Pilot testing a patient decision aid as a strategy to reduce overtreatment for older women with early-stage breast cancer

Cecilia M Pesavento; Ruby J Kazemi; Abigail Kappelman; Jessica L Thompson; Chad Jobin; Ton Wang; Lesly A Dossett

doi:10.1016/j.amjsurg.2024.115774

Pilot testing a patient decision aid as a strategy to reduce overtreatment for older women with early-stage breast cancer

Am J Surg. 2024 Sep:235:115774. doi: 10.1016/j.amjsurg.2024.115774. Epub 2024 May 25.

Authors

Cecilia M Pesavento¹, Ruby J Kazemi², Abigail Kappelman³, Jessica L Thompson⁴, Chad Jobin⁵, Ton Wang⁶, Lesly A Dossett⁷

Affiliations

¹ University of Michigan Medical School, Ann Arbor, MI, USA; Vanderbilt University Medical Center, Department of Surgery, Nashville, TN, USA. Electronic address: ceciliapesavento@gmail.com.
² University of Michigan Medical School, Ann Arbor, MI, USA.
³ University of Michigan Medical School, Ann Arbor, MI, USA; University of Michigan, Department of Epidemiology, Ann Arbor, MI, USA.
⁴ Corewell Health West, Department of Cancer Health, Grand Rapids, MI, USA.
⁵ Michigan Medicine, Ann Arbor, MI, USA.
⁶ Duke University School of Medicine, Department of Surgery, Durham, NC, USA.
⁷ University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA; University of Michigan, Department of Surgery, Ann Arbor, MI, USA.

PMID: 38834420
DOI: 10.1016/j.amjsurg.2024.115774

Abstract

Background: Despite national guidelines recommending omission of sentinel lymph node biopsy (SLNB) and post-lumpectomy radiotherapy (RT) in older women with early-stage, hormone receptor-positive (HR+) breast cancer, these practices persist. This pilot study assesses whether a decision aid can target patient-level determinants of low-value treatments.

Methods: We adapted and pilot-tested a decision aid in women ≥70 years old with early-stage HR + breast cancer. Primary outcomes included acceptability and appropriateness of the decision aid. Secondary outcomes included treatment choice and satisfaction with decision.

Results: Twenty-three patients enrolled in the trial. 19 completed survey one; 16 completed survey two. Primary outcomes demonstrated that 84% of patients agreed or strongly agreed the aid was acceptable and appropriate. Secondary outcomes demonstrated that 19% of patients underwent SLNB (below pre-intervention baseline), and 85% received adjuvant RT (change not statistically significant).

Conclusions: We demonstrate that a decision aid may effectively target patient-level factors contributing to overuse of low-value therapies.

Keywords: Breast cancer; Older women; Radiotherapy; Sentinel lymph node biopsy; de-implementation.

MeSH terms

Aged
Aged, 80 and over
Breast Neoplasms* / pathology
Breast Neoplasms* / therapy
Decision Support Techniques*
Female
Humans
Mastectomy, Segmental
Neoplasm Staging
Overtreatment*
Pilot Projects
Radiotherapy, Adjuvant
Sentinel Lymph Node Biopsy*