Physicians and Patients Perspectives about a Patient Decision Aid Tool for Breast-Conserving Surgery in the Cancer Institute of Iran
AbstractBackground: We aimed to explore opinions of breast cancer patients and clinicians in Iran about a patient decision aid (PDA) for breast-conserving surgery. Methods: We conducted a qualitative study and evaluated the opinions of breast cancer patients and clinicians about a PDA for breast-conserving surgery in the Cancer Institute of Iran. We applied Barun and Clarke’s thematic analysis approach for data analysis. We categorized the results into three themes including “perceived advantages”, “perceived disadvantages”, and “suggested strategy” and seven subthemes. Results: Both patients and clinicians believed that PDA was useful for improvement of breast cancer conserving surgery and quality of care among Iranian patients. In contrast to the clinicians, the patients were interested in knowing more about surgery techniques. Both groups believed that considering the cultural issues in the adaptation process is essential and families (i.e. husband) should be involved in the decision-making process in Iran.Conclusion: PDA is a useful tool for implementation of breast cancer conserving surgery in Iran and other low and middle-income countries. However, it should be adapted based on the context and cultural issues in each country. We recommend implementing PADs in the routine practice for increasing breast-conserving surgery in Iran. However, further research is needed to reach an optimal PDA for Iranian patients.
Rouhollahi MR, Mohagheghi MA, Mohammadrezai N, Ghiasvand R, Ghanbari Motlagh A, Harirchi I, et al. Situation analysis of the National Comprehensive Cancer Control Program (2013) in the I. R. of Iran; assessment and recommendations based on the IAEA imPACT mission. Arch Iran Med. 2014;17(4):222-31.
Mohebbi E, Nahvijou A, Hadji M, Rashidian H, Seyyedsalehi M, Nemati S, et al. Iran Cancer Statistics in 2012 and Projection of Cancer Incidence by 2035. Basic and Clinical Cancer Research 2017;9(3):3-22.
Rashidian H, Daroudi R, Ghiasvand R, Harirchi I, K Z. Prevalence and Incidence of Premenopausal and Postmenopausal Breast Cancer in Iran in 2010. Basic & Clinical Cancer Research. 2013;5(3):2-10.
Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227-32.
Arndt V, Stegmaier C, Ziegler H, Brenner H. Quality of life over 5 years in women with breast cancer after breast-conserving therapy versus mastectomy: a population-based study. J Cancer Res Clin Oncol. 2008;134(12):1311-8.
Ohsumi S, Shimozuma K, Kuroi K, Ono M, Imai H. Quality of life of breast cancer patients and types of surgery for breast cancer--current status and unresolved issues. Breast Cancer. 2007;14(1):66-73.
Reimer T, Gerber B. Quality-of-life considerations in the treatment of early-stage breast cancer in the elderly. Drugs Aging. 2010;27(10):791-800.
Belkora JK, Volz S, Teng AE, Moore DH, Loth MK, Sepucha KR. Impact of decision aids in a sustained implementation at a breast care center. Patient Educ Couns. 2012;86(2):195-204.
Obeidat R, Finnell DS, Lally RM. Decision aids for surgical treatment of early stage breast cancer: a narrative review of the literature. Patient Educ Couns. 2011;85(3):e311-21.
Resnicow K, Abrahamse P, Tocco RS, Hawley S, Griggs J, Janz N, et al. Development and psychometric properties of a brief measure of subjective decision quality for breast cancer treatment. BMC Med Inform Decis Mak. 2014;14:110.
Waljee JF, Rogers MA, Alderman AK. Decision aids and breast cancer: do they influence choice for surgery and knowledge of treatment options? J Clin Oncol. 2007;25(9):1067-73.
Lee C, Chang Y, Adimorah N. Decision making about surgery for early-stage breast cancer. Journal of the American College of Surgeons. 2012;214 (1):1-10.
Elwyn G, Edwards A, Kinnersley P. Shared decision-making in primary care: the neglected second half of the consultation. Br J Gen Pract. 1999;49(443):477-82.
O'Connor AM, Tugwell P, Wells GA, Elmslie T, Jolly E, Hollingworth G, et al. Randomized trial of a portable, self-administered decision aid for postmenopausal women considering long-term preventive hormone therapy. Med Decis Making. 1998;18(3):295-303.
Straus S, Tetroe J, Graham I. Knowledge translation in health care: moving from evidence to practice: BMJ books: John Wiley & Sons; 2009. 93-111 p.
Fowler FJ, Jr., Levin CA, Sepucha KR. Informing and involving patients to improve the quality of medical decisions. Health Aff (Millwood). 2011;30(4):699-706.
Collins E, Moore C, Clay K. Can women with early-stage breast cancer make an informed decision for mastectomy? Journal of Clinical Oncology. 2009;27 (4):519-25.
Hawley S, Griggs J, Hamilton A. Decision involvement and receipt of mastectomy among racially and ethnically diverse breast cancer patients. J Natl Cancer Inst. 2009;101 (19):1337-47.
Katz SJ, Lantz PM, Janz NK, Fagerlin A, Schwartz K, Liu L, et al. Patient involvement in surgery treatment decisions for breast cancer. J Clin Oncol. 2005;23(24):5526-33.
Rashidian H, Nedjat S, Majdzadeh R, Gholami J, Haghjou L, Abdollahi BS, et al. The perspectives of Iranian physicians and patients towards patient decision aids: a qualitative study. BMC Res Notes. 2013;6:379.
Mardani- Hamooleh M, Taghavi-Larijani T, Heidari H, Avazpour M. Female Cancer Patients’ Perceptions regarding Health-related Behaviors: A Qualitative Analysis. Basic & Clinical Cancer Research 2017 9(2):4-12 2017;9(2):4-12.
https://decisionaid.ohri.ca/azlist.html. [Access Date: 20180414
Ford S, Schofield T, Hope T. What are the ingredients for a successful evidence-based patient choice consultation?: A qualitative study. Social Science & Medicine. 2003;56(3):589-602.
Izquierdo F, Gracia J, Guerra M, Blasco JA, Andradas E. Health technology assessment-based development of a Spanish breast cancer patient decision aid. Int J Technol Assess Health Care. 2011;27(4):363-8.
Agrawal M, Grady C, Fairclough DL, Meropol NJ, Maynard K, Emanuel EJ. Patients' decision-making process regarding participation in phase I oncology research. Journal of Clinical Oncology. 2006;24(27):4479-84.
Bekker HL, Hewison J, Thornton JG. Understanding why decision aids work: linking process with outcome. Patient Educ Couns. 2003;50(3):323-9.
McKeown RE, Reininger BM, Martin M, Hoppmann RA. Shared decision making: views of first-year residents and clinic patients. Acad Med. 2002;77(5):438-45.
Veronesi U, Saccozzi R, Del Vecchio M, Banfi A, Clemente C, De Lena M, et al. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast. N Engl J Med. 1981;305(1):6-11.
Dufour-Lussier V, Lieber J, Nauer E, Toussaint Y. Text adaptation using formal concept analysis. Case-Based Reasoning Research and Development: Springer; 2010. p. 96-110.
Durand MA, Witt J, Joseph-Williams N, Newcombe RG, Politi MC, Sivell S, et al. Minimum standards for the certification of patient decision support interventions: feasibility and application. Patient Educ Couns. 2015;98(4):462-8.