must be able to speak English with the fluency required to have a direct discussion around treatment decision-making (i.e. without interpreter)
- CLINIC STAKEHOLDER (SURGEONS AND CLINIC STAFF): Breast surgeon(s) and nursing staff, medical assistant, or mid-level provider at each participating clinic who participates in the care of patients newly diagnosed with breast cancer
- INSTITUTIONAL: 10 clinics that annually provide surgical care for 120-300 patients newly diagnosed with breast cancer will be selected to participate in this study
- INSTITUTIONAL: Surgeons at eligible clinics must consent to the study as a requirement for site participation
研究計画
研究はどのように設計されていますか？
デザインの詳細
- 主な目的：ヘルスサービス研究
- 割り当て：ランダム化
- 介入モデル：クロスオーバー割り当て
- マスキング：なし（オープンラベル）
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
|
アクティブコンパレータ：Arm I (surgical consultation)
Prior to institutional crossover, participants receive care as per usual care. |
Usual Care |
|
実験的：Arm II (web-based breast cancer surgery decision aid)
Following a 10 week implementation period, at the time of institutional crossover, participants will receive a web-based decision aid prior to the surgical consultation.. |
Usual Care Web-based decision aid received prior to the surgical consultation |
この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Patient Power: Self-efficacy in Patient Physician Interactions
時間枠：3 weeks
|
Power is defined as patients' self-perceived capacity to influence the decision-making encounter. This construct is measured using the Patient's Self-Efficacy in Patient-Physician Interactions (PEPPI)-5 point scale; the primary outcome measure is a total score ranging from 5-25, where higher scores indicate increased self-efficacy. The patient completes the PEPPI-5 questionnaire within 3 weeks post-surgical consultation. |
3 weeks
|
|
Patient Power: Active Patient Participation
時間枠：1 day
|
Power is also separately measured by the validated Active Patient Participation Behaviors System to assess active patient participation during the surgeon consultation and is measured off the audio-recording of the consultation; a summary measure of patient's active involvement in the interaction is coded by the study team and represents a total count of patients' communicative behaviors (i.e., count of patient asking questions, count of patient assertive responses and count of patient expressions of concern) ranging from 0-114, where higher scores indicate increased active patient participation. The consultation for a patient will typically be study day 1 (day of registration). |
1 day
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Patient Knowledge
時間枠：Up to 3 weeks
|
Patient knowledge is measured from 5 knowledge questions in the Decision Quality Instrument-Breast Surgery survey, with a percent correct recorded as the secondary outcome measure, ranging from 0-100%. The patient completes the Decision Quality Instrument-Breast Surgery survey within 3 weeks post-surgical consultation. |
Up to 3 weeks
|
|
Percentage of Concordant Between Surgery Received and Patient Treatment Preference
時間枠：Up to 3 weeks
|
This binary outcome indicates whether the surgery received (mastectomy or lumpectomy) was concordant with the patient's treatment preference. Patient's goals/concerns (keep the breast, remove the breast for peace of mind, avoid radiation), rated from 0 (not at all important) to 10 (extremely important), and treatment preference (lumpectomy only, lumpectomy and radiation, mastectomy, other surgery, or not sure) are measured with the Decision Quality Instrument (DQI)-Breast Surgery survey, completed within 3 weeks post-consultation. Concordance is derived using the method of Sepucha et al. (2012): (1) estimate a predicted probability (pp) of surgery preference from a multivariable logistic regression model with patient's goals/concerns and stage as independent variables; (2) classify patients as concordant if pp >= 0.5 and mastectomy was received, or pp < 0.5 and lumpectomy was received; and (3) calculate the percentage of concordant. |
Up to 3 weeks
|
協力者と研究者
捜査官
- スタディチェア：Heather B. Neuman,, MD, MS、University of Wisconsin, Madison
出版物と役立つリンク
一般刊行物
- Schumacher JR, Zahrieh D, Chow S, Taylor J, Wills R, Hanlon BM, Rathouz PJ, Tucholka JL, Neuman HB. Increasing socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making through a shared decision-making intervention (A231701CD): protocol for a cluster randomised clinical trial. BMJ Open. 2022 Nov 17;12(11):e063895. doi: 10.1136/bmjopen-2022-063895.
- Schumacher JR, Hanlon BM, Zahrieh D, Rathouz PJ, Tucholka JL, McKinney G, Tan AD, Breuer CR, Bailey L, Higham AM, Wecsler JS, Arnold AH, Froix AJ, Dull S, Abbott AM, Fine SG, McGuire KP, Seydel AS, McNamara P, Chow S, Neuman HB. Impact of a Web-Based Decision Aid on Socioeconomically Disadvantaged Patients' Engagement in Breast Surgery Decision-Making: Stepped-Wedge Clinical Trial (Alliance-A231701CD). Ann Surg Oncol. 2025 Aug;32(8):5540-5550. doi: 10.1245/s10434-025-17452-0. Epub 2025 May 17.
- Saucke MC, Jacobson N, McKinney G, Neuman HB. Role of the Surgeon in De-Escalating Emotion During a Breast Cancer Surgery Consultation: A Qualitative Study of Patients' Experiences in Alliance A231701CD. Ann Surg Oncol. 2024 Dec;31(13):8873-8881. doi: 10.1245/s10434-024-16156-1. Epub 2024 Sep 25.
- Zahrieh D, Croghan IT, Inselman JW, Mandrekar SJ. Guidelines for Data and Safety Monitoring in Pragmatic Randomized Clinical Trials Using Case Studies. Mayo Clin Proc. 2023 Nov;98(11):1712-1726. doi: 10.1016/j.mayocp.2023.02.019.
- Saucke MC, Jacobson N, Chow S, McKinney G, Neuman HB. Providing information to prepare breast cancer patients for their surgical consultation: barriers and recommendations (an analysis from Alliance A231701CD). Support Care Cancer. 2026 May 14;34(6):537. doi: 10.1007/s00520-026-10726-7.
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
その他の研究ID番号
- A231701CD
- NCI-2018-00643 (レジストリ識別子：NCI Clinical Trial Reporting Program)
個々の参加者データ (IPD) の計画
個々の参加者データ (IPD) を共有する予定はありますか?
IPD プランの説明
Individual participant data that underlie the results reported in this article, after deidentification (text, tables, figures, and appendices).
IPD 共有時間枠
Beginning 6 to 12 months following article publication.
IPD 共有アクセス基準
Investigators whose proposed use of the data has been approved by an independent review committee ("learned intermediary") identified for this purpose.
IPD 共有サポート情報タイプ
- STUDY_PROTOCOL
- ICF
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
米国FDA規制機器製品の研究
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