Improving value-concordant shared decision making through the use of patient decision aids in breast cancer: a narrative review

Background and Objective: Patient decision aids (pDAs) are evidence-based tools that aid patients in making informed, value-based choices about their medical treatment. In breast cancer surgery, pDAs help patients weigh the physical and emotional consequences between treatment options e.g. between breast conserving surgery (BCS) and mastectomy. Despite their utility, pDAs are not widely used. In this narrative review, we aim to increase pDA awareness in breast cancer surgical care by discussing outcomes of pDAs, best practices for developing and adapting pDAs, and challenges of pDA implementation. Methods: We performed a database search and literature review of studies that discuss the use of pDAs in breast cancer surgical treatment published from 1994-2024. Key Content and Findings: Decision aids are effective in facilitating shared decision making in the medical setting. In breast cancer surgical care, pDAs have been shown to increase patient knowledge, improve patient satisfaction with decision, lower pain scores, and improve general health and functioning after surgery. Decision aids have varying effects on the choice of BCS versus mastectomy. Effective pDAs for breast cancer surgery are developed systematically using defined standards and are iteratively tested to ensure they are usable in diverse populations. Various barriers impede pDA use in breast cancer surgical care. These barriers include patient reluctance, provider reluctance, provider lack of knowledge, short appointment times, and limited support for providers. Potential strategies to overcome these barriers include provider education, increased physician buy-in, and the utilization of multidisciplinary teams. Future pDA development for breast cancer surgical care should continue to prioritize patient and provider feedback and include patient reported outcomes and quality of life measures. Conclusions: As breast cancer prognosis improves and patient survival increases, pDAs will continue to be essential in helping patients decide what treatments align best with their long-term values and goals.