Improving Patient-Centered Communication in Breast Cancer: A RCT of a Shared Decision Engagement System
The diagnosis of breast cancer triggers a cascade of decisions as patients consider multiple treatment
modalities navigated by different specialists. Precise evaluative treatment algorithms have better individualized
treatment recommendations, [yet sifting through the complexity of the test information and treatment options
can be often challenging to patients and can often cause anxiety]. Thus, the advances of precision medicine
cannot be realized without parallel advances in patient-centered communication (PCC). This rapidly evolving
decision context has fueled a pressing need for more patient-centered communication to address the full
breadth of issues—both cognitive and emotional—faced by patients in making breast cancer treatment
decisions. There is a critical need for tools that can engage the patient both emotionally and cognitively and be
integrated into the breast oncology care clinical workflow. This project is a multi-level, factorial study that
crosses a patient-level RCT of 700 newly-diagnosed breast cancer patients within 25 breast surgical oncology
practices to evaluate a shared decision engagement system (ShaDES) to support PCC. The system links an
emotional support-enhanced version of the research group’s previously developed iCanDecide patient-facing
decision tool with a clinic level trial of a Clinician Dashboard to help clinicians address remaining cognitive and
emotional needs in their patients. In collaboration with the Alliance NCORP Research Base and its Statistics
and Data Core, the trial will: 1) evaluate the impact of the emotional support enhancements to iCanDecide on
primary and secondary outcomes measuring patient appraisal of PCC, 2) evaluate the impact of the Clinician
Dashboard on patient appraisal of PCC, 3) examine potential mediators of the patient and clinic interventions,
and 4) conduct a process evaluation of the two intervention components to inform revision and future
widespread implementation of ShaDES. [The results will lay the groundwork for broad implementation of a
shared decision engagement system to improve patient-centered communication in breast cancer.]
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