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NCT03136367

What Matters Most: Choosing the Right Breast Cancer Surgery for You

Completed NA Results posted Last updated 5 January 2021
What this trial tests

NA trial testing Option Grid in Breast Cancer in 571 participants. Completed in 31 May 2019.

Timeline
18 September 2017
Primary endpoint
31 May 2019
31 May 2019

Quick facts

Lead sponsorDartmouth-Hitchcock Medical Center
PhaseNA
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingsingle
Primary purposehealth services research
Enrollment571
Start date18 September 2017
Primary completion31 May 2019
Estimated completion31 May 2019
Sites5 locations across United States

Drugs / interventions tested

Conditions studied

Sponsor

Dartmouth-Hitchcock Medical Center

Who can join

18 and older, female only, with Breast Cancer. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Change in Decision Quality: Knowledge Subscale Primary · Immediately before the index surgical consultation visit, immediately after the index surgical consultation visit and at one week post-surgery

Change in decision quality, measured using the validated 16-item Decision Quality Worksheet for Breast Cancer Surgery. Decision quality is measured through three constructs: knowledge, decision process, and concordance. Knowledge is five questions that results in a score from 0 to 5 with higher numbers indicating higher knowledge. Decision process is a measure how much shared decision making process occurred, based on patient-report. It is a seven-item scale with higher numbers indicating higher shared decision process. For the concordance score, patients rated their goals and concerns on an 1

Immediately before the index surgical consultation visit
GroupValue95% CI
Arm 1: Option Grid2.83± 1.29
Arm 2: Picture Option Grid2.95± 1.22
Arm 3: Usual Care2.77± 1.21
Immediately after the index surgical consultation visit
GroupValue95% CI
Arm 1: Option Grid2.82± 1.13
Arm 2: Picture Option Grid2.90± 1.07
Arm 3: Usual Care2.74± 1.07
One week post-surgery
GroupValue95% CI
Arm 1: Option Grid3.00± 1.11
Arm 2: Picture Option Grid2.88± 1.05
Arm 3: Usual Care2.87± 1.12
Change in Decision Quality: Decison Process Subscale Primary · Immediately after the index surgical consultation visit and at one week post-surgery

Change in decision quality, measured using the validated 16-item Decision Quality Worksheet for Breast Cancer Surgery. Decision quality is measured through three constructs: knowledge, decision process, and concordance. Knowledge is five questions that results in a score from 0 to 5 with higher numbers indicating higher knowledge. Decision process is a measure how much shared decision making process occurred, based on patient-report. It is a seven-item scale from 0 to 7 with higher numbers indicating higher shared decision process. For the concordance score, patients rated their goals and conc

Immediately after the index surgical consultation visit
GroupValue95% CI
Arm 1: Option Grid5.66± 1.24
Arm 2: Picture Option Grid5.47± 1.58
Arm 3: Usual Care4.57± 2.10
One week post-surgery
GroupValue95% CI
Arm 1: Option Grid5.67± 1.26
Arm 2: Picture Option Grid5.02± 1.73
Arm 3: Usual Care4.64± 1.95
Change in Decision Quality: Concordance Subscale Primary · Immediately after the index surgical consultation visit and at one week post-surgery

Change in decision quality, measured using the validated 16-item Decision Quality Worksheet for Breast Cancer Surgery. Decision quality is measured through three constructs: knowledge, decision process, and concordance. Knowledge is five questions that results in a score from 0 to 5 with higher numbers indicating higher knowledge. Decision process is a measure how much shared decision making process occurred, based on patient-report. It is a seven-item scale with higher numbers indicating higher shared decision process. For the concordance score, patients rated their goals and concerns on an 1

GroupValue95% CI
Arm 1: Option Grid95.3
Arm 2: Picture Option Grid92.9
Arm 3: Usual Care95.4
Number of Participants Who Chose Lumpectomy or Mastectomy as Their Treatment Choice Secondary · 1 week post-surgery

Treatment choice, or which surgical or treatment option the patient chose, mastectomy or lumpectomy (breast conserving surgery)

GroupValue95% CI
Arm 1: Option Grid42
Arm 2: Picture Option Grid161
Arm 3: Usual Care146
Arm 1: Option Grid10
Arm 2: Picture Option Grid39
Arm 3: Usual Care46
Change in Quality of Life Secondary · Immediately before the index surgical consultation visit and at 12 weeks post-surgery

Quality of life reported by the patient measured using the validated 6-item EQ-5D-5L measure. We used the available resources from EuroQol to convert EQ-5D-5L states into an index value, using the EQ-5D-5L crosswalk value sets. Index values ranged from full health (1) and to no health (-0.109), according to the US crosswalk value set.

Immediately before the index surgical consultation visit
GroupValue95% CI
Arm 1: Option Grid0.83± 0.13
Arm 2: Picture Option Grid0.82± 0.13
Arm 3: Usual Care0.82± 0.14
12 weeks post-surgery
GroupValue95% CI
Arm 1: Option Grid0.82± 0.10
Arm 2: Picture Option Grid0.85± 0.13
Arm 3: Usual Care0.82± 0.12
Anxiety Secondary · Immediately before the index surgical consultation visit, immediately after the index surgical consultation visit, at 1 week post-surgery, and at 12 weeks post-surgery

Patient-reported anxiety, measured using the validated 8-item PROMIS anxiety short form. Each question was coded from one to five. Total scores were obtained by scoring the raw score of each item answered. The lowest possible raw score was 8; the highest possible raw score was 40 with higher numbers indicating higher anxiety.

Immediately before the index surgical consultation visit
GroupValue95% CI
Arm 1: Option Grid20.8± 6.8
Arm 2: Picture Option Grid20.2± 7.4
Arm 3: Usual Care20.7± 7.7
immediately after the index surgical consultation visit
GroupValue95% CI
Arm 1: Option Grid20.0± 6.7
Arm 2: Picture Option Grid20.4± 8.1
Arm 3: Usual Care20.6± 7.9
1 week post-surgery
GroupValue95% CI
Arm 1: Option Grid17.2± 7.3
Arm 2: Picture Option Grid17.0± 7.1
Arm 3: Usual Care17.1± 6.7
12 weeks post-surgery
GroupValue95% CI
Arm 1: Option Grid13.1± 6.5
Arm 2: Picture Option Grid13.0± 5.6
Arm 3: Usual Care14.9± 6.9
Shared Decision-making (Self-reported) Secondary · Immediately after the index surgical consultation visit

Self-reported shared decision-making about breast cancer surgical options measured using the validated 3-item CollaboRATE measure. Each item was rated on a scale from 0 to 9 with a possible score range from 0 to 27. We dichotomized this measure using the top score approach, grouping participants scoring 9 on all three items versus all others.

GroupValue95% CI
Arm 1: Option Grid7348 – 99
Arm 2: Picture Option Grid7655 – 97
Arm 3: Usual Care5852 – 65
Shared Decision-making (Observed) Secondary · During the index surgical consultation visit

Shared decision-making observed during the surgical consultation, measured using the validated observer-rated OPTION5. The five items on the measure ask raters to score the consultation on how much the clinician: 1) confirms that alternatives exist, 2) reassures that they will support the patient to become informed, 3) gives information or checks understanding about the options, 4) makes an effort to elicit the patient's preferences, and 5) integrates the patient's elicited preferences. Each of the five items is scored from zero to four for a summary score ranging from zero to 20 and a scaled

GroupValue95% CI
Arm 1: Option Grid69.9242.51 – 95.16
Arm 2: Picture Option Grid65.7241.84 – 89.45
Arm 3: Usual Care41.0236.20 – 45.85
Decision Regret Secondary · At 1 week post-surgery, 12 weeks post-surgery, and 1 year post-surgery

Patient-reported feelings of decision regret, measured using the validated 5-item decision regret scale. Items 2 and 4 were reverse coded so a higher number indicated more regret. Scores were then converted to a 0-100 scale by subtracting 1 from each item then multiply by 25. To obtain a final score, the items were summed and averaged. A score of 0 meant no regret and a score of 100 meant high regret.

1 week post-surgery
GroupValue95% CI
Arm 1: Option Grid10.9± 13.9
Arm 2: Picture Option Grid8.1± 12.3
Arm 3: Usual Care12.9± 14.5
12 weeks post-surgery
GroupValue95% CI
Arm 1: Option Grid12.0± 15.9
Arm 2: Picture Option Grid7.6± 12.3
Arm 3: Usual Care10.8± 16.2
1 year post-surgery
GroupValue95% CI
Arm 1: Option Grid10.4± 14.1
Arm 2: Picture Option Grid6.0± 10.3
Arm 3: Usual Care7.6± 14.3
Integration of Health Care Delivery Secondary · Immediately before the index surgical consultation visit and at 12 weeks post-surgery

Patient-reported measure of integration of healthcare delivery, measured using IntegRATE, a 4-item scale. IntegRATE sum scores are determined by summing each participant's scores across the 4 items (range 0-12). A higher score indicates higher integration.

Immediately before the index surgical consultation visit
GroupValue95% CI
Arm 1: Option Grid10.4± 1.8
Arm 2: Picture Option Grid10.2± 2.0
Arm 3: Usual Care10.3± 1.9
12 weeks post-surgery
GroupValue95% CI
Arm 1: Option Grid10.9± 1.1
Arm 2: Picture Option Grid10.8± 1.5
Arm 3: Usual Care10.6± 1.8
Exploration of Strategies That Promote the Interventions' Sustained Use and Dissemination Secondary · 12 weeks post-surgery (patients) or after trial participation ended (surgeons)

Semi-structured interviews with clinic stakeholders and patients 12 weeks post-surgery, field notes, and clinic observations to explore strategies that promote the interventions' sustained use and dissemination

Patients
GroupValue95% CI
Patients in Intervention Arms30
Patients in Intervention Arms29
Patients in Intervention Arms40
Patients in Intervention Arms30
All trial surgeons
GroupValue95% CI
Surgeons Involved in the TrialNA
Surgeons Involved in the TrialNA
Surgeons Involved in the TrialNA
Surgeons Involved in the TrialNA
Intervention surgeons
GroupValue95% CI
Surgeons Involved in the TrialNA
Surgeons Involved in the TrialNA
Surgeons Involved in the TrialNA
Surgeons Involved in the TrialNA

Sponsor's own description

What Matters Most is a study that aims to determine how best to help women of lower socioeconomic status make high-quality decisions about early stage breast cancer treatments. What Matters Most will be comparing two decision aids used in the clinic visit to usual care (what normally happens in the clinic). The first decision aid (Option Grid) presents evidence-based information about lumpectomy and mastectomy in a tabular format using text only. The second decision aid (Picture Option Grid) presents evidence-based information about lumpectomy and mastectomy using pictures, pictographs and simplified text. What Matters Most aims to show that the interventions can reduce disparities in decision-making and treatment choice between women of high and low SES.

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Interventions for increasing the use of shared decision making by healthcare professionals.
    Légaré F, Adekpedjou R, Stacey D, Turcotte S, et al · · 2018 · cited 365× · PMID 30025154 · DOI 10.1002/14651858.cd006732.pub4
  2. Decision aids for people facing health treatment or screening decisions.
    Stacey D, Lewis KB, Smith M, Carley M, et al · · 2024 · cited 203× · PMID 38284415 · DOI 10.1002/14651858.cd001431.pub6
  3. What matters most: Randomized controlled trial of breast cancer surgery conversation aids across socioeconomic strata.
    Durand MA, Yen RW, O'Malley AJ, Schubbe D, et al · · 2021 · cited 61× · PMID 33170506 · DOI 10.1002/cncr.33248
  4. What matters most: protocol for a randomized controlled trial of breast cancer surgery encounter decision aids across socioeconomic strata.
    Durand MA, Yen RW, O'Malley AJ, Politi MC, et al · · 2018 · cited 18× · PMID 29439691 · DOI 10.1186/s12889-018-5109-2
  5. Implementation and sustainability factors of two early-stage breast cancer conversation aids in diverse practices.
    Schubbe D, Yen RW, Saunders CH, Elwyn G, et al · · 2021 · cited 15× · PMID 33971913 · DOI 10.1186/s13012-021-01115-1
  6. Recent Advancements of Nanomedicine in Breast Cancer Surgery.
    Meng X, Wang X, Zhang Z, Song L, et al · · 2024 · cited 5× · PMID 39759962 · DOI 10.2147/ijn.s494364
  7. An absence of equipoise: Examining surgeons' decision talk during encounters with women considering breast cancer surgery.
    Politi MC, Saunders CH, Grabinski VF, Yen RW, et al · · 2021 · cited 2× · PMID 34914705 · DOI 10.1371/journal.pone.0260704
  8. Implementation and sustainability factors of two early-stage breast cancer conversation aids in diverse practices
    Schubbe D, Yen RW, Saunders CH, Elwyn G, et al · · 2020 · DOI 10.21203/rs.3.rs-115361/v1

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Other recruiting trials for Breast Cancer

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