PSYCHO-ONCOLOGY Psycho-Oncology 15: 1001–1013 (2006) Published online 2 March 2006 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/pon.1040 A DECISION AID TO ASSIST IN ADJUVANT THERAPY CHOICES FOR BREAST CANCER LAURA A. SIMINOFF a, *, NAHIDA H. GORDON a , PAULA SILVERMAN a,b , THOMAS BUDD c and PETER M. RAVDIN a Case Western Reserve University, USA b University Hospitals, USA c Cleveland Clinic Foundation, USA SUMMARY Background: Decision aids are tools that help patients make specific and deliberative choices among options. This study was a group randomized controlled trial of a novel decision aid to help patients with breast cancer make adjuvant therapy (AT) decisions. Methods: Fourteen oncology practices (n ¼ 58 physicians) were randomized to receive the decision aid or a control pamphlet. Complete data were obtained from 405 patient–oncologist pairs. Eligible patients had stage I–III disease and had completed their primary treatment. The decision aid is a simple to use computer program, titled Adjuvant!, that provides estimates of outcome with and without AT. Graphical representations of outcome are shared with patients. Consultations were audiotaped, patients interviewed, and physicians completed a self-admin- istered survey. Results: In a multivariable model, the 54 patients (13.3%) who took no AT were more likely to have received the decision aid (p ¼ 0:02). A differential effect of the Adjuvant! Decision Guide was noted between node negative and positive patients. It was stated by 86.2% of patients that the decision aid was influential when making their treatment decision. Over 95% of patients reported that the Adjuvant Decision Guide was easy to understand and 75% of physicians believed that it helped them understand their patient’s treatment preferences and 81.4% reported the information as useful for themselves. Conclusions: This study showed that a decision aid made a difference in the choice of whether or not to take AT. The decision aid allowed patients and physicians to consider the benefits of AT in an easy to understand format. Treatment decisions were more individualized for patients in the intervention than in the control group. The use of the decision aid was acceptable to both patients and physicians. Copyright # 2006 John Wiley & Sons, Ltd. KEY WORDS: breast cancer; decision making; patient participation; decision support techniques; adjuvant therapy INTRODUCTION What are decision aids? Shared decision-making enables patients to more explicitly consider their own values and pref- erences when making treatment decisions. Deci- sion aids are interventions designed to help people make specific and deliberative choices among op- tions through the provision of information about patient-specific options and outcomes (O’Connor et al., 1999). Decision aids differ from traditional health education materials in that they (1) explic- itly describe treatment choices, (2) provide quantitative estimates of risks and/or benefits, (3) tailor information to individual patients and; (4) implicitly or explicitly provide a context in which patients can consider treatment options in light of their own values (O’Connor et al., 1999; Whelan et al., 2002). A comprehensive review and meta-analysis by Whelan et al. reports that deci- sion aids developed for use with cancer patients Received 13 June 2005 Copyright # 2006 John Wiley & Sons, Ltd. Accepted 10 January 2006 *Correspondence to: School of Medicine, Department of Bioethics (TA-215), Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4976, USA. E-mail: las5@case.edu