P3: Patient Satisfaction Following Pilot of Decision Aid to Reduce Overtreatment of Older Women with Early-Stage Breast Cancer

To reduce overtreatment of women ≥70 years old diagnosed with early-stage hormone receptor-positive (HR+) invasive breast cancer (IBC), we piloted a patient decision aid to target patient-level drivers of two low-value treatments: sentinel lymph node biopsy (SLNB) and post-lumpectomy radiotherapy (RT), both of which offer no survival benefit. We evaluated acceptability and appropriateness of the decision aid and its impact on treatment decisions.


Methods: We enrolled women ≥70 years old with early-stage HR+ IBC meeting criteria for SLNB and RT omission at a single institution. Patient recruitment and receipt of the decision-aid occurred between diagnosis and the initial surgeon appointment. We assessed primary outcomes of intervention acceptability and appropriateness after the first appointment; these results were previously presented. Secondary outcomes, measured 60-120 days after surgery, included identification of treatment choices and patient satisfaction with decision (Satisfaction With Decision, SWD scale). Items were measured on a 5-point Likert scale.


Results: 23 patients were enrolled, 19 completed the initial survey, and 16 completed the second survey. Of these patients, 94% received a lumpectomy and 75% received hormone therapy. Notably, 19% underwent SLNB and 69% received RT. This is in comparison to national averages of 80% and 65%, respectively. Analysis of secondary outcomes (mean and standard deviation of Likert scores on the SWD scale) revealed high satisfaction; patients felt they were adequately informed (4.56 ± 0.89), made the best decision (4.69 ± 0.48) that aligned with their personal values (4.75 ± 0.58), expected successful execution of their decision (4.88 ± 0.34), felt ownership over their decision (4.75 ± 0.77), and had overall satisfaction with their decision (4.81 ± 0.40). Likert scores of 4 and 5 correlated with “agree” and “strongly agree”, respectively. Thematic analysis of open-ended questions revealed some persistent confusion and conflicting information amongst clinicians about treatment recommendations, presenting an opportunity for refining the decision aid or implementing other strategies.


Conclusions: In this pilot study, patient satisfaction with final treatment decisions was consistent with initial approval of the decision aid. Change in treatment choice as compared to historical controls demonstrates a possible effect of the decision aid, but only for SLNB omission. This will inform a sample size calculation for a multi-center effectiveness trial.