Individualizing Decision Quality for Patients with Breast Cancer: A RCT of a Com

新诊断为乳腺癌的患者面临一系列复杂的决定，涉及局部区域和 全身治疗。目前，这些决策中的许多不符合高质量决策的定义， 定义为既知情(即，基于对治疗风险的准确了解，又 利益)和偏好-一致性(即，与患者的潜在偏好一致)。此外， 评估性测试的引入使许多患者的决定变得更加复杂。有一个 需要提高乳腺癌患者局部和系统治疗决策的质量，以及 帮助患者理解评估性测试在这一决策过程中的作用。确保患者可以 有效地考虑这些决定，提出他们的观点，并与他们的临床医生沟通是可能的 以提高他们的整体决策准备和满意度。项目3将重点放在 通过评估创新决策工具对局部、区域性和系统性的影响实现个性化护理 初诊乳腺癌患者的治疗决策。创新的在线决策工具具有 由CanSORT团队在过去两年中开发和测试(R21 CA129859)。试点数据 这表明这个工具对患者的知识和决策结果有积极的影响。的目标是 项目3是评估此工具在与我们的沟通部门协作进行增强后的影响 和传播核心，关于局部和系统性乳腺癌的决策质量 治疗决策。我们将对444例新诊断的患者进行随机对照试验 浸润性早期乳腺癌患者，由两个SEER集水区的28-30名外科医生检查。 患者将随机进入我们的综合决策工具或现有的“最先进”网站。 主要结果将是局部区域和系统治疗的高质量决策率 患者查看CanSORT工具与现有网站的比较。其他结果将包括患者 了解评价性测试和决策审议的程度。这次随机对照试验的结果将是 与未来的乳腺癌患者做出这些决定和他们的临床医生高度相关，

Patients newly diagnosed with breast cancer face a series of complex decisions regarding locoregional and systemic treatment. Currently many of these decisions do not meet the definition of a high quality decision, defined as one that is both informed (i.e., based on an accurate understanding of the treatment risks and benefits) and preference-concordant (i.e., consistent with the patients' underlying preferences). Moreover, the introduction of evaluative tests has made these decisions more complicated for many patients. There is a need to improve the quality of locoregional and systemic treatment decisions for breast cancer patients, and to help patients understand the role of evaluative tests in this decision process. Ensuring patients can deliberate effectively about these decisions, assert their views and communicate with their clinicians is likely to improve their overall decision preparedness and satisfaction. Project 3 will focus on the third pillar of individualized care by evaluating the impact of an innovative decision tool on locoregional and systemic therapy decision making for newly diagnosed breast cancer patients. The innovative online decision tool has been developed and tested over the past two years by the CanSORT team (R21 CA129859). Pilot data suggests that this tool has a positive impact on patient knowledge and decision outcomes. The goal of project 3 is to evaluate the impact of this tool, after it is enhanced in collaboration with our Communication and Dissemination Core, on the quality of decision making for locoregional and systemic breast cancer treatment decision making. We will conduct a randomized controlled trial (RCT) of 444 newly diagnosed patients with invasive early stage breast cancer, seen by 28-30 surgeons in two SEER catchment areas. Patients will be randomized to view our comprehensive decision tool or a "state of the art" existing website. The primary outcomes will be the rate of high quality decisions about locoregional and systemic therapy for patients viewing the CanSORT tool vs. the existing website. Additional outcomes will include patient knowledge about evaluative tests and the extent of decision deliberation. The results of this RCT will be highly relevant to future breast cancer patients making these decisions and to their clinicians,