Eliciting patients' preferences for adjuvant chemotherapy in breast cancer: development and validation of a bedside decision-making instrument in a French Regional Cancer Centre

• Published in: Health expectations : an international journal of public participation in health care and health policy 2000-06, Vol.3 (2), p.97-113
• Main Authors: Carrère, Marie-Odile, Moumjid-Ferdjaoui, Nora, Charavel, Marie, Brémond, Alain
• Format: Article
• Language: English
• Subjects: Acceptable noise levels; Attitudes; Breast cancer; Cancer; Cancer therapies; Chemotherapy; choice of treatment; Clinical decision making; Comprehension; Consistency; Correlation coefficient; Correlation coefficients; Cultural differences; Cultural factors; Decision Board; Decision making; Decision making models; Developed countries; Ethics; France; Genetic counseling; Group decision making; Health care; Hormone replacement therapy; Human rights; Internal medicine; Medical personnel; Medicine; Mental health; Nurses; Oncologists; Oncology; Original; Patient participation; patient preferences; Patients; Physicians; Post-menopause; Postmenopausal women; Preferences; Property; Regional development; Regions; Respondents; Science; Social sciences; Stroke; Surgery; Tests; Treatment; Treatment preferences; Volunteers; Womens health
• ISSN: 1369-6513; 1369-7625
• DOI: 10.1046/j.1369-6513.2000.00086.x

Introduction In developed countries, the physician‐patient relationship is moving from a paternalistic model to new decision‐making models that take patient preferences into account. Objectives Our aim was to develop a Decision Board (DB) and to test its acceptability in a French Regional Cancer Centre regarding the decision on whether or not to use chemotherapy after surgery in postmenopausal women with breast cancer. This paper presents the development process for this instrument and reports the pretesting phase, as well as the corresponding results. Methods A working group was created with oncologists, psychologists and economists. Following the first phase, i.e. the development process, a first version of the instrument was presented to health professionals. Their feedback led to important modifications of the instrument. The DB was then presented to experienced patients, which resulted in slight changes. The second phase consisted of pretesting the comprehension, internal and across‐time consistency of the DB on healthy volunteers. Results The DB was pretested in a group of 40 healthy volunteers. Eighteen respondents chose chemotherapy and 22 chose not to have chemotherapy. Comprehension rates were very high (≥87.5%). Internal consistency was assessed considering option attitudes based on outcomes and option attitudes based on process. Women shifted their choices in a predictable way. Across‐time consistency was appraised using the test‐retest method with Visual Analog Scales. The Intraclass Correlation Coefficient was 0.97. Discussion‐conclusion Due to cultural differences, the DB developed in our French Cancer Centre is quite different from the DBs previously developed elsewhere. Our instrument showed good comprehension and consistency properties, which are corroborated by the DB literature. Whether our DB is acceptable for patients with breast cancer must still be tested. Patients’ reactions will tell us which type of decision‐making model is at work. Further research is needed in order to explore the shared decision‐making process and clarify the concept.