BMC Med Inform Decis Mak - Measuring decision quality: psychometric evaluation of a new instrument for breast cancer chemotherapy.

Tópicos

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Resumo

CKGROUND: Women diagnosed with early stage (I or II) breast cancer face a highly challenging decision - whether or not to undergo adjuvant chemotherapy. We developed a decision quality instrument for chemotherapy for early stage breast cancer and sought to evaluate its performance.METHODS: Cross-sectional, mailed survey of recent breast cancer survivors, providers, and healthy controls and a retest survey of survivors. The decision quality instrument includes questions on knowledge and personal goals. It results in a knowledge score and concordance score, which reflects the percentage of patients who received treatments that match their goals. Hypotheses related to acceptability, feasibility, validity, and reliability of the survey instrument were examined.RESULTS: Responses were received from 352 patients, 89 providers and 35 healthy controls. The decision quality instrument was feasible to implement with few missing data. The knowledge scores had good retest reliability (intraclass correlation coefficient (ICC) =0.75). Knowledge scores discriminated between providers and patients (mean difference 31.1%, 95% CI 26.9, 35.3) and between patients and healthy controls (mean difference 11.2, 95% CI 5.4, 17.1). Most providers reported that the knowledge items covered essential content. Two of the five goal items had a ceiling effect, and one goal had low content validity. The goal items had moderate retest reliability (ICC's 0.57 to 0.78). In the multivariable model of treatment, none of the patient goals was associated with receipt of chemotherapy. Age and hormone receptor status were the only variables independently associated with chemotherapy. Most patients (77.6%) had treatment concordant with that predicted by the model. Patients who had concordant treatment had similar levels of confidence and regret as those who did not.CONCLUSIONS: The Decision Quality Instrument is a reliable and valid measure of patient knowledge about chemotherapy, but its ability to measure concordance with patient goals is limited. In this sample, patient goals were not associated with treatment, and most patients reported they were not asked their preference, suggesting that goals were not adequately considered in decision making.

Resumo Limpo

ckground women diagnos earli stage ii breast cancer face high challeng decis whether undergo adjuv chemotherapi develop decis qualiti instrument chemotherapi earli stage breast cancer sought evalu performancemethod crosssect mail survey recent breast cancer survivor provid healthi control retest survey survivor decis qualiti instrument includ question knowledg person goal result knowledg score concord score reflect percentag patient receiv treatment match goal hypothes relat accept feasibl valid reliabl survey instrument examinedresult respons receiv patient provid healthi control decis qualiti instrument feasibl implement miss data knowledg score good retest reliabl intraclass correl coeffici icc knowledg score discrimin provid patient mean differ ci patient healthi control mean differ ci provid report knowledg item cover essenti content two five goal item ceil effect one goal low content valid goal item moder retest reliabl icc multivari model treatment none patient goal associ receipt chemotherapi age hormon receptor status variabl independ associ chemotherapi patient treatment concord predict model patient concord treatment similar level confid regret notconclus decis qualiti instrument reliabl valid measur patient knowledg chemotherapi abil measur concord patient goal limit sampl patient goal associ treatment patient report ask prefer suggest goal adequ consid decis make

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