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Cancer Control Research

Abstract

DESCRIPTION (provided by applicant): Few healthcare decisions have received more national attention that the appropriate treatment for early stage breast cancer. For the past decade there has been debate around whether mastectomy or breast conserving surgery (BCS) with radiation is the "best" treatment for early stage breast cancer. In this R21 application, we propose to focus on the breast cancer surgical treatment decision making process which has been identified as a mechanism for improving the quality of care. The broad hypothesis of our study is that high quality decisions regarding early stage breast cancer will result in high quality care. Sepucha and others define a high quality decision as one that is informed and is concordant with the preferences of the decision maker. In fact, research from our team suggests that current decisions about treatment for early stage breast cancer do not meet the criteria of a 'high quality decision.' While decision aids directed toward decision making about early stage breast cancer treatment have been developed and evaluated, there are gaps both in the content and the populations in which these tools have been used. We argue that the new knowledge generated by our prior research and that of others motivates the need for new tools specifically focused on improving the quality of breast cancer treatment decisions. Better quality decisions will result in better quality care. The overall goal of this R21 project is to develop and pilot test a decision tool to improve the quality of decision making for early stage breast cancer treatment. The specific aims are: 1) Conduct group and individuals interviews with breast cancer surgeons affiliated with the American College of Surgeons (ACoS) regarding the content of the tool and integration of the tool into clinical delivery systems; 2) Conduct group and individual interviews with diverse breast cancer survivors to obtain feedback on the content and on the type of information desired in making treatment decisions; 3) Work with the Center for Health Communication Research (CHCR) at the University of Michigan to develop an initial interactive, web-based decision tool for use in early stage breast cancer treatment decision making; and 4) Pilot test the decision tool in three practices in the Chicago, IL area and at the University of Michigan Breast Center to evaluate the content, look and feel of the tool, and the ability of the tool to influence knowledge and preferences. Improvements in quality of care for breast cancer will not be seen without improvements in the quality of treatment decisions. Prior research from our team, and others, demonstrates that current treatment decisions for breast cancer are not "high quality." This project will develop and test a decision tool designed specifically to improve the quality of breast cancer treatment decisions by women, which will be subsequently tested in an R01 proposal. This project has direct relevance for improving the quality of cancer care for all women.