Aims and Objectives: This project was designed to inform and educate lower literacy women with Stage I, IIA, IIB, and IIIA breast cancer using a culturally sensitive computerized decision support system (CDSS) and to determine whether they (1) make breast cancer treatment decisions more consistent with their personal preferences, (2) are more knowledgeable about treatment options, and (3) are more satisfied about treatment decisions prior and post treatment, compared with women who get standard care and education at a public hospital.

Methods: To accomplish the objectives, three major project components were designed and developed, (a) a breast cancer treatment decision analytic model, (b) a utility for assessment of a computerized program on breast cancer treatment outcomes, and (c) a CDSS for early stage breast cancer treatment. Outcome states identified when building the decision analytic model are assessed by means of eliciting patients' utilities and integrated, along with content material (from the patient's perspective) identified through interview with 50 patients, in the CDSS whose effectiveness is then tested by conducting clinical trials. In both the utility assessment program and CDSS, education and information is delivered through multimedia approaches (e.g., voice-over narrative in simple English or Spanish; use of photo novella and/or 'soap opera' presentation of situational material that allows women to explore possible consequences associated with different decisions). This study has a randomized controlled trial (RCT) design with one intervention group and one control group. The setting is an urban community hospital located in a large urban area. A total of 130 women, 65 assigned to each the intervention and control groups will be recruited to participate in the clinical trials. Primary outcomes will include breast cancer treatment decisions consistent with preferences, knowledge about treatment, satisfaction with decision, decisional conflict, and satisfaction with the decision making process. For those women using the CDSS system, we will also conduct an evaluation of their satisfaction in using system.

Results (Progress Report): To date this project has: (1) developed a breast cancer treatment decision-analytic model to organize the CDSS, and to predict optimal treatment; (2) produced and pilot-tested a utility for assessment of the program with ranked preference on breast cancer treatment outcomes; and (3) produced and pilot-tested the CDSS. We are presently conducting the RCT.

Conclusions: We will demonstrate the CDSS program and provide findings from the first 60 patients who participated in the RCT.

BENEFIT TO PARTICIPANTS ATTENDING SESSION:

This presentation will be of benefit to participants because they will have the opportunity to test and review a medical application (i.e. patient education program) which was designed to aid English and Spanish speaking, lower literacy women, who have been diagnosed with breast cancer, in making a treatment decision. The presentation will highlight the design considerations used in order to make the program appealing for this population of women.

Maria L. Jibaja-Weiss
Baylor College of Medicine
Department of Family and Community Medicine 5615 Kirby Drive, Suite 610
Houston, TX 77005
Phone: 713-798-3636
Fax: 713-798-7940
Email: mariaj@bcm.tmc.edu

Co-Authors:
Nancy E. Neff, M.D., Thomas Granchi, M.D., Robert J. Volk, Ph.D., Stephen Spann, M.D., Robert Beck, M.D., Noriaki Aoki, M.D., Doris Georgiou, Ph.D. (Neff, Granchi, Volk, Spann, Aoki, Georgiou) Baylor College of Medicine
One Baylor Plaza
Houston, Texas 77030
(Beck)
Fox Chase Cancer Center
7701 Burholma Room R-253
Philadelphia, PA 19111
Email: nneff@bcm.tmc.edu
tgranchi@bcm.tmc.edu
bvolk@bcm.tmc.edu
sspann@bcm.tmc.edu
naoki@bcm.tmc.edu
dg034668@bcm.tmc.edu