Patients should have the opportunity to make well-informed decisions about their treatment. This is particularly important when multiple options exist with comparable health outcomes, each with their own benefits and risks. In early stage breast cancer, the choice between mastectomy and breast conserving surgery falls into this type of decision as both procedures have been shown to have a similar survival rate. For this and other scenarios, researchers at Dartmouth College (USA) have created a set of decision aids, called the “Option GridTM” system. In a recent paper, they have adapted their format to patients with lower health literacy, associated for example with a lower socio-economic status.
The context
Patients should have the opportunity to make well-informed decisions about their treatment. This is particularly important when multiple options exist with comparable health outcomes, each with their own benefits and risks. In early stage breast cancer, the choice between mastectomy and breast conserving surgery falls into this type of decision as both procedures have been shown to have a similar survival rate. For this and other scenarios, researchers at Dartmouth College (USA) have created a set of decision aids, called the “Option GridTM” system. In a recent paper, they have adapted their format to patients with lower health literacy, associated for example with a lower socio-economic status.
The nuts and bolts
Decision aids increase the knowledge of the patient, and support meaningful conversations with the physician. Having the opportunity to steer treatment decisions lowers regret and improves quality of life. Option Grids are one-page decision aids that summarize the impact of different treatment options on the most important considerations a patient should make. They are developed based on the most recent clinical insights published in systematic reviews or guidelines, while user testing guarantees that the descriptions make sense to patients. Because of their short format, they can be included in clinical consultations without lengthening them. For breast cancer surgery, 9 considerations are listed, including what is removed, the chances of recurring, long-term survival and the need for chemo- or radiotherapy.
How will this help me?
While decision aids are a valuable tool for most patients, some are still underserved. Women with low socio-economic status were reported to receive suboptimal care. They have less knowledge and health-literacy, which leads to poorer communication with the physician and a higher decision regret. To adapt Option Grids to these patients’ needs, pictures were added for clarity. Research has shown that using pictures rather than words helps people with lower reading skills understand complex concepts.
Based on the standard Option Grid for early stage breast cancer, different prototypes with pictures were created. In multiple rounds, adaptations were made based on interviews with both men and women without breast cancer, but from low socio-economic status populations and a less than average education. The use of images was not considered patronizing and helped in conveying complex medical information. The finalized product was tested in patients, and found to be very helpful, especially in patients who were anxious and emotional after a recent diagnosis, hindering them to process information rationally and efficiently. Given the emotional context of a diagnosis on everyone, this indicates that using pictures could benefit a wide range of women, irrespective of their literacy skills.
Sources
‘Much clearer with picture’: using community-based participatory research to design and test a Picture Option Grid for underserved patients with breast cancer – BMJ Open (2016).