Enabling the use of individualized information at point of care: A tailored, quantitative decision aid for breast cancer adjuvant therapy

In response to the proliferation of decision aids to facilitate evidence based shared decision making, we developed a needs assessment framework and the CReDITED development process to improve the efficiency and quality of decision aid development. The needs assessment framework helps identify impact areas within breast cancer for decision aid development. CReDITED helps guide the development from Charter, through the stages of Requirements, Design, Implementation & Testing, Evaluation, to Diffusion. Using the needs assessment and CReDITED, we developed an application, the Presentation of Adjuvant Survival (PAS), a computerized, survival-focused, individually tailored decision aid for use by physician and patient during a consultation. Since we were using a quantitative presentation and not all patients are comfortable with numbers, we designed the Disposition-to-Numbers scale to use to measure the impact of PAS on patients' preference for numerical formats. The prototype was tested in case studies. Preliminary results show that the tool has potential to improve comprehension of the main benefits of treatment, in this case survival benefits. It also has potential to decrease overall decision conflict, likely because of improved knowledge of treatment pros and cons. However, results suggest that improved knowledge may lead to increase in decision uncertainty. PAS was found to be acceptable by both patients and physician in case studies. We are planning a pilot study and, upon success, will carry out a large scale multi-site randomized controlled trial.