Development and evaluation of a breast cancer prevention decision aid for higher-risk women

Abstract

Objective: To develop and evaluate the effectiveness of a breast cancer prevention decision aid for women aged 50 and older at higher risk of breast cancer. Design: Pre-test-post-test study using decision aid alone and in combination with counselling. Setting: Breast Cancer Risk Assessment Clinic. Participants: Twenty-seven women aged 50-69 with 1.66% or higher 5-year risk of breast cancer. Intervention: Self-administered breast cancer prevention decision aid. Main outcome measures: Acceptability; decisional conflict; knowledge; realistic expectations; choice predisposition; intention to improve life-style practices; psychological distress; and satisfaction with preparation for consultation. Results: The decision aid alone, or in combination with counselling, decreased some dimensions of decisional conflict, increased knowledge (P < 0.01), and created more realistic expectations (P < 0.01). The aid in combination with counselling, significantly reduced decisional conflict (P < 0.01) and psychological distress (P < 0.02), helped the uncertain become certain (P < 0.02), and increased intentions to adopt healthier life-style practices (P < 0.03). Women rated the aid as acceptable, and both women and practitioners were satisfied with the effect it had on the counselling session. Conclusion: The decision aid shows promise as a useful decision support tool. Further research should compare the effect of the decision aid in combination with counselling to counselling alone.