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Oncologist use of the Adjuvant! model for risk communication: a pilot study examining patient knowledge of 10-year prognosis.

Belkora JK, Rugo HS, Moore DH, Hutton DW, Chen DF, Esserman LJ - BMC Cancer (2009)

Bottom Line: printouts would be associated with significant changes in the proportion of patients with accurate understanding of local therapy prognosis.before and after the oncology visit, testing whether pre/post changes were significant using McNemar's two-sided test at a significance level of 5%.printouts to communicate local therapy recurrence and mortality estimates to patients, as they may leave a majority of patients misinformed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, University of California San Francisco, San Francisco, CA, USA. jeff.belkora@ucsfmedctr.org

ABSTRACT

Background: Our purpose was to collect preliminary data on newly diagnosed breast cancer patient knowledge of prognosis before and after oncology visits. Many oncologists use a validated prognostic software model, Adjuvant!, to estimate 10-year recurrence and mortality outcomes for breast cancer local and adjuvant therapy. Some oncologists are printing Adjuvant! screens to use as visual aids during consultations. No study has reported how such use of Adjuvant! printouts affects patient knowledge of prognosis. We hypothesized that Adjuvant! printouts would be associated with significant changes in the proportion of patients with accurate understanding of local therapy prognosis.

Methods: We recruited a convenience sample of 20 patients seen by 2 senior oncologists using Adjuvant! printouts of recurrence and mortality screens in our academic medical center. We asked patients for their estimates of local therapy recurrence and mortality risks and counted the number of patients whose estimates were within +/- 5% of Adjuvant! before and after the oncology visit, testing whether pre/post changes were significant using McNemar's two-sided test at a significance level of 5%.

Results: Two patients (10%) accurately estimated local therapy recurrence and mortality risks before the oncology visit, while seven out of twenty (35%) were accurate afterwards (p = 0.125).

Conclusion: A majority of patients in our sample were inaccurate in estimating their local therapy recurrence and mortality risks, even after being shown printouts summarizing these risks during their oncology visits. Larger studies are needed to replicate or repudiate these preliminary findings, and test alternative methods of presenting risk estimates. Meanwhile, oncologists should be wary of relying exclusively on Adjuvant! printouts to communicate local therapy recurrence and mortality estimates to patients, as they may leave a majority of patients misinformed.

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Study schema. Study schema showing chronological steps in this pre/post single-arm study.
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Figure 1: Study schema. Study schema showing chronological steps in this pre/post single-arm study.

Mentions: The two participating oncologists were involved in the general design of the study, including the selection of the primary outcome and measure of patient knowledge. Prior to the study, the oncologists caucused to standardize their use of the intervention. They agreed to see all study patients in 60 minute visits. Half of each visit was devoted to history taking, a physical exam, and disclosure of treatment risks and side effects. The oncologists presented consistent information about treatment risks and side effects based on systematic reviews. The second half of the visit was devoted to reviewing Adjuvant! printouts showing recurrence and mortality rates as a function of the patient's situation, and answering patient questions about the printouts. Patients were eligible to participate in the study if they could speak and read English, if they had completed surgery for stage I, II, or IIIa breast cancer, if they had not initiated any form of adjuvant therapy, and if their medical charts included tumor size, tumor grade, hormone receptor status, node status, and age. Patients were not eligible to participate in the study if they had metastatic disease, if they needed further surgery to complete staging, or if they were unable to provide informed consent. Patients were enrolled between October, 2001 and February, 2002. (Figure 1)


Oncologist use of the Adjuvant! model for risk communication: a pilot study examining patient knowledge of 10-year prognosis.

Belkora JK, Rugo HS, Moore DH, Hutton DW, Chen DF, Esserman LJ - BMC Cancer (2009)

Study schema. Study schema showing chronological steps in this pre/post single-arm study.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2684746&req=5

Figure 1: Study schema. Study schema showing chronological steps in this pre/post single-arm study.
Mentions: The two participating oncologists were involved in the general design of the study, including the selection of the primary outcome and measure of patient knowledge. Prior to the study, the oncologists caucused to standardize their use of the intervention. They agreed to see all study patients in 60 minute visits. Half of each visit was devoted to history taking, a physical exam, and disclosure of treatment risks and side effects. The oncologists presented consistent information about treatment risks and side effects based on systematic reviews. The second half of the visit was devoted to reviewing Adjuvant! printouts showing recurrence and mortality rates as a function of the patient's situation, and answering patient questions about the printouts. Patients were eligible to participate in the study if they could speak and read English, if they had completed surgery for stage I, II, or IIIa breast cancer, if they had not initiated any form of adjuvant therapy, and if their medical charts included tumor size, tumor grade, hormone receptor status, node status, and age. Patients were not eligible to participate in the study if they had metastatic disease, if they needed further surgery to complete staging, or if they were unable to provide informed consent. Patients were enrolled between October, 2001 and February, 2002. (Figure 1)

Bottom Line: printouts would be associated with significant changes in the proportion of patients with accurate understanding of local therapy prognosis.before and after the oncology visit, testing whether pre/post changes were significant using McNemar's two-sided test at a significance level of 5%.printouts to communicate local therapy recurrence and mortality estimates to patients, as they may leave a majority of patients misinformed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, University of California San Francisco, San Francisco, CA, USA. jeff.belkora@ucsfmedctr.org

ABSTRACT

Background: Our purpose was to collect preliminary data on newly diagnosed breast cancer patient knowledge of prognosis before and after oncology visits. Many oncologists use a validated prognostic software model, Adjuvant!, to estimate 10-year recurrence and mortality outcomes for breast cancer local and adjuvant therapy. Some oncologists are printing Adjuvant! screens to use as visual aids during consultations. No study has reported how such use of Adjuvant! printouts affects patient knowledge of prognosis. We hypothesized that Adjuvant! printouts would be associated with significant changes in the proportion of patients with accurate understanding of local therapy prognosis.

Methods: We recruited a convenience sample of 20 patients seen by 2 senior oncologists using Adjuvant! printouts of recurrence and mortality screens in our academic medical center. We asked patients for their estimates of local therapy recurrence and mortality risks and counted the number of patients whose estimates were within +/- 5% of Adjuvant! before and after the oncology visit, testing whether pre/post changes were significant using McNemar's two-sided test at a significance level of 5%.

Results: Two patients (10%) accurately estimated local therapy recurrence and mortality risks before the oncology visit, while seven out of twenty (35%) were accurate afterwards (p = 0.125).

Conclusion: A majority of patients in our sample were inaccurate in estimating their local therapy recurrence and mortality risks, even after being shown printouts summarizing these risks during their oncology visits. Larger studies are needed to replicate or repudiate these preliminary findings, and test alternative methods of presenting risk estimates. Meanwhile, oncologists should be wary of relying exclusively on Adjuvant! printouts to communicate local therapy recurrence and mortality estimates to patients, as they may leave a majority of patients misinformed.

Show MeSH
Related in: MedlinePlus