Danish multi-centre study on Shared Decision Making with breast cancer patients in the spotlight at ESTRO

Stine Rauff Søndergaard is a doctor and PhD student at the Oncology Department at Vejle Hospital. At ESTRO she will share Danish experiences with Shared Decision Making on the main European stage for radiation therapy. Stine Rauff Søndergaard is the PI for the randomised multicentre study (DBCG RT SDM Trial), collecting evidence for the implementation of Shared Decision Making for Danish breast cancer patients.

In collaboration between the Lillebælt Hospital Center for Shared Decision Making, the Radiotherapy Committee of DBCG and patient representatives, a generic decision support tool has been adapted to support Shared Decision Making about adjuvant radiotherapy.

The decision support tool, also called the decision helper, consists of descriptive cards and text. Participant information in relation to the randomised study and distinct preparation cards for professionals have also been developed. The main purpose of the study was to investigate whether the decision support tool affects the patients' self-reported experience of engagement in the decision about the treatment.

‘We are often thinking along the established practices in health care. Many cancer patients say that cancer treatment feels like getting on an unstoppable train ride. But people are diverse and have various opinions, preferences and conditions of life. That’s why we, as doctors, need to think outside the box and look at the individual and what he or she really wishes for their treatment. This is both a requirement in Cancer Plan IV and an ethical imperative. And so, in the line of the DBCG tradition of evidence based approaches to patient related matters, there was a need for this randomised multicentre study to shed light on whether using a decision helper actually benefits patient involvement,’ says Stine Rauff Søndergaard.

678 patients increase knowledge about the effect of Shared Decision Making

Doctors from four radiotherapy clinics were randomised to either continue their usual practice in relation to information about the treatment or to receive a short introduction to Shared Decision Making based on the developed decision support tool. The 678 included patients from four departments were candidates for adjuvant radiotherapy after breast-conserving surgery.

The comprehensive study examines the effect of the decision support tool and succeeding practice on the experience of shared decision making by both patient and doctor, potential regrets after the decision, fear of recurrence, the patient's knowledge of radiotherapy and perceived quality of life. It is thus a significant amount of data that forms the basis for shedding light on Shared Decision Making from the perspective of both patients and professionals.

‘We measured patient involvement in several ways – with three questionnaires for patients and one for physicians. In all of these questionnaires, we found significantly more patient involvement among the patients where the decision helper was used, compared to the control group. Furthermore, using the decision helper lessened the patient’s doubts about their decision – all while the patient’s fear of recurrence did not increase. I’m actually surprised about the significantly positive effects of the decision support tool, also bearing in mind that the physicians were only instructed for 30 minutes on shared decision making and using the decision helper. So it is really great that they got involved so fast and were able to use the decision helper in a beneficial way.

Hear Stine Rauf Søndergaard present the results at the ESTRO conference May 15 2023 10:30-11:30.

I hope that the evidence generated from the study can benefit all Danish cancer patients. Initially, by hopefully making this decision helper a national standard for consultations on adjuvant whole breast irradiation after early stage breast cancer that has not spread to the lymph nodes,’ says Stine Rauff Søndergaard.

Facts

• Stine Rauff Søndergaard's PhD project is supported by DCCC Radiotherapy in 2018.
• Read the ESTRO abstract here.
• Data for 6-month follow-up will follow this summer. Read more about the DBCG RT SDM Trial at ClinicalTrials.gov.