Using paper conversation aids when speaking with women of lower socioeconomic status (SES) with breast cancer improved outcomes compared to usual care alone, according to a study.
“Conversation aids increase patients’ knowledge and participation in decision making and improve risk perceptions without increasing the visit duration. They can be integrated into routine care and electronic health records,” the study authors explained. However, “The effect of paper‐based conversation aids that include a pictorial intervention specifically designed to meet the needs of disadvantaged patients has not been evaluated across socioeconomic strata.”
The study consisted of three arms: option grid (text only), picture option grid (pictures plus text), and usual care. The grid options were papers that consisted of evidence-based summaries of choices for breast cancer surgery. The main outcome was decision quality; additional outcomes observed included treatment choice, treatment intention, shared decision making (SDM), anxiety, quality of life, decision regret, and coordination of care. Outcomes were assessed pre-consultation (T0), during the consultation (T1), immediately after the consultation (T2), one week postoperatively or within two weeks of the first postoperative visit (T3), 12 weeks postoperatively or within two weeks of the second postoperative visit (T4), and one year postoperatively (T5).
Overall, 16 surgeons met with 571 patients in the picture option grid (n=248), option grid (n=66), and usual care arms (n=257). The picture option grid arm, compared to usual care, had higher knowledge (T2 and T3), an improved decision process (T2 and T3), lower decision regret (T3), and more observed and self-reported SDM. The option grid group, compared to the usual care arm, had higher decision process scores (T2 and T3), better coordination of care (T4), and more observed SDM (T1). The paper aids were not correlated with concordance, treatment choice, or anxiety. The picture option grid appeared to be more impactful on women of lower SES and health literacy.
The study was published in Cancer.
The researchers concluded, “The Picture Option Grid may be most effective, especially for disadvantaged populations. It has the potential to reduce disparities in knowledge and quality of life while improving other outcomes across socioeconomic strata.”